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新发感染者共4.8万 男男性行为感染率高 “56%艾滋病感染者尚未被发现”
2011年12月08日 02:04来源：时代周报 本报记者 韩玮 发自上海
12月1日国际艾滋病日的前后几天，MSM（即“男男性行为者”）的字眼突然在报端密集出现，遗憾的是，这一群体被如此重视只是因为一种病毒。
据中国性病艾滋病预防控制中心预计，今年，艾滋病新发感染者共4.8万，其中，通过男男性行为感染的占比29.4%，而在2004年，据北京市卫生官员报告，MSM中HIV呈阳性者不足1%。
“目前，尽管增幅有所下降，但我国的艾滋病感染者数量仍逐年上升。”清华大学艾滋病综合研究中心常务副主任张林琦告诉时代周报记者，一些迹象表明，艾滋病正通过异性以及男同的渠道从高危人群向一般人群扩散，其中，向年轻人、老年人传播的趋势较为突出。
而这也遵循了艾滋病在各国的流行轨迹。比如美国、泰国、非洲等地，HIV病毒均先在高危人群内传播，再传向一般人群。不过，此种相似并非幸事，当病毒潜入一般人群，藏得更深，防控将是一场艰难的战役。
艾滋病干预来得太晚
“目前，每100个健康男男性行为者中，4—16人一年后会感染HIV，这样的新发感染率是所有人群中最高的，而重庆、贵阳、成都等部分西南城市，这一数值在15%以上，甚至超过20%。”中国性病艾滋病预防控制中心主任吴尊友告诉时代周报记者。
“这个问题已在中国存在20年以上了。”卫生部艾滋病专家委员会委员、《同性爱》作者张北川观察、研究MSM群体多年，他告诉时代周报记者，1989年，北京发现第一例性传播的阳性感染者，他便是一个男同。所以，考虑到潜伏期，HIV病毒大约在上世纪80年代初就开始进入北京男同群体。
1997年，张北川开始在MSM中实行艾滋病干预。1998—2006年间，他先后进行了6次科研调查。第一次，1998年，他调查了400名男男性行为者后发现，只有2人坚持使用安全套。“在这样的情况下，艾滋病的蔓延无异于洪水猛兽。而等到2006年，情况有了好转，安全套的使用率接近三成。”
与此相比，政府的行动“来”得太晚。“1993年，曾有一名司局级官员提出，要想控制艾滋病就必须保障男同的人权，而后，这名官员被撤职。受此影响，中国对MSM群体的艾滋病干预停顿了好长一段时间，直至2007年才开始从政府层面展开大规模行动。”张北川说。
在张北川看来，MSM中的艾滋病流行并非处于快速上升期，而是滞涨期，换言之，感染率缓慢增长，但MSM的基数越来越大，涉及传播的范围越来越广。“比如，打工的农民进城了。在农村时，他们从未听说过&LSquo;同性恋’，而进城后则会进行男男性行为等活动，同时，还拥有多名性伴侣。”
“上世纪90年代末以来，MSM中的艾滋病流行呈现4个特点。首先，大量男同浴池、男同酒吧开始出现，其中的活跃者艾滋病感染率很高。其次，类似于上述情况，随意传播、甚至故意传播的现象十分常见。再次，年轻的男同开始通过互联网交流，线上交往，线下见面，这种交友方式对HIV传播起到了重要的辅助作用。此外，还有重要的一点，中国男同普遍结婚，同时又保持男男性行为。”
“正因如此，病毒在MSM中的蔓延不可避免，而且，其他的一般人群也会受之影响、拖累。”张北川说。
病毒从高危进入一般人群
实现“零”战略—零新发感染、零歧视和零死亡，这是今年国际艾滋病日的主题，但在中国，随着病毒逐渐进入一般人群，防艾之路任重道远。
“我国亟待进一步扩大检测，寻找感染者，同时，要对找到的病人实行有效的治疗以及高水平的关爱。”在张林琦看来，目前，防艾工作的一大问题是，相当部分的感染者处于“隐蔽”状态，同时，接近50%的艾滋病人没有接受治疗。
而他们之所以“弃明投暗”，一定程度上与政府的工作方式有关。“有时候，释放善意要通过适当的方法，我们习惯于设立阶段性目标，而这就会影响做事的方式，效果未必好。”
在复旦大学社会发展与公共政策学院人类学专业硕士生导师潘天舒看来，防艾的手段必须多样化，同伴、朋友、家庭、社区、NGO等多种渠道都要充分运用，同时，官方、非官方的资源，体制内、体制外的力量都应结合。
然而，长期以来，政府对于民间力量的鼓励、支持并不到位。“此前，上海某民间组织曾开展防艾活动，上海市艾协、上海市卫生局均有参与，但最后却让公安局找去了，因为，它没有合法身份。”
张北川告诉时代周报记者，最近不断有消息称，NGO的注册门槛或被降低，而这将有助于这些组织开展防艾工作、获得资金支持，等等。
城市化进程的大潮中，HIV病毒随着人群流动悄然传播，中国的艾滋病感染者越来越多，但这不说明，由艾滋病引起的道德上的划分和歧视已远离艾滋群体。
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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艾滋病新鸡尾酒疗法 附 HIV感染者，早吃药早受益
New infections a total of 48,000 MSM infection rate "56% of HIV infected persons has not yet been found."
At 02:04 on December 8, 2011 Source: Die Zeit newspaper reporter from Shanghai Han Wei
December 1 World AIDS Day before and after a few days, MSM (or "MSM"), the words suddenly appear in the newspapers intensive, unfortunately, this group is so seriously only because of a virus.
According to the China Centre for STD and AIDS Control and Prevention estimated that this year, a total of new HIV infections were 48,000, of which, by the proportion of MSM infected with 29.4% in 2004, according to health officials in Beijing report, MSM in HIV positive were less than 1%.
"At present, albeit decreased, but the number of people living with HIV in China is still increasing every year." Tsinghua University AIDS Research Center Deputy Director Zhang Linqi told Die Zeit reporter, some of the signs that HIV is through heterosexual and male from the same channel high-risk groups to the general population, which, to the young, the old trend of the spread of the more prominent.
This also follows the trajectory of HIV prevalence in the country. Such as the United States, Thailand, Africa and other places, HIV virus are first in the high-risk groups to spread, and transmits it to the general population. However, this similarity is not a blessing, when the virus to sneak into the general population, possession deeper, prevention and control will be an uphill battle.
AIDS intervention came too late
"Currently, for every 100 healthy men who in the 4-16 after a year infected with HIV, such as emerging infections is the highest of all groups, and Chongqing, Guiyang, Chengdu and other cities in the southwest part of this value in more than 15%, even more than 20%. "Chinese STD and AIDS Prevention and Control Center Wu Zunyou told Die Zeit correspondent.
"This problem has existed in China more than 20 years of." Ministry of Health, AIDS Committee of Experts, "with love" by Zhang Beichuan, observe, study and MSM groups for many years, he told Die Zeit correspondent in 1989, Beijing found that the first cases of sexually transmitted HIV positive, he is a man with. Therefore, taking into account the incubation period, HIV virus around the early 1980s, with groups of men began to enter Beijing.
In 1997, Zhang Beichuan in MSM in beginning to implement AIDS interventions. 1998-2006, he has conducted six research surveys. The first, in 1998, he investigated 400 men who found that only 2 people insist on using condoms. "In such circumstances, the spread of AIDS is no different from a scourge, while until 2006, the situation has improved, condom usage, refrain."
In contrast, the government's action "to" too late. "In 1993, there was a departmental officials, in order to control AIDS must protect the human rights of gay, then, the official was dismissed. Affected by China's AIDS intervention groups for MSM pause for a long period of time , until 2007, began large-scale operation from the government level. "Zhang Beichuan said.
Zhang Beichuan view, MSM is not in the AIDS epidemic in the rapid rise, but stagflation period, in other words, slow growth rate of infection, but more and more MSM base, involving the spread more widely. "For example, a migrant city in the countryside, they had never heard of &LSquo; gay ', and the city will be after the MSM and other activities, also have multiple sex partners."
"Since the late 1990s, MSM HIV prevalence in the present four characteristics. First, a large number of gay baths, gay bars began to appear, including a high prevalence of AIDS in the active Secondly, similar to the above, the random spread of , or even deliberately spread are common again, the young man began with the exchange through the Internet, online communication, the line to meet friends this way of HIV transmission has played an important supporting role. In addition, there is an important point, Chinese men with universal marriage, while maintaining the MSM. "
"For this reason, the spread of the virus in the MSM is inevitable, and the other the general population will be affected by the impact of a drag." Zhang Beichuan said.
Virus into the general population from high-risk
To achieve "zero" strategy - zero new infections, zero discrimination and zero death, which is International AIDS Day theme this year, but in China, with the virus gradually into the general population, AIDS Prevention of the road long way to go.
"China needs to further expand the testing to find infected at the same time, patients found to be effective for the treatment and high levels of care." In Zhang Linqi seems, at present, AIDS prevention work is a major problem is that a considerable part of those infected in the "hidden" state, while nearly 50% of AIDS without treatment.
The reason they "jumped out cast dark", to some extent, the way work with the government. "Sometimes, goodwill and through appropriate methods, we are accustomed to the establishment of milestones, which will affect the way of doing things, the effect may not be good."
Social development in the Fudan University School of Anthropology and Public Policy Master Instructor Pan Tianshu view, the means of AIDS prevention must be diversified, companions, friends, family, community, NGO and other channels should be fully utilized, while the official, non- official resources within the system, power outside the system should be combined.
However, a long time, the power of government to encourage private support is not in place. "Previously, Shanghai has a non-governmental organizations to carry out AIDS prevention activities, Shanghai Ai Association, the Shanghai Health Bureau were involved, but in the end allows the Public Security Bureau to find, because it has no legal status."
Zhang Beichuan, told Die Zeit reporter, recently there have been news, NGO registration threshold or lower, which will help these organizations to carry out AIDS prevention work, access to financial support, and so on.
The tide of urbanization, HIV virus spread quietly with the crowd flow, China's increasing number of HIV infections, but this does not explain, caused by the AIDS division of the moral and discrimination have been away from the HIV group.
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