海南省艾滋病流行形势 与防治对策

1. 海南省艾滋病流行形势与防治对策 HIV/AIDS Epidemic, Control and Prevention Measures in Hainan Province Hainan Center for Disease Control and Prevention 2011年10月

2. : KEY TOPICS 主要内容 • 海南省基本情况 • 海南省艾滋病流行形势与特点 • 海南省艾滋病防治对策与措施 • 我省今后5年艾防规划 Basic overview of Hainan Transmission and characteristics of HIV/AIDS in Hainan Provincial HIV/AIDS control/ prevention tactics and policies Hainan’s 5-year HIV/AIDS plan

3. 春牛春杖， 无限春风来海上。 便丐春工， 染得桃红似肉红。 春幡春胜， 一阵春风吹酒醒。 不似天涯， 卷起杨花似雪花。 —苏轼

4. 海 南 概 况: Overview of Hainan 海南省位于中国最南端，北以琼州海峡与广东省划界，西临北部湾与越南民主共和国相对，东濒南海与宝岛台湾相望，东南和南边在南海中与菲律宾、文莱和马来西亚为邻。 海南省行政区域包括海南岛和西沙群岛、中沙群岛、南沙群岛的岛礁及其海域。 Hainan is China’s Southernmost province. The Qiongzhou straight marks to border of Guangdong province to the North. To the west is Vietnam, Taiwan is to the Northeast, and The Philippines and Malaysia to the south. Hainan administrative areas include Hainan and surrounding sea, Xisha, Dongsha and Nansha islands.

5. Overview of Hainan 海南全省陆地总面积3.54万平方公里，海域面积200多万平方公里，是中国陆地面积最小，海洋面积最大的省。海南岛四周低平，中间高耸，以五指山、鹦歌岭为隆起核心，向外围逐级下降。山地、丘陵、台地、平原构成环形层状地貌，梯级结构明显.2008年末全省常住人口为864.7300万人，少数民族约140多万人。汉族、黎族、苗族、回族是世居民族。前海南乡亲及其后裔遍布五大洲，据估计应有500多万人。侨乡文昌海外人口比岛内还多。 Hainan has an area of 35.4 thousand square kilometers, and 2 million sq km of maritime waters. It is the province with the least land are and most maritime area in all of China. The center of the island is mountainous, and slopes down towards the coast in cascading ring-like plateau formations. In 2008 Hainan had a resident population of over 8.5 million people, of which ethnic minorities are nearly 1.5 million. Han, Li, Hui, Miao are all ethnic minorities native to Hainan. People from Hainan, and descendents from Hainan, are spread across 5 continents and likely total nearly 5 million worldwide. There are now more people from Wenchang living abroad than in Hainan.

6. 海 南 概 况: Overview of Hainan 海南省行政建制始于秦始皇时期（公元前214年），大致经历了始置、罢弃、遥领、重建的过程。早期的海南岛一直从属于现在的广东省 。 A centralized Hainan administration began during the Qin Huashi period of rule, (around 214 BC). The province has experienced uprisings, abandonment, remote rule and reconstruction. Early Hainan Island was governed as part of Guangdong province.

7. 海 南 概 况: Overview of Hainan 海南岛地处热带，与夏威夷纬度相近，长夏无冬。岛上终年气候宜人，四季鸟语花香。海洋、矿物、动植物资源丰富，尤其石油与天然气蕴藏量可观，洋浦开发区为中国南方最大的近海石油天然气加工、储存和出口基地。海南所孕育的热带雨林和红树林为中国少有的森林类型，海南丰富的生物在中国占有十分显著的地位，是开展科研、旅游和教学最理想的选择之地。 Hainan has a tropical climate, and due to its latitude, has long summers and no winter. Hainan has abundant animal, marine, plant and mineral resources. It also has considerable reserves of natural gas and oil. The Yangpu development zone is southern China’s largest offshore oil and gas processing, storage and export base. Hainan’s tropical rain and mangrove forests are rare in china. The rich ecology is of special importance to the nation, and creates an ideal environment for traveling and teaching.

8. 一、海南省基本情况: Overview of Hainan 1. Hainan was established as a province in 1988, and is China’s southernmost province. Guangdong and Guangxi are to the north, to the south are Malaysia, Singapore, and Wencai, to the east Philippines and the west Vietnam. Hainan is an important port for South and Southeast Asia, Africa, Europe, and many other regions. 2. Hainan has a population of 8,650,000, and 354,000 sq km of land. It has 2 prefecture-level cities, and 10 counties. Hainan is China’s largest free economic zone. It is also the origin of many overseas Chinese, with over 1300000 Hainanese people spread over 60 countries throughout the world. 400000 of those people are in Hong Kong, Thailand, and other Southeast Asian countries. 3. The provincial capital is Haikou, located on the Qiongzhou straight in northern Hainan. Haikou is Hainan’s cultural, political and social center. Haikou has experienced rapid population growth since Hainan's establishment, with over 1,800,000 current residents. 1、海南省是一个1988年新建立的省份，位于我国的最南端，北与广东、广西相连，南与马来西亚、印度尼西亚、文莱、新加坡，东与菲律宾、西与越南隔海相望。既是中国的南疆，又是中国与东南亚、南亚、大洋州、非洲、欧洲等许多国家交往的海上交通要冲。 2、海南省人口865万，陆地面积3.54万平方公里。设2个地级市、6个县级市、10个县。是我国最大的经济特区，也是我国著名的侨乡，累计有130万华侨分布在全球60多个国家和地区，其中在新、港、马、泰等东南亚分布着40多万。 3、省会设在海口，位于海南岛北部的琼州海峡，是海南省的政治、经济和文化中心。海口在建省后，人口迅速增长，迄今，已发展成为180万人口的中等城市。

9. 一、海南省基本情况: Overview of Hainan 行政区划：至1999年底，全省有2个地级市、6个县级市、4个县、6个民族自治县、5个市辖区，1个办事处（西南中沙群岛办事处、县级）和洋浦经济开发区管理局。 ＊行政管理体系：小政府大社会。省直接管理县。 Administrative Divisions: Through the end of 1999, Hainan had 2 prefecture level cities, 6 county-level cities and 4 counties, 6 ethnic minority autonomous zones, and 5 municipal districts, Dongsha Islands Office, and the administration of Yangpu Economic Development Zone. ＊AdministrativeSystems:Small government, big society. Directprovincial management of counties.

10. 海口世纪大桥远景 : View of Haikou Century Bridge

11. 海口市区远景图: View of Haikou City

12. 一、海南省基本情况: Overview of Hainan 4. Hainan is a travel destination, attracting more than 20 million Chinese tourists each year. The tourist industry and related development have become the foundation of Hainan’s economy. 5. Sanya is the 2nd largest city in Hainan, with a population of 260, 000, and migrant population of 200, 000. Annual tourists to Sanya total more than 10,000,000. High population mobility (including migrant populations and tourists) have fueled public health problems, including the spread of HIV/STIs. 4、海南省作为一个旅游大省，近年来每年进出我省的国内外游客超过2000万人次，旅游业的发展促进了相关的服务行业的发展，成了我省的一项重要经济支柱。 5、三亚市是海南省第2大城市，市区人口26万，流动人口20 万人，每年到三亚旅游的人数超过1000万。随着人口的流动，也带来了一些公共卫生的问题，其中包括性病和艾滋病的流行问题。

13. 三亚市区远景图: View of Sanya City

14. 三亚市鹿回头山顶公园: Luhuitou Mountain Park

15. 一、海南省基本情况: Overview of Hainan 6、琼海市位于海南岛东部，人口44万人，闻名遐尔的万泉河从琼海市境内流入大海。琼海市博鳌镇是“亚洲论坛”永久会址所在地，论坛每年定期在博鳌召开年会。据统计，自2000年以来，各种会议及“黄金周”期间，接待游客、与会人员约520万人次，平均每年有170万人次，会议及“黄金周”期间，各宾馆、酒店住房率达90%以上，比平时提高30%。 6. Qionghai is located in Eastern Hainan, has a population of 440,000, and is famous fro the Wanquan River that flows through the city into the sea. Bo Ao, near Qionghai, is “Asia’s Forum”, where many international meetings and conferences are held annually. The annual ‘golden week’, during which many conferences are held, has attracted over 5,200,000 visiting attendees and tourists, with an annual average of more than 1,700,000 attendees. During the conference season, hotels and guesthouses operate at more than 90% occupancy, more than 30% increase over the remainder of the year.

17. 博鳌亚洲论坛成立会址景区景观:View of Scenic Boao Asia Forum

18. 博鳌水城: Boao

19. 一、海南省基本情况: Overview of Hainan Danzhou city, located in northwest Hainan, is 3265 sq meters, the area with most land and largest population in Hainan (98000 people). It is the economic, cultural, transportation and communications center of Western Hainan. Yangpu development zone is Hainan’s key economic development zone, with production of petrochemical pulp, paper manufacturing and other industrial projects. 儋州市位于海南岛西北部，面积3265平方公里，有98万人口，是海南省土地面积最大、人口最多的市县，也是海南西部的经济、交通、通信和文化中心，洋浦经济开发区位于该市境内。 洋浦经济开发区是海南开发建设的“重中之重”。洋 浦发展以重化工业为重点，主要建设石油化工和浆纸制造 等工业项目。 2007年，这个开发区以不到全省千分之一 的土地，创造出占全省４０％以上的工业产值，进出口占 ６０％，提供全省国税的一半。

20. 洋浦经济开发区: Yangpu Economic Development Zone

23. 二、海南省艾滋病流行形势分析Analysis of Hainan’s AIDS Epidemic HIV/AIDS prevalence and transmission rates Hainan’s first AIDS case was reported in 1991. As of June 30, 2011, a total of 1080 HIV/AIDS cases had been reported in Hainan, of which 307 were living with AIDS and 346 had already died. According to 2009 national AIDS epidemic calculations, there were an estimated 2500 cases among Hainan residents aged 15-49, a prevalence of .03% • 1、流行强度流行率： • 1991年我省发现首例艾滋病病毒感染者。 • 截止2011年6月30日，全省累计报告 • HIV/AIDS1080例，其中 • AIDS 307例， • 死亡 346例。 • 2009年按国家艾滋病疫情方法估计，我省估计15-49岁年龄组感染人数有2500人。流行率约为2.89/万。

24. 二、海南省艾滋病流行形势分析Hainan’s AIDS Epidemic: Analysis and Trends 近两年我省HIV/AIDS疫情报告数在全国排序位于第25位，占全国报告数的0.22%。 按照总人口患病率比较，我省排序位于第15位，处于中等水平。 Of all China’s provinces, Hainan ranks 25th for HIV/AIDS cases, accounting for .22% of the nation’s total infections. HIV/AIDS cases in proportion to the population rank Hainan the 15th province in HIV/AIDS prevalence.

25. 2、流行的时间分布: Epidemic Phases 我省已经完成了原始的传染源输入和传染源积蓄两个历史阶段，现在开始进入增长阶段。 Hainan has completed the introduction and spreading phases of the epidemic, and has already entered the expansion phase.

26. （2）海南省艾滋病流行的三个时期: 3 Phases of the AIDS Epidemic in Hainan • 三个流行时期：3 Epidemic Phases • 1991—1993年为传入期。这期间感染的主要原因是经境外传入，共发现11例感染者。均是经境外感染后返回国内时监测被发现的。 * Phase 1:1991 to 1993. Initial introduction of the disease. During this phase, 11 total cases were discovered. Carriers not local to Hainan were returned to their province of origin for treatment. • 1994—2001年为散发期，这期间主要是外省传入的有偿供血感染者明显增加，境内由性接触传播也跟着增长，感染的原因由境外感染为主转为以境内感染为主。 * Phase 2:1994 to 2001. Spreading phase. During this phase the epidemic was fueled by migration of carriers to Hainan, who had been infected while selling plasma. There was an increase in sexual transmissions during this time, and establishment the disease among local populations. • 2002年—至今为增长期，这期间由于吸毒人群中共用注射器而引起局部地区的吸毒人群中流行。 * Phase 3: 2002- present. Expansion phase. An increase in rates of new infections amongst IV drug users sharing syringes.

27. Annual June Complitation of Hainan’s HIV/AIDS Cases Phases: 1991-94年 传入期 Introduction 1995-2001年 散发期 Spreading 2002-Present Expansion

28. 海南省艾滋病地区分布与时间变化的关系 Hainan Geographical Distribution of HIV/AIDS: Changes Over Time Hainan HIV/AIDS epidemic geographical distribution 1991 1995 海口市 海口市 0 0 1-10 1-10 11-50 11-50 51-100 51-100 101-200 101-200

29. 海南省艾滋病地区分布与时间变化的关系 Hainan Geographical Distribution of HIV/AIDS: Changes Over Time Hainan HIV/AIDS epidemic geographical distribution 2000 2005 海口市 海口市 0 0 1-10 1-10 11-50 11-50 51-100 51-100 101-200 101-200

30. 海南省艾滋病地区分布与时间变化的关系 Hainan Geographical Distribution of HIV/AIDS: Changes Over Time Hainan AIDS epidemic geographical distribution: 2010 海口市 0 1-10 11-50 51-100 101-200

31. 海南省艾滋病地区分布情况: Geographical Distribution of AIDS in Hainan 4、我省累计报告病例数居前五位的市县依次为： 三亚184例、儋州177例、海口125例、乐东117例和东方109例。（按现住址统计） 4. The 5 cities and counties with the most reported cases of HIV/AIDS in Hainan are: Sanya, 184; Danzhou, 177; Haikou, 125; Ledong 117; Dongfang, 109.

32. 海南省艾滋病地区分布情况Geographical Distribution of HIV/AIDS in Hainan Geographical distribution of HIV/AIDS in Hainan by city # of HIV/AIDS cases

33. 海南省艾滋病性别分布情况: Age & Gender Distribution of HIV/AIDS in Hainan Age Distribution of Hainan’s 1080 HIV/AIDS Cases 80 & older F M 14 & younger

34. 全省1080例HIV/AIDS感染途径构成比: Modes of transmission of Hainan’s 1080 HIV/AIDS Cases Injection drug use Heterosexual sex Homosexual sex Blood transfusion/medical Mother to child Other/unknown

35. 全省各年度HIV感染途径构成比分析: Analysis of HIV transmission modes by year Unknown Mother-Infant transmission Blood transfusion/ use of infected injection tools Homosexual transmission Heterosexual transmission Injection Drug use

36. 我省不同年份MSM人群HIV感染趋势变化情况: Yearly trends and changes in infection rates among MSM Year/TimeInfection Rate (%) • 2008 1.75 • 20091.97 • 20103.23 • June 2011 6.19

37. 各市县HIV感染途径分析Modes of HIV Transmission by Cities and Regions Unknown Mother-Infant Blood transfusion/ medical Homosexual transmission Heterosexual transmission Injection Drug use

38. 海南省艾滋病流行特征: Characteristics of HIV Transmission in Hainan • 1. The primary mode of HIV transmissions in Hainan has evolved from injection drug use and sharing of contaminated syringes, to sexual transmission. In the past 2 years, new sexually transmitted cases have exceeded new IDU related infections. • 2. Compared with the rest of the nation, Hainan still has low HIV/AIDS prevalence. However, rates of new infections are increasing. There are significant regional differences in HIV/AIDS distribution throughout the province. • 3. Rates of infection through homosexual transmission are increasing, and with continued growth could become a primary means of infection in Hainan, requiring special focus and attention. • 1、从HIV传播途径来看，我省已经从“以共用注射器吸毒传播为主的模式”，发展为“以性接触传播和共用注射器吸毒传播并重的模式”，近两年经性接触传播构成比已超过经注射吸毒传播所占比例。 • 2、从地区分布来看，就全国范围比较，海南省属低发地区，但HIV感染者和病人的数量呈逐年上升趋势；从本省各市县来看，艾滋病疫情分布地区差异较大。 • 3、男男性接触呈现较快增长态势；可能成为我省下一波艾滋病流行的主要因素，必须引起高度重视。

39. 三、海南省艾滋病防治对策与措施 1、建立健全监测检测体系 • （1）在全省设立艾滋病监测哨点，2010年我省共设了19个艾滋病丙肝监测哨点，开展对吸毒人群、暗娼人群、男男性行为人群、性病门诊男性就诊者、流动人口、孕产妇、青年学生、无偿献血人群等8类人群的监测。 • （2）以县为单位，每年搜索各类高危人群（女性性服务者、吸毒者、男男性行为者、性病门诊就诊者）样本进行血清学HIV抗体检测。 • （3），包括HIV阳性者性伴追踪、自愿咨询检测、孕产妇检测、术前检测、无偿献血人群检测等数据，全面分析各类人群HIV感染动态。 • （4）加强对公安司法监管场所羁押人员开展HIV抗体常规筛查，让感染者浮出水面，以便加强管理，减少二代传播的发生。 Establish Improved Surveillance and Testing Systems In 2010 Hainan had 19 surveillance centers to test for AIDS and hepatitis C among female sex workers, MSM, male STD clinic patients, migrant populations, pregnant women, young students, unpaid blood donors, etc in 8 categories of population monitoring. • Collect samples for HIV testing among high-risk populations (female sex workers, drug users, MSM, STD clinic patients). Collect and comprehensively review HIV testing results compiled by all various testing agencies. • Conduct comprehensive analysis of dynamics of HIV infections among all populations including pregnant women, unpaid blood donors, partners of HIV-positive patients. • Increase testing among imprisoned and detained populations, and improve care of any skin wounds among them, to reduce risks of secondary transmissions.

40. 三、海南省艾滋病防治对策与措施Hainan’s AIDS Prevention and Intervention Measures 2. Improving interventions for high-risk populations • 1. Sex workers: outreach intervention, partner education, condom vending machines and free condom distribution networks, women’s health centers, distribution of health information and condoms. • 2. Clients of sex workers: in all hotels, motels, saunas, massage parlors (any entertainment venues where sex service is provided) instate measures for promoting 100% condom use. Educate about, and prevent risks of infection through sexual promiscuity. In STI clinics provide‘4 Cs’ of service and care. • 3. Men who have sex with men (MSM): support grassroots organizing, partner education and volunteer outreach. • 4. Drug using populations: Establish methadone treatment clinics in regions with serious drug abuse problems. Hainan already has 29 methadone clinics which treat 2600 people, about 25% of IV drug users. Increase promotion of safe needle exchange, expand beyond 20 existing needle exchange centers, which current reach 12% of Hainan’s IV drug users. • 5. Encourage all departments and agencies to carry out HIV/AIDS education and prevention, including construction sites, women’s organizations, schools, etc. 2、开展对高危人群的行为干预 • （1）针对失足妇女的干预：外展干预、同伴教育、安全套自动销售机和免费发放网络、妇女健康中心、发放宣传材料和安全套 • （2）针对嫖客人群的干预：在全省的宾馆、旅馆以及桑拿、按摩等可能有提供性服务的公共娱乐场所推行100%使用安全套干预措施。预防艾滋病通过性乱行为传播。在性病门诊提供“4个C”的服务。 • （3）针对男男性行为人群：草根组织、同伴教育、志愿者外展 • （4）针对吸毒人群： • 在吸毒严重的地区设立美沙酮维持治疗门诊，全省共设立29家美沙酮门诊。覆盖2600人，约占静脉注射吸毒人群的25%。 • 在吸毒人群当中推行清洁针具交换措施，全省共建立了20个针具交换点，覆盖约12%的吸毒人群。 • 收戒措施：约占吸毒者的40%。 • （5）鼓励各部门、各机构开展艾滋病防控工作：妇联组织、建设工地、大中学校等。

41. 省预防医学会指导外展干预: Hainan’s medical and prevention teams leading outreach intervention

42. 培训社会小组外展活动能力Social Outreach Skills Building and Training Activities

43. 社区关怀小组培训活动Community Care Group Training Activities 把我们的心连成海，做相亲相爱的一家人 Connect our hearts, love and care for each other like a family

44. 三亚市外展人员到公园开展外展干预: Sanya city outreach staff conducting intervention in a park

45. 烛光纪念Candlelight Commemoration

46. 三、海南省艾滋病防治对策与措施 3、开展免费自愿咨询检测服务 设立自愿咨询检测服务点，在全省县以上的疾病预防控制中心、皮肤性病防治所、妇幼保健院、以及综合性医院建立艾滋病抗体筛查实验室，并依托实验室开展免费艾滋病自愿咨询检测服务。 Implementation of free voluntary testing and counseling services At all of Hainan’s county level (and above) CDC stations, skin and STI clinics, and hospitals should establish AIDS antibody screening labs, along with free voluntary testing and counseling services.

47. 三、海南省艾滋病防治对策与措施 4、加强艾滋病感染者/病人的随访管理 对新报告的艾滋病病毒感染者/病人开展流调，加强随访管理，对感染者/病人进行宣传教育和提供随访关怀服务，以控制二代传播的发生及艾滋病的流行蔓延。随访频次为感染者每6个月随访一次、病人每3个月随访一次。 Improve care and services for HIV/AIDS carriers Improve epidemiological surveillance and follow up care for newly reported HIV/AIDS patients. Improve education and resources for continued comprehensive follow-up care for patients, be proactive in curbing the spread of Hainan’s second generation HIV/AIDS epidemic. Follow up with patients infected with HIV every 6 months, with AIDS patients every 3 months.

48. 三、海南省艾滋病防治对策与措施 5、开展抗病毒药物治疗、落实国家“四免一关怀”政策。 符合治疗条件 （1）临床诊断为艾滋病病人——出现临床症状。 （2）HIV抗体呈阳性，同时CD4细胞计数检测小于350/ul。 抗病毒药物治疗时应注意： （1）服药的依从性。 （2）耐药性监测。 Expand antiretroviral therapy, and implement China’s “4 Frees, One Care” policy. Comply with treatment stipulations 1. Clinical diagnosis of AIDS patients and symptoms. 2. HIV antibody testing, CD4 count detection at less than 350/ul. Careful consideration of proper antiviral therapy: 1. Adherence to medication 2. Surveillance of antimicrobial resistance

49. 全省417例CD4小于350的HIVAIDS病人地区分布情况Geographical distribution of HIV/AIDS Cases with CD4 count less than 350 HIV cases, CD4 count less than 350 AIDS

50. 累计接受免费抗病毒治疗病人地区分布Geographical distribution of patients receiving free ARV treatment Free ARV Treatment