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中国艾滋病防控首席专家：危险逼近一般人群
2009年12月09日 09:53 来源：中国新闻网
中国的艾滋病流行仍处于快速增长期；性传播成为最主要的传播途径，更易蔓延至一般人群；疫苗研究失败之后再露曙光
本刊记者/蔡如鹏(文) 甄宏戈(摄影)
11月24日，联合国艾滋病规划署在上海发布了《2009年全球艾滋病流行报告》。同时，中国卫生部也发布了我国的疫情报告：截至今年10月31日，中国累计报告艾滋病患者和感染者近32万例，其中艾滋病病人10万余例。此外，报告的评估结果显示，到今年年底，中国存活的艾滋病感染者和病人总数估计将达74万人。
12月1日是第22个世界艾滋病日。在此前夕，《中国新闻周刊》专访了中国疾病预防控制中心艾滋病首席专家邵一鸣研究员。
感染人数：曾经预测1000万，目前估计74万，仍处于快速增长期
中国新闻周刊：多年以来，包括你在内的许多专家一直都在呼吁重视艾滋病，加大投入。对于艾滋病在中国的传播，曾有人警告说“将来要是不控制好，到2010年感染人数将达到1000万”。但今天的事实是，估计中国只有不到100万的病人和感染者，艾滋病的威胁在中国是否被夸大了？
邵一鸣：1000万是1998年国家在制订(防控艾滋病)中长期规划时国内外估计数据的中位数。这是基于当时的敏感人群、高危行为、国家的投入等因素，假设在最坏的情况下可能出现的结果。
我作为专家组的成员，承担测算国家规划至2010年艾滋病的控制目标，最终将它确定为150万，即我们的防治目标是要防住有可能发生的85%的感染。目前来看，这个目标是完全可以实现的。
中国新闻周刊：在刚刚发布的《2009年全球艾滋病流行报告》中，有关中国的数据是如何得到的？
邵一鸣：这个数据分两部分，一部分是实际的数据，即我们查出来的报告病例有32万。另一部分是估计性数据，主要是针对一些高危人群，比如吸毒人群、性工作者，和一般人群的抽样检测，由此得到的平均感染率，再乘以总人群，最后相加而获得的。对于艾滋病数据的统计，各国采取的策略不一，发达国家多以报告数字为主，较少采用估计的方法，主要看每年检测和流行病哨点查出来的多少，来了解疫情状况和各年间的动态变化。因为估计数据受多种因素的影响，把握性不如检测和监测数据高。
中国新闻周刊：估计数据主要受哪些因素影响？
邵一鸣：从技术上讲, 艾滋病各类高危人群总数不易把握，造成用抽样结果推算总体的精确度受阻。非技术因素包括行政干预。因为估计数字要经各地行政部门认可后才可逐级上报。这就可能出现一些地方不愿意排在前面，他们报上来的数据就有可能偏低；也有些地方希望数字偏高，这样才能得到中央政府更多的经费支持。行政因素的干扰在我国现有国情下是消除不了的。所以实际检测数字的可信度更高，是说明动态疫情变化的最好数据。
中国新闻周刊：你曾说，从上世纪90年代中期开始，艾滋病在中国进入了快速增长期。从新的数据看，有什么变化？
邵一鸣：现在仍然处于快速增长期。应该说，中国目前还是处于流行压力很大的阶段。
传播途径：性传播超过吸毒和血液传播，更易蔓延至一般人群，令防控难度加大
中国新闻周刊：新的报告称，当前艾滋病在中国最主要的传播途径已从血液传播转向性传播，怎么看待这种转变？
邵一鸣：性传播现在超过了50%，这就意味着艾滋病从高危人群向一般人群传播的速度会加快。从以吸毒和血液传播为主，转变到以性传播为主，很多国家用了5年时间。我们国家差不多用了15年的时间，但是它还是到来了。
这一转变意味着未来艾滋病防治工作的难度会更大。因为吸毒和血液传播人群比较局限, 对这些途径我们有有效的技术手段加以阻断，但是如果以性传播为主，情况就复杂多了，因为性活动是人们普遍的行为，所以疾病更容易通过这种途径传播到一般人群, 阻断技术也复杂多了。
中国新闻周刊：同性性行为导致的艾滋病传播已占到传播总数的32%，造成这种现象的主要原因是什么？
邵一鸣：这是个非常重要的数据，但是我们现在对这个人群的了解，只是冰山一角，不像我们对吸毒人群、性工作者的了解那么多。对于同性恋人群，我们的工作网络还在建立之中，对这个人群的检测数量是很少的，而且干预的手段和措施，也不像对于吸毒人群、性工作者那样，有现成的经验可供借鉴。
中国新闻周刊：有消息称，卫生部已经考虑明年把农民工作为重点防制的群体，加强工作力度。这是出于什么考虑？从已有的数据看，农民工的感染率是不是很高？
邵一鸣：并不是说这个人群现在感染的比例有多高，这方面数据还比较缺乏。把农民工作为防控重点的主要原因是：第一，农民工数量巨大，有2.5亿之众；第二，他们的流动性很大，而且是双向流动，一年内可在城乡间来回一到几次；第三，他们一般以青壮年男性为主，他们不跟家庭在一起，可能会有一些异性甚至同性性活动，所以具有感染的风险；第四, 他们往往游离于常规的预防控制体系之外。
疫苗研究：失败之后再露曙光，中国有创新性技术
中国新闻周刊：2007年美国分步试验的失败，对整个艾滋病疫苗界产生了空前的震动。现在的情况如何？
邵一鸣：今年，在泰国开展的第一、二代疫苗的联合临床试验上已取得突破。在16000人的试验中，疫苗的保护率有31.2%。这是在研制艾滋病疫苗的25年摸索中，第一次看到一线曙光。
中国新闻周刊：这个比率达到多少才能向市场推广？
邵一鸣：应该达到60%以上。所以，现有疫苗的这个效率还是不够的，但是它的重要意义在于，过去有些人比较悲观，认为这个病毒太难对付，根本做不出来疫苗，不用再做了。对于这种悲观情绪，这次的结果是一个最好的回应。
中国新闻周刊：在疫苗方面，中国的进展如何？
邵一鸣：我们在艾滋病疫苗研制方面，有跟踪的研究，也有创新性的研究。国际上搞了二十多年，基本都不敢碰活的疫苗载体，但在十几年前，我们就决定用活载体做疫苗研究，现在, 许多国家都在向活载体疫苗转向。对于这个疫苗的安全性，我们是非常有把握的。在国家科技重大专项的支持下, 该疫苗己完成I期临床一期试验，计划明年向二期临床推进。
China's AIDS prevention and control of the Chief Expert: dangerous approaches to the general population,
At 09:53 on December 9, 2009 Source: China News Net
China's AIDS epidemic is still in a period of rapid growth; sexually transmitted become the major mode of transmission, more easily spread to the general population; vaccine research and then the depression after the failure of
Reporter / Cai Ru-peng (text) ZHEN Ge (Photography)
November 24, the United Nations AIDS Program in Shanghai, issued the "2009 Report of the Global AIDS Epidemic." Meanwhile, the Chinese Ministry of Health also issued a report on the epidemic situation in China: as of October 31 this year, China has reported AIDS patients and infected nearly 32 million cases of which 10 thousand cases of AIDS patients. In addition, the report's findings show that by the end of this year, China's survival and the total number of patients living with HIV is estimated at 740,000 people.
December 1 is the first 22 World AIDS Day. In this eve, "China News Weekly" interview with the Chinese Center for Disease Control and Prevention of AIDS SHAO Yiming, chief expert researcher.
The number of infections: had predicted 10 million, now estimated at 740,000, still in the period of rapid growth
China Newsweek: Over the years, many experts, including you, have been calling attention to AIDS, and increase investment. For the spread of AIDS in China, it has been warned that "if it does not control the future, well, the number of infections by 2010 will reach 10 million." But the fact is, estimated that fewer than 1 million patients and infected persons, AIDS in China, whether the threat was exaggerated?
SHAO Yi-ming: 10 million in 1998, countries in the formulation (prevention and control of AIDS) and long-term planning, estimates the median home and abroad. This is based on the time-sensitive crowd, high-risk behavior, the country's investment and other factors, assuming that in the worst case possible results.
As a member of the Group of Experts to undertake planning to measure the national AIDS control targets by 2010, it will ultimately be determined to be 1.5 million, that our goal is to combat anti-lived may occur 85% of those infected. The current situation, this goal is entirely achievable.
China News Weekly: In the recently released "2009 Report of the Global AIDS Epidemic", the relevant data for China is how to get it?
SHAO Yi-ming: This data divided into two parts, part is the actual data, which we found out there are 320,000 reported cases. Another part is to estimate the data, mainly aimed at high-risk groups, such as drug users, sex workers, and the general population sample testing, the resultant average infection rate, multiplied by the total population, the final sum obtained. AIDS data for the statistics, countries have adopted different strategies, mostly developed countries, mainly the number of reported less use of estimation methods, mainly depends on annual testing and epidemiological sentinel check out how much to understand the epidemic situation and for each year, dynamics. Because the estimates affected by a variety of factors, grasp the nature of testing and monitoring data than high.
China News Weekly: estimates mainly affected by what factors affected?
SHAO Yiming: Technically, AIDS is not easy to grasp the total number of various types of high-risk groups, resulting in sampling results with the overall accuracy of the projection blocked. Non-technical factors include the administrative intervention. It is estimated that the figure must be approved by the executive branch only after around the reported level by level. This may occur in some places do not want standing in the front, they reported that the data is likely to up the low side; also hope that the figure high in some places, so that the central government to get more financial support. Administrative factors interference in our country under the present conditions is to eliminate not work. Therefore, the credibility of the actual detection of the number higher, is to specify the dynamic changes of the best data on the epidemic.
China News Weekly: You once said that, from the mid-90s of the last century, AIDS in China has entered a period of rapid growth. From the new data to see, what changed?
SHAO Yi: It is now still in rapid growth period. It should be said that China is still at the stage of popular pressure.
Of transmission: sexually transmitted than drug use and blood-borne more easily spread to the general population, so that prevention and control more difficult
China News Weekly: A new report says the current spread of AIDS in China, the most important ways to shift from blood-borne sexually transmitted, how do you view this transformation?
SHAO Yiming: Sexual transmission is now more than 50%, which means that the AIDS high-risk groups to the general population from the spread of speed up. From a drug and blood-borne mainly to taking sexually transmitted mainly, many countries had made in five years. Our country has spent almost 15 years, but it still arrived.
This shift means that the future of AIDS prevention and control work is more difficult. Because of drug use and blood-borne populations more limited, for these channels we have effective technical means to block, but if in order to sexually transmitted mainly, the situation is more complicated, because sexual activity is widespread acts, and so the disease is more easily through the This approach spread to the general population, block technology has complicated than that.
China Newsweek: same-sex sexual behavior due to the spread of AIDS has accounted for 32% of the total spread, resulting in what is the main reason for this phenomenon?
SHAO Yi-ming: This is a very important data, but we now know that the crowd is just tip of the iceberg, unlike our drug users, sex workers to understand that much. For gay people, our work in establishing the network among the people of this test are only a few, and interfere with the means and measures, not for drug users, sex workers, as there are ready-made experience for reference.
China News Weekly: It is reported that the Ministry of Health has considered the work of next year, farmers focus on control groups, to increase their efforts. This is for what consideration? From the existing data shows that the prevalence of migrant workers is not very high?
SHAO Yi-ming: do not say that the proportion of people infected is now how high the data is still relatively lacking in this respect. Farmers work to focus on prevention and control of the main reasons are: first, a huge number of migrant workers, 2.5 billion people; second, they are highly mobile, but also two-way flow, within a year could be a back and forth between rural and urban areas to the several times; and third, they are generally male-dominated young adults, they do not with the family together, there may be some heterosexual or homosexual sexual activity, and therefore have a risk of infection; fourth, they are often separated from the conventional prevention and control system outside.
Vaccine Research: After the failure of another depression, China has the innovative technologies
China News Weekly: in 2007 the United States step by step test fails, the entire AIDS vaccine industry in an unprecedented shock. The current situation?
SHAO Yi-ming: This year, the first carried out in Thailand, a joint clinical trials of second-generation vaccine has been a breakthrough. 16,000 people in the trial, the vaccine protection rate of 31.2%. This is in the development of an AIDS vaccine in 25 years of exploration, the first time I saw a ray of hope.
China News Weekly: the ratio of the number can be promoted in the market?
SHAO Yi: There should be more than 60%. Therefore, the efficiency of existing vaccines, this is not enough, but its significance lies in the past, some people are pessimistic, think that this virus too difficult to deal with, simply can not make to the vaccine, do not do it again. For this pessimism, this result is a best response.
China News Weekly: In the vaccine context, China's progress?
SHAO Yi: We are in AIDS vaccine development, there are tracking studies, but also innovative research. Engage in the international arena more than two decades, basically dare not touch live vaccine vector, but 10 years ago, we decided to do with the live vector vaccine research, and now, many countries are turning to the live vector vaccine. For the safety of this vaccine, we are very sure of. At the national science and technology with the support of major projects, the vaccine has completed Phase I clinical Phase I trials, plans next year to two clinical advance.
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