【摘要】 目的 了解成都市HIV/AIDS病例晚发现原因，为降低晚发现水平，促进病例早期发现提供科学依据。方法 采用横断面调查，对成都市9个区(市)县的HIV/AIDS病例进行问卷调查，收集其社会人口学资料、艾滋病知识知晓情况、医疗卫生服务利用情况、检测行为等信息，采用χ~2检验和二分类非条件logistic回归模型对晚发现影响因素进行分析。根据“信息饱和”原则确定样本量，对晚发现病例开展深入访谈。结果 共计调查757名HIV/AIDS病例，其中晚发现病例有258人(34.1%)。多因素logistic回归分析结果显示，相比于18～29岁年龄组，30～49岁(aOR=3.350,95%CI:1.725～6.506)和≥50岁(aOR=3.913,95%CI:1.876～8.161)年龄组晚发现风险更高；相比于怀疑自己有感染风险后主动检测发现者，被动检测发现者(aOR=2.002,95%CI:1.098～3.649)晚发现风险更高；相比于文化程度为初中及以下者，高中及以上者(aOR=0.472,95%CI:0.289～0.770)晚发现风险更低。258名晚发现感染者中，有218人(84.5%)在感染前从未有过去做HIV检测的想法，主要原因为没有听说过艾滋病(106人/48.6%)和觉得艾滋病离自己很遥远(82人/37.6%)。曾经有过去做HIV检测想法的40名晚发现感染者中，17人(42.5%)没有进行HIV检测,主要原因是担心隐私被暴露(12人/70.6%)、担心检测过程中他人的眼光(7人/41.2%)、担心检测阳性被歧视(7人/41.2%)。通过对16名晚发现感染者进行深入访谈，晚发现原因主要包括：从来没听说过艾滋病、对艾滋病认知存在严重误区、风险感知意识不足和存在侥幸心理。结论 为有效降低HIV/AIDS病例晚发现水平，应高质量推进艾滋病宣传教育，提升艾滋病知识知晓水平和发生高危行为后的风险感知能力，促进有过高风险行为的人群尽快主动进行HIV检测。还应构建支持性的社会环境，避免出现发生高危行为后因担心歧视而放弃主动检测。更多还原

【Abstract】 Objective To analyze the reasons of late HIV diagnosis in Chengdu, and to provide scientific basis for promoting early detection. Methods A cross-sectional survey was used, and the questionnaires were conducted among HIV/AIDS cases in 9 districts in Chengdu. The socio-demographic data, AIDS knowledge awareness, health seeking habits, testing behavior and other information were collected. The chi-square test and binary Logistic regression model were used to analyze the influencing factors. In-depth interviews were conducted, and the sample size was determined according to the principle of "information saturation". Results A total of 757 HIV/AIDS cases were investigated, of which 258(34.1%) were found late diagnosis. Multivariate Logistic regression analysis showed that the risk of late diagnosis was higher in age group 30-49 years old(aOR=3.350, 95%CI: 1.725-6.506) and ≥50 years old(aOR=3.913, 95%CI: 1.876-8.161) than 18-29 years old. Passive detection(aOR=2.002, 95%CI: 1.098-3.649) had a higher risk of late diagnosis than active detection. High school education or higher(aOR=0.472, 95%CI: 0.289-0.770) had a lower risk of late diagnosis than middle school education or lower. Among the 258 late diagnosis cases, 218(84.5%) never had the idea of HIV testing in the past, mainly because they had not heard of AIDS(106 cases/48.6%) and felt that AIDS was far away from them(82 cases/37.6%). Among the 40 cases who had ever considering taking an HIV test, 17(42.5%) did not take, mainly because they were worried about their privacy being exposed(12 cases/70.6%), worried about what others think during the test process(7 cases/41.2%), and worried about being discriminated against if they tested positive(7 cases/41.2%). In-depth interviews were conducted on 16 patients with late diagnosis. The reasons for late diagnosis mainly included: never heard of AIDS, serious misunderstanding of AIDS cognition, lack of risk perception awareness, and fluke mentality. Conclusion In order to effectively reduce the level of late HIV diagnosis, it is necessary to promote high-quality AIDS health education, improve the awareness of AIDS knowledge and risk perception after high risk behaviors, and encourage people with high risk behaviors to take the initiative to receive HIV testing as soon as possible. Building a supportive social environment to avoid giving up active testing for fear of discrimination is also essential.更多还原