中國HIV新發(fā)病例趨勢引發(fā)擔憂

A rise in HIV cases among young gay men and people over 60 in China has raised the question of whether the disease is spreading undetected among people who do not consider themselves at risk.

中國年輕男性同性戀者和60歲以上人群艾滋病毒(HIV)感染病例增多，這提出了一個問題，艾滋病是否正在不認為自己有感染風險的人群中悄然傳播。

Figures from the Chinese Center for Disease Control and Prevention released ahead of World Aids Day on Thursday, show 96,000 new HIV cases in the first nine months of this year, putting China on track to exceed the 115,000 new cases recorded in 2015. The country accounts for about 3 per cent of new HIV cases worldwide, and 2 per cent of the total global HIV-positive population.

中國疾病預防控制中心(CDC)在12月1日世界艾滋病日前發(fā)布的數(shù)據(jù)表明，今年頭9個月新診斷發(fā)現(xiàn)艾滋病感染者9.6萬人，使今年可能超過2015年錄得的11.5萬新發(fā)病例。中國約占世界新發(fā)HIV感染病例的3%，占全球HIV陽性人口總數(shù)的2%。

Trends among the new cases indicate government efforts to manage HIV may be missing the mark.

新發(fā)病例的趨勢表明，政府控制HIV的努力可能未能達到目的。

“China is one of the countries with the best data but that comes at a price,” said Catherine Sozi, UNAids country director in China. Chinese data reflect documented HIV cases, not the survey projections used in many other countries. “By the time you know every gay man who is HIV positive or every female sex worker the disease has moved elsewhere.”

“中國是數(shù)據(jù)最好的國家之一，但這是有代價的，”聯(lián)合國艾滋病規(guī)劃署(UNAids)中國地區(qū)負責人蘇凱琳(Catherine Sozi)說。中國的數(shù)據(jù)反映記錄在案的HIV病例，而其他許多國家使用調(diào)查預測的數(shù)字。“等到你獲知每一個HIV陽性的男同性戀者或者女性性工作者，疾病已經(jīng)轉移到其他地方。”

Of the new cases this year, 28 per cent involved men who have sex with men. Last year’s data also showed new cases rising among young people and particularly among gay college students. Chinese commentators view this as a consequence of the stigma attached to homosexuality in China, which might prevent people from being tested for HIV, while non-government organisations worry that a crackdown on NGOs limits their ability to reach the gay community.

在今年的新發(fā)病例中，28%源于男男同性性接觸行為。去年的數(shù)據(jù)也表明，年輕人，尤其是男同性戀大學生中的新發(fā)病例出現(xiàn)上升。國內(nèi)評論人士認為這是中國同性戀污名化造成的一種后果，人們可能因此不去檢測HIV，而非政府組織(NGO)擔憂，中國對NGO的打擊限制了他們觸及同性戀群體的能力。

But Dr Sozi believes the new cases among gay men reflect not a failure to reach them, but the Chinese gay community’s relative success in persuading people to get tested.

但蘇凱琳認為，男同性戀群體中的新發(fā)病例反映的是中國同性戀群體在說服人們接受測試方面相對成功，并非相關機構未能觸及這一群體。

Blued, a gay hook-up app with millions of users, has initiated Aids-education campaigns and operates several free testing centres in Beijing. Its campaign could be boosted by the introduction of self-testing kits that allow people to test in privacy, without having to out themselves at a state-run hospital.

擁有數(shù)百萬用戶的男同性戀交友應用軟件Blued發(fā)起了艾滋病教育運動，并在北京運營了幾家免費檢測中心。引入自我檢測套件或許有助于促進Blued的運動，因為這讓人們能夠私下進行檢測，無需在國營醫(yī)院暴露自己的身份。

The World Health Organisation this week formally recommended the use of self-testing to help reach the estimated 14m people globally who do not know they are HIV positive. In China that includes young gay men who typically have very little sex education when they become sexually active in high school or college.

本周世界衛(wèi)生組織(WTO)正式推薦使用自我檢測手段，以幫助觸及全球范圍內(nèi)那些不知道自己是HIV陽性的人，據(jù)估計這些人的人數(shù)達到1400萬。在中國，這個數(shù)字包含一些年輕的男同性戀者，他們在高中或者大學進入性活躍期時，通常接受的性教育極少。

“Chinese society still has lots of misunderstanding toward homosexuality and Aids so affected people are reluctant to receive help from the government and NGOs,” says Blued founder Geng Le.

Blued創(chuàng)始人耿樂表示：“中國社會對同性戀和艾滋病依然存在許多誤解。因此，受感染人群不愿接受來自政府和非政府組織的幫助。”

In a sign of evolving social norms, Chinese social media cheered when Aids testing kits popped up at a handful of universities in Beijing and Chengdu. “The school is so concerned about gays,” one post said, while others complained that testing kits should also be available in women’s bathrooms.

當艾滋病試劑盒出現(xiàn)在北京和成都的幾所大學時，中國社交媒體曾拍手稱快，顯示出中國社會規(guī)范的進步。其中一個帖子表示：“學校對同志如此關懷。”而其他人則抱怨稱，女廁所也應該提供試劑盒。

But outreach to groups known to be at risk could bypass migrant workers or sexually active college students, populations that are unaware Aids is a risk.

不過，伸向已知高風險人群的援手，可能會忽略外來務工人員或性活躍的大學生，而他們正是沒有認識到艾滋病風險的人群。

Chinese government officials and society believe Aids is limited to gay men, drug users, prostitutes and pockets of people who contracted the disease from blood sales or transfusions. “A whole generation may know about Aids, they are aware, but they don’t think it has anything to do with them,” Dr Sozi said.

中國政府官員和中國社會都認為，艾滋病僅限于男同性戀者、吸毒者、妓女和通過賣血或輸血感染上這種疾病的人群。蘇凱琳博士表示：“整整一代人也許聽說過艾滋病，他們知道艾滋病，然而他們卻認為這和他們沒有任何關系。”

She points to the otherwise unusual rise of Aids among older people — a group that could reflect migrant workers who visited prostitutes far from home and the wives they returned to after a life on the road. Figures show 15 per cent of the new cases in 2015 were recorded among people over the age of 60.

她提到了較年長人群中艾滋病病例的異常增長——這一人群可能代表著因遠離家鄉(xiāng)而買春的外來務工人員以及他們在外漂泊后返鄉(xiāng)團聚的配偶。數(shù)據(jù)顯示，2015年新增病例中，15%的人年齡在60歲以上。

Chinese NGOs can apply for grants to do outreach to known at-risk groups, after Chinese premier Li Keqiang personally allocated money from the central government budget to fill a gap when international agencies stopped funding China programmes around 2013.

2013年左右，當多家國際機構停止為中國艾滋病項目提供資金時，中國總理李克強親自從中央政府預算中撥款填補空缺。在那之后，中國非政府組織可以申請資金，向已知的高風險人群施以援手。

Provincial governments are also relatively flexible in allocating Aids spending to cities and regions where it is known to be prevalent. Only six provinces account for about 60 per cent of China’s known HIV cases.

在向已知的艾滋病流行城市和地區(qū)分配防艾資金方面，各省政府也相對靈活。目前中國已知艾滋病病例中，大約60%集中在僅僅6個省份。

While Chinese data track individuals diagnosed with HIV, it does not record the secondary infections that kill most Aids patients. In Africa, that is often tuberculosis, a disease that is common among segments of Chinese society including coal miners that are not categorised as at-risk groups for Aids.

盡管中國的數(shù)據(jù)跟蹤被診斷帶有HIV病毒的人，該數(shù)據(jù)卻不會記錄導致多數(shù)艾滋病患者喪生的繼發(fā)性感染。在非洲，這種繼發(fā)性感染往往是肺結核，這是在中國社會一些群體中十分常見的疾病，包括不被歸為艾滋病高風險人群的煤礦工人。