中文摘要：

目的 了解云南省德宏州HIV感染者拒绝抗病毒治疗的比例及其影响因素.方法 对德宏州截止2013年12月31日拒绝抗病毒治疗、年龄≥16岁的所有存活HIV感染者进行调查.结果 德宏州存活的HIV感染者中拒绝抗病毒治疗的比例为7.4％（605/8 136）.拒绝治疗的605例患者以男性、年龄31～45岁、农民、已婚、少数民族、小学及以下文化程度、性传播、CD4＋T淋巴细胞计数＞350 cell/mm3为主,构成比分别为72.9％、57.2％、75.4％、52.2％、41.3％、58.7％、61.2％、66.6％.多因素logistic回归分析显示：在控制了潜在混杂因素影响后,感染者所在县（市）、性别、年龄、民族、CD4＋T淋巴细胞计数等特征与其拒绝抗病毒治疗有显著关联,盈江县、女性、年龄31 ～ 45岁的HIV感染者拒绝抗病毒治疗的比例显著低于瑞丽市、男性、年龄≤30岁感染者;而傣族、无CD4＋T淋巴细胞计数的HIV感染者拒绝抗病毒治疗比例则显著高于汉族、CD4＋T淋巴细胞计数≤350 cell/mm3的感染者.605例HIV感染者拒绝抗病毒治疗的原因：怕暴露84例（13.9％）、对抗病毒治疗认识有误区111例（18.3％）、自觉健康状况良好340例（56.2％）、其他70例（11.6％）.其中181例CD4＋T淋巴细胞计数≤350 cell/mm3的患者拒绝治疗的原因：怕暴露40例（22.1％）、对治疗认识有误区36例（19.9％）、自觉健康状况良好84例（46.4％）、其他21例（11.6％）;不同县（市）、不同性别、不同年龄、不同婚姻状态、不同感染途径者其拒绝抗病毒治疗的原因显著不同.结论 德宏州有一定比例的HIV感染者拒绝抗病毒治疗,应针对不同特征及不同原因拒绝治疗的HIV感染者进行针对性的健康教育,进一步提高抗病毒治疗覆盖率.

英文摘要：

Objective To examine the proportion and influencing factors on HIV-infected individuals who rejecting the antiretroviral therapy among all the HIV positives,in Dehong prefecture,Yunnan province.Methods A cross-sectional analysis was conducted on all the local HIV-infected survivals aged over 16 year old who refused to receive antiretroviral therapy （ART） by the end of 2013 in Dehong prefecture.Results The proportion of those rejecting the ART among HIV-infected survivals and aged over 16 years old in Dehong prefecture,was 7.4％ （605/8 136）.Factors related to the ‘rejection＇ among the 605 refusals would include：being male （72.9％）,aged 31-45 years （57.2％）,peasants （75.4％）,married （52.2％）,with minor ethnicity （41.3％）,illiterate or only having primary school education （58.7％）,infected through sexual contacts （61.2％）,and with CD4＋T cell counts ＞350 cells/mm3 （66.6％）.Data from the multiple logistic regression analysis indicated that rejecting the ART was significantly associated with areas,gender,age,ethnicity and CD4 ＋T cell counts of the HIV patients.Those who were from Yingjiang county,female,aged 31-45 years old had lower proportions of ART refusals than those who were from Ruili city,male,aged ≤30 year old.Those who were of Dai minority and had no records on CD4＋T cell counts,had higher proportions of ART refusals than those who were of Han ethnicity and had CD4 ＋ T cell counts ≤350 cells/mm3.Reasons for the 605 HIV-infected patients with rejection to the ART would include fear of disclosure of HIV infection status （84,13.9％）,misunderstandings of the effectiveness and side effects of ART （111,18.3％）,self-realized wellness （340,56.2％） and others （70,11.6％）.Of them,reasons for the 181 patients with CD4＋T cell counts ≤350 cells/mm3 that rejecting ART would include fearfulness on the disclosure of HIV infection status （40,22.1％）,misunderstandings of the effectiveness and side effects of ART （36,19.9％）,s