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中国距艾滋病“三零愿景”有多远
http://www.sina.com.cn 2011年12月07日17:53 新民周刊
今年世界艾滋病日的主题可归结为“三零愿景”，即“零新发感染、零歧视和零死亡”，这体现了人类在未来抗艾斗争中的努力方向。不过，从愿景变为现实的那一天仍旧任重而道远。
记者/应 琛
自艾滋病于1981年在美国首次确认后，至今全球已有3400多万人成为艾滋病病毒感染者，这一疾病成为人类谈之色变的“世纪瘟疫”。
这场近30年的抗艾斗争考验着人类的科研智慧，考验着人类的同情心，以及在未知恐惧面前的凝聚力。
任何一种疾病的最终攻克，除了是科学的胜利之外，消除歧视则是人人都可参与的切实行动。
“但事实上，为艾滋病患者争取人文关怀的斗争十分艰难。”中国疾病预防控制中心艾滋病首席专家邵一鸣在接受《新民周刊》采访时表示。
世界卫生组织于1988年1月将每年的12月1日定为世界艾滋病日，为的是提高公众对艾滋病危害的认识，更有效地唤醒人们采取措施预防艾滋病的传播和蔓延，号召世界各国和国际组织在这一天举办相关活动，宣传和普及预防艾滋病的知识。
今年世界艾滋病日的主题可归结为“三零愿景”，即“零新发感染、零歧视和零死亡”，这体现了人类在未来抗艾斗争中的努力方向。
第65届联合国大会艾滋病高级别会议则通过了《政治宣言》，各国承诺将加大行动力度，于2015年制止并开始扭转艾滋病病毒的蔓延趋势。
邵一鸣表示，“三零目标”从愿景变为现实的那一天仍旧任重而道远。
中国艾滋病现状：男同性传染剧增
截至2010年底，估计全世界共有3400万艾滋病感染者。艾滋病新发感染者的数量持续下降。2010年新增的艾滋病感染者数量大约为270万，其中大约39万发生在儿童之中。这比疫情最为严重的一年——1997年减少了21%。
而在中国，自1985年发现第一例艾滋病至今，中国的防艾工作已经走过26年。中国政府一直高度重视艾滋病防治和消除歧视工作。
但中国内地每年艾滋病死亡人数正大幅度增加，已成传染病死亡“第一凶手”。国家卫生部疫情报告显示：去年全国报告艾滋病发病15982例，死亡7743例，在法定报告传染病中名列第一，从2008年开始，艾滋病死亡病例已连续3年居于传染病死亡榜首。
邵一鸣在接受记者采访时称，造成这一现象的主要原因是：以前积累的艾滋病病毒感染者陆续进入发病期；相当一部分感染者因担心招致社会歧视，一直不敢检测而处于隐蔽状态。由于病情发现过迟，确诊时已到晚期，患者已来不及进行抗病毒药物治疗。近5年报告的艾滋病死亡病例中，高达80%的人未接受过抗病毒治疗。
据了解，近年来，中央财政艾滋病防治专项经费投入进一步加大，2007年为9.4亿元、2008年10.7亿元、2009年12.2亿元，2010年增加到20.7亿元、2011年增加到22亿元，地方财政也在逐步增加财政支持力度。
根据卫生部和联合国艾滋病规划署、世界卫生组织联合评估结果，截至2011年底，估计中国现存活感染者和病人约78万人，其中病人约15.4万人；2011年新发感染者约4.8万人，因艾滋病相关死亡约2.8万人。
邵一鸣指出，艾滋病死亡病例主要分布在艾滋病病人与感染者报告例数较多的地区，分布与疫情严重程度基本相一致。过去5年艾滋病死亡病例报告增多的省共有16个。
不过，中国艾滋病疫情总体形势向好。从全球来看，中国的感染者和病人数约占全球的2%，仍属于低流行国家。但局部地区和人群已进入高流行状态，性传播感染的比例上升超过80%。
以云南、广西、四川和广东四省区为例，艾滋病传播途径原本以吸毒为主，近年性传播得病率剧增，其中广东3.2万名艾滋病感染者中，性传播受感染者就超过了七成，异性传播也增至五六成，配偶间感染率也超过四成。至于上海方面，男性同性传播的比例为51.9%，防治难度加大。
邵一鸣强调：“我国人口的基数大，防艾形势仍然严峻。”
当前我国艾滋病感染几乎波及所有人群，60岁以上“艾滋老人”和20出头的“艾滋学生”数量逐年增加，同性性传播特别是男男传播快速上升。邵一鸣进一步指出，艾滋病疫情已由高危人群向一般人群扩散。
中国疾控中心性病艾滋病预防控制中心提供的数据显示，2005年至2010年，在艾滋病病毒感染者中，60岁以上男性由483人逐年递增至3031人，所占比例由2.2%扩大为8.9%；在艾滋病病人中，60岁以上男性由237人增至2546人，所占比例由5.4%扩大为11%。
专家分析称，由于生活水平提高，健康状况改善，老年人尤其是老年男性的性活跃年龄在延长，退休之后仍精力旺盛，再加上丧偶或伴侣没性趣等原因，一些老年男性会去寻求性服务。这些老人往往选择比较隐蔽的低档暗娼，且不使用安全套，感染艾滋病的风险很高。
同时，随着检测面的扩大，学生人群报告感染者人数显著增加。今年1至10月，新报告学生感染者和病人1252人，占学生历年累计报告数的21%。学生中，特别是20至24岁男大学生，近两年报告感染者数增加明显。
歧视让蔓延更难控制
“我们要防病，而不是防病人！”这是邵一鸣经常挂在嘴边的一语句话。
对艾滋病感染者和患者来说，除了疾病本身对生命健康的威胁，最大的影响往往来自社会歧视。
根据《中国艾滋病病毒感染者所面临的歧视现状分析报告》显示：中国艾滋病病毒感染者在就业、就医、保险、教育等方面受到明显歧视，被调查的1877位感染者中，有14.8%被拒绝雇佣或因此失业，12.1%至少有一次被医疗机构拒诊，12.2%遭保险公司拒保，9.1%被保险公司拒赔，9.%感染者的健康子女被迫辍学。
“这也就是为什么近几年来男同间艾滋病传染率高居不下的根本原因。”邵一鸣向记者解释，“在中国传统观念的压力下，大多数男同性恋者是在隐瞒性取向的情况下，与女方结婚的。婚后，他们无法给妻子带来和谐的性生活，让‘同妻’备受情感空虚的折磨。更严重的后果是，男同性恋者如果与多名性伴侣发生关系，感染艾滋病的风险就会急剧上升。”
据卫生部门统计，我国新发现的艾滋病病毒感染者中，男男性行为传播比例已从2007年的12.2%猛增至2009年的32.5%。世界卫生组织和联合国艾滋病规划署均将 “同妻”列入艾滋病易感人群。
长期从事同性恋与艾滋病研究的青岛大学医学院教授张北川曾保守认为，中国的男同性恋者约2000万，他们中80%会进入婚姻或已在婚内，相当于1600万。之所以大多数男同性恋者会与异性结婚，主要是出于来自家庭和社会的压力，很多 “男同”父母不清楚儿子的性取向，即使知道了，也希望抱孙子，为家族传宗接代，“社会的歧视让艾滋病患者得不到正确的对待。尤其是对发病率高的男男性接触者的歧视，导致艾滋病感染传播更隐蔽更难控制。而消除歧视，获益的不是这个小群体，获益的将是整个社会。”
针对 “同妻”饱受伤害的现象，邵一鸣建议，同性恋者要自尊、自重、自爱，在结婚前一定要告诉女友自己的性取向，否则就是不道德的；如果知道自己已感染艾滋病，除必须告知性伴侣外，在性生活时必须采取安全套等措施，不能让这一疾病降临到无辜者的身上。
当然，男同性恋者向女友公开自己的性取向，就基本意味着恋爱的终结，也会面临更大的家庭和社会压力。为此，很多学者呼吁我们的社会对同性恋者更加宽容，不要逼他们步入传统婚姻，对配偶造成伤害。
但为何消除人们对艾滋病的歧视却如此之难？
邵一鸣认为，对艾滋病的无知是导致歧视和恐惧的根本原因。而无知又是我国缺少长期的、固定的宣传教育所致，“例如媒体，每年都只在艾滋病日前后才对艾滋病比较关注，这段时期，报纸电视上可以频繁看到艾滋病的相关新闻。但其他时间却少之又少。国外在这方面就做的比较系统了。”
“其实，人们大可不必‘谈艾色变’，我国目前已经有很好的方法来控制它。即使身边的伴侣被感染了，仍可以继续生活在一起，根本不需要搞得妻离子散、家破人亡。”邵一鸣强调。
我国争取10年内推出艾滋病疫苗
“鸡尾酒”疗法发明之前，人们几乎认定，所有的艾滋病人都会死亡。而现在，艾滋病治疗后存活期目前为30年，发达国家说他们已经能达到50年。
2009年初，由国内从事艾滋病疫苗研究的几十家研发单位自发组成的中国艾滋病疫苗联盟成立，这是我国第一个艾滋病疫苗研究组织。当时，邵一鸣就曾表示，艾滋病疫苗的研制是一项艰巨的系统工程，而联盟是开展协同攻关和参与国际合作的最佳平台。中国科学家需要在合作深度和广度上作更大的努力，真正做到顶层设计，互通有无，资源共享，荣辱共担的有机整合。
而日前，卫生部部长陈竺就我国的艾滋病防治工作接受新华社记者的专访时表示，在抗病毒治疗方面，我国积极救治艾滋病病人，扩大了治疗覆盖面，2011年1至9月，新增135个抗病毒治疗县(区)，全国抗病毒治疗县(区)已经有1800多个；新增抗病毒治疗2.65万人，抗病毒治疗人数共14万，目前在治人数11万。
“从治疗效果来看，我国成人抗病毒治疗效果处于发展中国家前列，儿童抗病毒治疗总病死率接近发达国家，预防或延缓了大量死亡。”陈竺说，“在科研方面，近年来，我国‘艾滋病和病毒性肝炎等重大传染病防治’、‘重大新药创制’科技重大专项对艾滋病防治工作给予了积极支持。两专项围绕艾滋病诊、防、治三个关键环节，重点开展新型艾滋病病毒诊断试剂、生物预防技术和产品、抗病毒药物和免疫重建方案、自主创新艾滋病疫苗、新型艾滋病病毒监测和预警系统及综合防治示范等研究，共安排中央财政经费约8亿元。”
据悉，目前，第四代艾滋病诊断试剂和全自动高通量核酸血筛检测设备研制成功，将窗口期缩短至2周以内。艾滋病初筛检测试剂和设备已基本国产化，质量可靠，在全国广泛应用。
记者了解到，传染病的疫苗临床试验一般要进行三期。艾滋病疫苗一期临床试验历时3年顺利结束，二期用于有危险性感染的人群，重点评价其免疫原性，检测设计的免疫指标、对抗病毒等是否可以实现；第三期是在更大的高危人群中直接测试这个疫苗，检测其能否保护接种人群不被细菌和病毒感染。
邵一鸣也向记者透露，他和研究团队培植的具有中国自主知识产权的艾滋病新疫苗，目前已完成一期临床试验，即将申报二期试验。
根据介绍，由邵一鸣研究团队培植的艾滋病疫苗是通过基因技术，将艾滋病病毒片段截取下来，放在天花疫苗载体上，培养出新疫苗。2009年结束的一期临床试验证明，该疫苗是安全的，接种者能够产生抗体。
邵一鸣表示，基于5年前对艾滋病病毒认识而研发的第二代疫苗研制工作已经启动，有望今年年底或明年上半年进入试验。基于对当前艾滋病认识而研发的第三代艾滋病疫苗申报试验工作亦将开始。
“希望能让疫苗较早进入第三期，产生一个初步能看到一定效果，或是能展示未来发展方向的临床试验结果，争取在未来10年推出具有中国自主知识产权的艾滋病疫苗。”邵一鸣说。
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
China from AIDS "30 vision" of how far
http://www.sina.com.cn 2011 年 12 月 07 日 17:53 Xinmin Weekly
World AIDS Day theme this year can be attributed to "30 Vision", that "zero new infections, zero discrimination and zero deaths," which reflects the future of mankind in the struggle against AIDS in the direction. However, from the vision into reality is still a long way that day.
Reporters / should Chen
Since AIDS was first recognized in the United States in 1981, it has been more than 34 million people worldwide have become infected with HIV, the disease of human talking crazy "century plague."
This nearly 30-year struggle against AIDS research and human intelligence test, a test of human compassion, and the fear of the unknown in front of cohesion.
Eventually overcome any kind of disease, in addition to the victory of science, the elimination of discrimination is a practical action everyone can participate.
"But in fact, humane care for AIDS patients to fight the fight very difficult." Chinese Center for Disease Control AIDS Shao Yiming, chief expert in the "Xinmin Weekly" interview.
World Health Organization in January 1988 to December 1 each year as World AIDS Day, in order to raise public awareness of the hazards of AIDS, to awaken people to take more effective measures to prevent the spread of AIDS and the spread, and called on the world international organizations in related activities held this day, publicity and popularization of knowledge of AIDS prevention.
World AIDS Day theme this year can be attributed to "30 Vision", that "zero new infections, zero discrimination and zero deaths," which reflects the future of mankind in the struggle against AIDS in the direction.
65th Session of the UN General Assembly on AIDS through high-level meeting of the "Political Declaration", countries pledged to increase the intensity of efforts, in 2015 to halt and begin to reverse the spread of HIV.
Shao Yiming, said, "30 goals" from the vision into reality is still a long way that day.
China AIDS status: Male homosexual transmission of surge
As of the end of 2010, with an estimated total of 34 million people living with HIV. AIDS, the number of new infections are declining. 2010, the number of new HIV infections is approximately 2.7 million, of which about 390 000 in children being. Than the most serious epidemic year - 1997, a decrease of 21%.
In China, since 1985 since the first cases of AIDS, AIDS prevention work in China has gone through 26 years. The Chinese government has always attached great importance to the work of AIDS prevention and elimination of discrimination.
But the number of AIDS deaths each year in Mainland China is a significant increase in deaths from infectious diseases has become "the first murderer." Ministry of Health report shows that the epidemic: report of AIDS last year, the incidence of 15,982 cases, 7743 cases of death, the statutory reporting of infectious diseases ranked first, starting in 2008, AIDS deaths have been living for three consecutive years, deaths from infectious diseases list.
Shao Yiming, said in an interview with reporters, the main reason for this phenomenon: the accumulation of past HIV incidence in succession into the period; a considerable part of the infected person for fear of incurring social discrimination, has not detected while in the hidden state. As the condition found late, when diagnosed at a late stage, the patient was too late for antiviral drugs. Past five years, reported AIDS deaths, up to 80% of people who had not received antiretroviral therapy.
It is understood that in recent years, central government funding for AIDS prevention and treatment of special further increase in 2007 was 9.4 billion yuan, 1.07 billion yuan in 2008, 2009, 1.22 billion yuan in 2010 to 2.07 billion yuan, 2.2 billion in 2011 to Yuan, local governments are gradually increasing financial support.
According to the Ministry of Health and UNAIDS, the World Health Organization assessment, as of the end of 2011, estimated that China is about the survival of patients infected and 78 million, of which about 15.4 million patients; new infections in 2011 were about 4.8 million people due to AIDS-related deaths of about 2.8 million people.
SHAO Yi-ming pointed out that AIDS deaths mainly in patients with HIV infection were reported in districts with more number of cases, distribution and severity of the epidemic is essentially the same. AIDS deaths over the past five years, reported an increase in the provincial total of 16.
However, the overall situation of China's AIDS epidemic to the good. From a global perspective, China's number of patients infected and about 2% of the world, is still a low prevalence country. But in some areas and population groups have access to high-prevalence states, the proportion of sexually transmitted infections increased by more than 80%.
Yunnan, Guangxi, Sichuan and Guangdong, the four provinces, for example, the original route of transmission of AIDS to drug-based, sharp increase in recent years, the rate of sexually transmitted disease, including 32,000 AIDS in Guangdong, the sexually transmitted infection were more than seven as, heterosexual transmission has increased to 56 percent, infection rates between spouses over 40%. As for Shanghai, the male sex ratio of 51.9% transmission, prevention and treatment more difficult.
Shao Yiming stressed: "China's population base, AIDS prevention situation is still grim."
China's current HIV infection has affected almost all people over 60, "HIV old" and the 20-something "AIDS students" the number increases every year, especially the male homosexual male sexually transmitted spread rapidly rising. Shao Yiming further pointed out that the AIDS epidemic from high-risk groups to the general population.
Chinese Center for Disease Control and Prevention of STD and AIDS Center data show that from 2005 to 2010, in HIV infected persons, men over 60 years of age increased from the 483 to 3031 people each year, expanding from 2.2% the proportion of 8.9% ; in AIDS patients, 60 years old male from the 237 to 2546 people, expanding from 5.4% the proportion of 11%.
Experts said that as living standards improve, improved health, the elderly, especially older men, sexually active age extension, still energetic after retirement, plus no interest in sex spouse or partner and other reasons, some of the older men will seek of service. These people tend to choose more subtle low-end sex workers, and do not use condoms, the risk of HIV infection is high.
Meanwhile, with the expansion of the detection plane, the crowd of students reported a significant increase in the number of infected persons. From January to October this year, a new report on students and patients infected with 1252, accounting for the number of students over the years has reported 21%. Students, especially male students aged 20 to 24, nearly two years, the number of reported infections increased significantly.
Discrimination more difficult to control the spread of
"We want to prevent disease, not preventing people!" This is a statement Shao Yiming catch-words.
AIDS infected people and patients, in addition to the disease itself a threat to life and health, the greatest impact often comes from social discrimination.
According to "China's HIV discrimination faced Analysis Report" shows: Chinese HIV-infected persons in employment, medical care, insurance, and education are clearly discriminatory, of the 1877 infected persons, 14.8% were rejected employment or have lost their jobs, 12.1% had at least one occasion been refused medical clinics, insurance companies, insurance coverage was 12.2%, 9.1% of the insurance company exclusions, 9% of infected healthy children were forced to drop out of school.
"This is why in recent years, men with AIDS infection rate remains high among the root causes." Shao Yiming, explained to reporters, "In the Chinese tradition, under pressure to conceal the majority of gay men in the case of sexual orientation, and woman to marry. marriage, they can not bring harmony to his wife's sex life, so that 'with the wife' highly emotional emptiness of torture. more serious consequence is that if gay men have relations with a number of sexual partners, HIV infection The risk will increase dramatically. "
According to health department statistics, China's newly discovered HIV, the proportion of MSM transmission from 12.2% in 2007 soared to 32.5% in 2009. World Health Organization and UNAIDS are the "with wife" into vulnerable to HIV.
Engaged in homosexuality and AIDS research, Qingdao University School of Medicine Professor Zhang Beichuan has been conservative that gay men in China about 20 million, 80% of them will enter the marriage or in marriage, the equivalent of 16 million. The reason why most gay men with heterosexual marriage, mainly because of pressure from family and society, many "gay" parents do not know his son's sexual orientation, even know, I hope grandmother, the family heir, "social discrimination for AIDS patients get proper treatment. especially for the high incidence of discrimination against MSM, leading to more subtle spread of HIV infection more difficult to control and eliminate discrimination, not to benefit this small group, will benefit society as a whole. "
For "with the wife," the phenomenon of suffering harm, SHAO Yi-ming suggested that homosexuals should self-esteem, self-respect, self-love, the marriage must tell his girlfriend before his sexual orientation, or is immoral; If you know you have been infected with HIV, in addition to inform sexual partners, but in the life of condoms and other measures must be taken, can not let this disease come to the innocent body.
Of course, gay men disclosing their sexual orientation to his girlfriend, it basically means the end of love, will face greater family and social pressure. For this reason, many scholars have called for our society more tolerant of homosexuals, do not force them into the traditional marriage, the spouse of damage.
But why eliminate discrimination against people of AIDS, but so difficult?
Shao Yiming that ignorance is the cause of AIDS and fear of the root causes of discrimination. And ignorance is our lack of long-term, fixed due to the publicity and education, "such as media, only a year after a few days ago of AIDS in HIV more concerned about this period, newspapers can be frequently seen on television news of AIDS, but other times are rare. abroad to do in this respect, a more systematic. "
"In fact, people need 'to talk about Ai pale', China has a very good way to control it even close to being infected partner can continue to live together, do not need to do a wives and children, disintegration of families. "Shao Yiming emphasized.
China launched an AIDS vaccine for 10 years
"Cocktail" therapy prior to the invention, it is found almost all people will die of AIDS. Now, AIDS survival after treatment for 30 years now, the developed countries that they have been able to reach 50 years.
In early 2009, the country engaged in AIDS vaccine research, dozens of spontaneously formed R & D units in China AIDS Vaccine Alliance, which is China's first AIDS vaccine research organizations. At the time, had said Shao Yiming, an AIDS vaccine development is a difficult system engineering, and the Alliance is to carry out collaborative research and the best platform to participate in international cooperation. Chinese scientists need breadth and depth of cooperation to make greater efforts, truly top-level design of each other, sharing resources, sharing honor the organic integration.
A few days ago, Health Minister Chen Zhu, China's AIDS prevention work on the acceptance of Xinhua News Agency reporters De Zhuanfang and Shi Biaoshi, the anti-viral treatment, active treatment of AIDS patients in China, expanding treatment coverage, January-September 2011, the new 135 antiviral treatment counties (districts), the National anti-viral treatment counties (districts) has more than 1,800; 2.65 million new anti-viral treatment, the number of anti-viral treatment of 14 million, the current rule number 11 million.
"From the treatment point of view, the effect of adult antiretroviral therapy in developing countries in the forefront of anti-viral treatment of children close to the total mortality in developed countries, to prevent or delay a lot of death." Chen Zhu said, "in scientific research in recent years, China 'AIDS and viral hepatitis and other major infectious diseases', 'a major new drug' major science and technology work for AIDS prevention and treatment given positive support two special focus on AIDS diagnosis, prevention and treatment three key areas, focusing on new HIV diagnosis reagents, bio-prevention technologies and products, antiviral and immune reconstitution program, AIDS vaccine innovation, the new HIV surveillance and early warning systems and integrated control demonstration study, the central government funds were arranged approximately $ 800 million. "
At present, the fourth-generation HIV diagnostic reagents and automated high-throughput nucleic acid test blood screening equipment was successfully developed, will reduce the window period to 2 weeks or less. AIDS screening test kits and equipment has basically domestic, reliable, widely used in the country.
Reporters learned that the infectious disease vaccine Phase III clinical trials generally. AIDS vaccine Phase I clinical trials successfully concluded last three years, two for dangerous infections of people, focusing on evaluation of its immunogenicity, testing the design of immune parameters, such as fighting the virus can be achieved; the third period in a larger high-risk populations to test the vaccine directly detect its ability to protect people from being vaccinated bacterial and viral infections.
Shao Yiming also told reporters he and China research team to cultivate independent intellectual property rights with the new AIDS vaccine, has completed Phase I clinical trials, about to declare Phase II trials.
According to introduction, by Shao Yiming AIDS vaccine research team is cultivated through genetic technology, the AIDS virus fragment interception down, on the smallpox vaccine carriers, to develop a new vaccine. The end of 2009, Phase I clinical trials demonstrated that the vaccine is safe, vaccination were able to produce antibodies.
Shao Yiming, said, based on five years ago, awareness of HIV vaccine research and development of second generation has been initiated, expected late this year or early next year into the trial. Based on current research and development of AIDS awareness and reporting third-generation AIDS vaccine trials will begin.
"I hope to make the vaccine early into the third period, resulting in a preliminary to see some results, or can show the future direction of clinical trial results, for the next 10 years, introduced China's independent intellectual property rights of AIDS vaccine." Shao Yiming said.
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