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揭秘：是谁在传播艾滋病毒？
www.39.net 2010-6-24 健康时报
74万减32万，等于42万。
这是一个很简单的减法，但得出的结果，却让人忧心忡忡。
我国约有74万艾滋病病毒携带者，其中42万人却并不自知。他们或者因为在窗口期去检测导致“HIV阴性”，或者心存侥幸不去检测，在未来的生活中，继续着高危生活……
结果就是，被传染人群继续扩大，而且全然不知“谁把艾滋病毒传染给了我”？
正文：
对于我们每个人而言，除了避免高危行为之外，知晓自己，知晓别人，这才是防艾最重要的法宝，否则，感染了艾滋病毒都不知道被谁传染的，这实在是最大的悲哀。
广西女子强制戒毒所的活动室，艾滋病病毒携带者周红（化名）站在跑步机旁，擦拭着头上的汗水。面对来自全国各地的记者的采访，她很从容地介绍在戒毒所每天的生活。尽管不能像外面的人那样自由，但“每天过得很充实”。
但当被问到HIV感染的经过，她的泪水却在眼眶里打转。她是在和别人共用针具静脉吸毒的时候感染的，但当时究竟是谁把艾滋病病毒传给了她，她说不出。
而在北京佑安医院爱心家园志愿者的访谈中，张剑（化名）讲述了刚得知自己是HIV阳性时候的反应，“那时我惊呆了，吓傻了，真的是我吗？这么低的概率，怎么会发生在我的身上？我把自己接触过的人想了一个遍，就是想不出谁传染给的我——他们都不像是艾滋病感染者啊！”
这是两个发生在不同地方、经不同途径感染艾滋病病毒的故事，但是两位主人公有同样的疑问——究竟是谁把艾滋病毒传染给了我？
“测不出”的窗口期，“不知道”的潜伏期，让艾滋病病毒蔓延开来
据卫生部、联合国艾滋病规划署和世界卫生组织联合估计数据：截至2009年底，估计中国现存活艾滋病病毒感染者和病人（HIV/AIDS）约74万人，其中AIDS病人10.5万人。
“截止到2009年，我们累计发现的HIV/AIDS感染者只有32万人，也就是说还有很大一部分人的感染状况我们是没有掌握的，甚至连感染者自己都不知道，这是一个非常棘手的问题。”6月7日，新闻出版总署在广西组织的禁毒防艾采访考察报告会上，中国疾控中心性病艾滋病预防控制中心党委书记韩孟杰语气凝重地说。
而在此前一个月，在清华大学举办的中盖项目艾滋病报道研修班上，卫生部疾控局副局长郝阳也坦承，这是一个防艾的现实难题。
艾滋病病毒是一种很狡猾的病毒。
人感染艾滋病病毒之后，最初有一段时间，通过现有的检测手段是无法检测出的，这段时间叫做“窗口期”。在这段时间内人体内虽有病毒，但是由于人体免疫系统对病毒的免疫反应有一定过程，也就是抗体的产生和可检测到需要一短时间，所以窗口期内无法检测到是否感染艾滋病病毒。
“这就像古时候打仗，对方侵略到了家门口了，但是我们调兵遣将还需要一定的时间，这个时间就是窗口期。”国务院防治艾滋病工作委员会办公室政策协调部主任陈清峰打了个很形象的比喻，在窗口期，艾滋病感染者如果献血，血站是肯定检测不出来的，把这样的血液输给其他人，其他人就会感染。
“尽管我们采取了一系列的手段来保证血液的质量和安全，由于窗口期带来的输血风险，仍然客观存在的，并且在世界上所有的国家都存在，”卫生部医政司副司长赵明钢表示。
据卫生部疾控局副局长郝阳透露，为了更好保障临床用血安全和受血者的健康，卫生部已经开始酝酿在全国血站进行RNA核酸检测技术，该技术对窗口期的病毒检出率和准确率能达到90%以上。
即便是过了窗口期，如果艾滋病病毒感染者不去做专门的检测，也不会知道自己“生了病”。
这是因为艾滋病病毒进入人体后，潜伏期很长，平均有7到10年，在这段时间里，感染者只要身体没有症状表现，和正常人几乎没有区别，他们如果去采取一些高危行为，很容易把病毒传染给健康人。
“很多高危人群，也怀疑自己感染了病毒，但害怕社会的歧视，加上侥幸心理，不会主动去做检测，结果就在长年的潜伏期里，无意中传播了病毒。”陈清峰主任说。
许多边境地区的吸毒人员经常聚众吸毒，这种没有任何防范意识的行为无形中也加重了艾滋病的感染疫情。在广西壮族自治区百色市公安局禁毒支队支队缉毒英雄事迹报告会上，曾把300多个毒贩送上刑场的缉毒队长唐桂宏告诉记者，今年2月3日，他们在群众的协助下一举捣毁一个边境线上的聚众吸毒窝点，当场抓获吸毒人员9人，查获吸毒道具一批。今年以来，这个支队与百色市禁毒支队联合查获毒品案件5起，缴获毒品海洛因2828克、麻古1288克，抓获犯罪嫌疑人9人。
非洲一些国家检测艾滋病感染只要15分钟，而我国最快也要5到10天！
一个人，如果知道自己感染了艾滋病病毒，那么他就会有意识地减少约68%的高危行为——这是国际有关机构统计得出的数据。
现任比尔及梅琳达•盖茨基金会中国项目主任的叶雷博士告诉记者：一百个HIV感染者中，有50个人知道自己感染病毒之后会采取安全措施，尽量保护朋友、配偶、伙伴，另外有30个人基本没变，还有20个人可能采取比较极端的行为，比如有意传播艾滋病毒。但是从整体上来看，传播高危行为下降了一半或者2/3。
从美国的艾滋病疫情来看，每年新发的感染人数一年比一年少，主要因为美国已经掌握75%—80%的感染者现状，这些人长期接受医疗管理、治疗或者随访，只有25%左右的人不知晓。
中国现在的困境在于：我们是40%知晓，60%不知晓。
1999年至今一直负责艾滋病临床工作的北京佑安医院传染科副主任医师张可告诉记者：“就我所接触的患者而言，知晓之后的正面意义要远远大于负面意义，因为很多人都会有很强的自我保护意识和自我控制意识，他们的行为改变很明显。”
叶雷博士认为，检测越简便，就会越普及。“而在国内，不管在医院常规检测或者VCT检测（自愿咨询检测）被初筛阳性的话，大部分地方不给你结果，得把血液样本送到全国80个实验室。即便最好的实验室也要一周内才能把结果送回来，有了最后的确认结果才能告知，整个过程需要5到10天。而在非洲的一些国家，只要手指上的两滴血，通过两种试剂的对比，15分钟就能得出结果。”
“5到10天！有多少个吸毒、性工作者或同性恋高危的人，会耐心地等候通知？！”叶雷说。
陈清峰主任说，从总体上看，我国艾滋病感染者总数占全部人口数的比例还不高，我国艾滋病还处于低流行状态。但从传染病控制的角度来说，全国74万个感染者就是74万个传染源，如果他们中的很多人也不知道自己已经感染，是相当可怕的事情。“对于每个个体来说，如果有一次共用针具吸毒、缺乏安全措施的性行为等高危行为，就有可能被感染上；如果感染上了，那么，对个体来说，这一次感染的概率就是100%——这绝不是危言耸听，因为我自己就知道好几个发生一次高危行为就被感染的案例。”
除了避免高危行为之外，知晓自己，知晓别人，采取安全措施，这才是防艾最重要的法宝
那么，怎样才能寻找我国处于“潜伏”中的艾滋病感染者？在本次报刊业进度和防艾培训考察报告会上，陈清峰主任认为要通过社区、自愿咨询检测门诊（VCT）和医院医生主动提供咨询检测等方式。
社区的快速检测是一个很高效的检测途径，目前在我国云南、广西等一些基层地区已经开始了试点工作。如果检测试剂的灵敏度和准确度能够进一步提高，未来不排除在一些较大医院进行推广的可能。
北京市疾病预防控制中心已经开始尝试在一些同性恋酒吧以自愿参与的方式提供快速检测。在北京佑安医院的爱心家园，志愿者告诉记者：尽管是在检测的淡季，每天也有40多个人前来进行初筛检测。
另外，要大力推行自愿咨询检测门诊。陈清峰介绍，目前，中国有艾滋病自愿咨询检测（VCT）站点共7335个，在每个县都能有2到3个以上的检测门诊，这些站点一般在当地疾控部门和医疗机构。北京市可能有十几家，检测者可自愿在此接受免费的检测和咨询服务。而未来，VCT服务希望能够覆盖到社区医院和农村基层卫生机构。
“这些门诊不会泄露被检测者的信息，而且完全免费，运行至今，取得了很好的效果。2009年全年大概有160万人群接受检测，其中筛查出阳性人群两万多人。”陈清峰告诉记者。
另外，卫生部和疾控中心在一些地区的医院中开展医生主动提供咨询检测的试点，特别是在和艾滋病感染途径（如性传播、静脉吸毒、母婴传播）密切相关的妇科、性病门诊、泌尿外科等科室。通过医疗机构的常规工作，最大限度地发现艾滋病感染者和病人。
有人提出，应该把HIV检测纳入到健康体检中，陈清峰认为在疫情严重的地区和人群是有必要的，但在艾滋病低流行地区推行的话，可能会消耗掉很大一部分社会资源，而且由于社会对艾滋病的歧视仍然存在，还会带来一系列的社会问题。低流行地区还是要以高危行为人群的监测、检测为主，摸索有效、及时发现感染者和病人的其它办法。
“尽管这些工作有的在试点，有的还是理念推广，但是国家会根据防治工作需要，推动相关政策出台。”陈清峰说，“对于我们每个人而言，除了避免高危行为之外，知晓自己，知晓别人，采取安全措施，这才是防艾最重要的法宝，否则，感染了艾滋病毒都不知道被谁传染的，这实在是最大的悲哀。”
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Secret: Who is in the transmission of HIV?
www.39.net 2010-6-24 Healthy Times
740,000 by 320,000, equivalent to 420 000.
This is a simple subtraction, but the result, but people worried.
China has almost 740,000 HIV carriers, of which 42 million is not knowing. Them or because the result in the window period to detect "HIV negative" or not to test luck in the next life, continued high risk of life ... ...
The result is that infected people to continue to expand, but had no idea "who the HIV virus to me?"
Body:
For each of us, apart from avoiding high-risk behavior, the knowledge of yourself, know others, this is the most important AIDS prevention magic weapon, or infected with HIV infection do not know by whom, it is the greatest tragedy .
Guangxi woman compulsory detoxification activity rooms, AIDS virus carriers Zhou Hong (a pseudonym) standing treadmill next to wipe the sweat head. Reporters from across the country face interview, she calmly describes the daily life in the drug. Although not as free as outsiders, but "had a very full day."
But when asked after HIV infection, but her tears in the eyes round and round. She is in and intravenous drug users sharing needles when the infection, but then who is the AIDS virus to her, she could not tell.
Love in Beijing You'an Hospital home interviews volunteers, Zhang Jian (pseudonym) describes just that when they are HIV-positive reaction, "I was shocked, scared silly, really me? such a low probability, how could occur in my body? I come into contact with people who want to own a time that is transmitted to the I can not think who - they do not like AIDS ah! "
These are two occurred in different places, different ways of HIV infection through the story, but the two heroes have the same question - Who is the HIV virus to me?
"Undetectable" window period "do not know," the incubation period for HIV spread
According to Health, UNAIDS and the WHO estimated data: As of the end of 2009, estimated that China is the survival of HIV infected persons and patients (HIV / AIDS) of about 74 million, of which 10.5 million AIDS patients.
"As of 2009, we found cumulative HIV / AIDS infected only 32 people, that a large percentage of infection is not our master, even the infected persons themselves do not know, this is a very difficult problem. "June 7, News and Publication Administration of anti-drug organization in Guangxi Report on AIDS prevention at the interview, the Chinese Center for Disease Control STD Prevention and Control Centre party secretary Han Mengjie dignified tone, said.
In the previous month, held at Tsinghua University in the training class covers project report AIDS, Ministry of Health, Hao Yang, deputy director of CDC Board also acknowledges that this is a practical problem of AIDS prevention.
AIDS virus is a very tricky virus.
People infected with HIV after the initial period of time, through the existing testing methods can not be detected, this time called the "window period." During this time, although the virus inside my wife, but because of the human immune system immune response against the virus have a certain process, that is, antibodies and can detect the need for a short period of time, so the window can not detect whether the period of HIV infection .
"It's like ancient war of aggression to the other door, but we deployed its forces will take some time, this time is the window period." The State Council AIDS Working Committee Office of Policy Coordination Department Director Chen Qingfeng I called it the image of analogy, in the window period, HIV infection if blood, blood bank is in the affirmative can not be detected, and the loss of blood so other people, other people become infected.
"Although we have taken a series of measures to ensure the quality and safety of blood, You Yu window period introduces the risk of blood transfusion, Rengran objective existence, and all countries in the world exist," the Ministry of Health Deputy Director of Medical Administration Zhao Gang said.
According to the Ministry of Health CDC said Hao Yang, Deputy Secretary, in order to better protect the blood for clinical safety and the recipient's health, the Ministry of Health has started brewing in the National Blood for RNA nucleic acid testing technology that the window of the virus The detection rate and accuracy rate can reach 90%.
Even after a window period of HIV infection if not done specific testing, did not know his "sick."
This is because the HIV virus enters the human body, a long incubation period, an average of 7 to 10 years in this period, the infected person as long as the body without symptoms, and almost no difference between normal people, if they go to take some high-risk behavior, it is easy to spread the virus to healthy people.
"A lot of high-risk groups, also suspected he was infected with a virus, but the fear of social discrimination, with luck, will not take the initiative to do testing, results in long incubation period, the inadvertently spread the virus." Chen Qingfeng, director said.
Many drug users in border areas frequently gathered to drug abuse, this is not the behavior of virtually any awareness of prevention of AIDS infection also increased the epidemic. Baise in Guangxi Public Security Bureau Narcotics detachment detachment of the heroic deeds of the report at the drug, once brought to the execution ground of more than 300 drug traffickers captain Tanggui Hong told reporters on February 3 this year, they help people smashed a boundary The gathering of online drug dens, drug addicts 9 was arrested, drugs seized a number of props. This year, the detachment and the detachment of the joint anti-narcotics seized in Baise City, 5 from drug cases and seized 2,828 grams of heroin, Ma Ancient 1,288 grams, arrested 9 suspects.
Detection of HIV infection in some African countries as long as 15 minutes, but China will take at least 5-10 days!
A man, if you know they are infected with HIV, he would have consciously reduced by about 68% of high-risk behavior - this is the body of international statistical data obtained.
Incumbent Bill & Melinda Gates Foundation • China Project Director Dr. Ye Lei told reporters: 100 HIV infected, 50 infected individuals aware of their security measures will be taken after, as far as possible to protect a friend, spouse, partner, Another 30 people basically not changed, there are 20 people may take a more extreme behavior, such as intentionally spread HIV. But from the whole, halved transmission risk behaviors, or 2 / 3.
AIDS epidemic, from the U.S. point of view, the number of annual new infections every year made a small, mainly because the United States have mastered 75% -80% of those infected status of these people receive long-term medical management, treatment or follow-up, only 25% of people do not know.
China's current dilemma is: We are aware of 40%, 60% do not know.
Since 1999, AIDS has been responsible for clinical epidemiology in Beijing You'an Hospital, Deputy Chief Physician Zhang told reporters: "I have contacted the patients, after knowing much larger than the positive significance of the negative sense, because many people will have strong self-protection awareness and consciousness of self-control, their behavior changes very clearly. "
Dr. Ye Lei believes that the more easily detected, the more popular. "In the home, whether in the hospital routine testing or testing VCT (voluntary counseling and testing) were screening positive, then, most places do not give you the results, blood samples were sent to 80 laboratories nationwide. Even the best laboratory should be sent within one week before the results came back, with the final confirmation of results can tell, the whole process takes 5-10 days. and some countries in Africa, as long as the fingers of two drops of blood, through the comparison of two reagents, 15 minutes to the outcome. "
"5-10 days! The number of drug users, sex workers or homosexual high-risk people will be patient and wait notice?!" Ye Lei said.
Chen Qingfeng, director said that, generally speaking, China's total number of AIDS the proportion of the total population is not high, China's AIDS epidemic is still in a low state. But from the perspective of communicable disease control, the National 740 000 740 000 infected people is the source of infection, if many of them do not know they are infected, is a very terrible thing. "For each individual, if there is a shared needle drugs, the lack of safety measures such as high-risk sexual behavior, it may be infected; if infected, then, to the individual, this time the probability of infection is 100% - This is not alarmist talk, because I know several high-risk behavior occurs once the case was infected. "
In addition to avoiding high-risk behavior, the knowledge of yourself, know others, to take safety measures, this is the most important AIDS prevention magic
So, how can we find our country in a "latent" in AIDS? In this newspaper industry training report on the progress and AIDS prevention at the meeting, Chen Qingfeng, director that through community, voluntary counseling and testing clinic (VCT) and hospital doctors take the initiative to provide counseling and testing, etc..
Rapid detection of the community is a very efficient means of detection, currently in China Yunnan, Guangxi and some local areas have begun pilot work. If the test kit's sensitivity and accuracy can be further enhanced, the future does not rule out some of the larger hospitals in the promotion possible.
Beijing Centre for Disease Control and Prevention has begun to try a number of gay bars in a voluntary way to provide quick detection. You'an Hospital in Beijing love their homes, volunteers told reporters: even in the off-season testing, everyday there are more than 40 individuals to come for screening test.
In addition, we should be voluntary counseling and testing clinics. Chen Qingfeng, at present, China has the AIDS voluntary counseling and testing (VCT) sites of 7335, in each county can have more than 2 to 3 test out, these sites generally in the local disease control departments and medical institutions. Beijing may have more than a dozen, can detect this accepted voluntary testing and counseling services free of charge. In the future, VCT services, hoping to cover to community hospitals and rural primary health facilities.
"These clinics will not disclose the information to be detected by, and completely free of charge, to run so far achieved good results. The year 2009, about 1.6 million people being tested, which screened positive for more than twenty thousand people." Chen Qingfeng told reporters.
In addition, the Ministry of Health and CDC in some areas of the hospital doctors carried out a pilot initiative to provide counseling and testing, and HIV infection, particularly in ways (such as sexual transmission, intravenous drug use, mother to child transmission) are closely related to gynecology, sexually transmitted diseases clinic Urology and other departments. Work through the conventional medical institutions to maximize the discovery of AIDS infection and patients.
It was suggested that HIV testing should be integrated into the health check, by Chen Qingfeng believe that a serious epidemic areas and populations is necessary, but low in HIV endemic areas, if implemented, could consume much of social resources, but also because of the social AIDS, discrimination still exists, but also bring a range of social problems. Low-endemic areas or high-risk behavior groups to the monitoring, detection-based, and explore effective and timely detection of infected persons and patients with other approaches.
"Despite these efforts, some in the pilot, or some idea of promotion, but the country needs based on prevention, promotion of policies issued." Chen Qingfeng said, "For each of us, apart from avoiding high-risk behavior, the knowledge of their own, known to others, to take safety measures, this is the most important AIDS prevention magic weapon, or infected with HIV infection do not know by whom, it is the greatest tragedy. "
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