上海和成都市HIV阳性MSM人群性传播危险行为及其影响因素

何欢; 张洪波; 丁凡; 林小杰; 周易; 肖剑; 陈芳; 黄文; 董燕燕; 杨巧红

Abstract

何欢,张洪波,丁凡,林小杰,周易,肖剑,陈芳,黄文,董燕燕,杨巧红.上海和成都市HIV阳性MSM人群性传播危险行为及其影响因素[J].Chinese journal of Epidemiology,2015,36(3):254-258

上海和成都市HIV阳性MSM人群性传播危险行为及其影响因素

Risky sexual transmission behavior and its influencing factors among HIV-positive MSM population in Shanghai and Chengdu in China

Received:August 06, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.03.014

KeyWord: 男男性行为者人类免疫缺陷病毒性传播行为性伴告知

English Key Word: Men who have sex with men Human immunodeficiency virus Sexual transmission behaviors Sexual partners disclosure

FundProject:中国全球基金艾滋病项目(CSO-2012-研26)

Author Name	Affiliation	E-mail
He Huan	Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
Zhang Hongbo	Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China	zhhongbo62@163.com
Ding Fan	Chengdu Tongle Health Consulting Service Center
Lin Xiaojie	Chengdu Tongle Health Consulting Service Center
Zhou Yi	Shanghai Beautiful Life Health Promotion Center
Xiao Jian	Shanghai Love Home Support Group
Chen Fang	Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
Huang Wen	Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
Dong Yanyan	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University
Yang Qiaohong	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University

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Abstract:

目的了解有无保护性行为HIV阳性的MSM人群性传播行为状况,及与健康状况和性伴告知的关系。方法在成都和上海市HIV感染者中,采用滚雪球方法共招募308名HIV阳性且有无保护性行为的MSM为调查对象,调查内容包括被确认HIV感染时间、CD₄⁺T淋巴细胞数、病毒载量、抗病毒治疗状况、焦虑和抑郁症状、最近6个月性伴种类和性行为、固定性伴和偶然性伴告知状况等。采用单因素和多因素方法分析性传播行为状况及其影响因素。结果 308名调查对象中,最近6个月至少有一次性传播行为的报告率为70.1%(216/308);确认HIV感染后拥有男性固定性伴、男性偶然或商业性伴的比例分别为89.0%(274/308)和68.2%(210/308),其中未告知固定性伴、未告知偶然或商业性伴的比例分别为59.1%(162/274)和94.3%(198/210)。未告知固定性伴者中,91.9%(149/162)有性传播行为,未告知偶然或商业性伴者中相应的比例为89.9%(178/198)。多因素分析显示,非同性性取向者拥有性传播行为的危险约是同性性取向者的6倍(aOR=5.896,95%CI:1.808～19.232);未将自己的HIV感染状况告知、或仅部分告知男性偶然性伴或商业性伴者,其继续传播行为的危险分别是告知性伴者的29倍和19倍(均未告知者:aOR=28.957,95%CI:7.511～65.004;部分告知者:aOR=18.956,95%CI:6.995～57.417);确认感染HIV时间为<6个月者其继续传播行为的危险性最高,1～2年者发生性传播行为的危险性最低(aOR=0.048,95%CI:0.033～0.788),≥2年者发生性传播行为的危险性有所升高;与未接受抗病毒治疗者相比,接受抗病毒治疗者发生性传播行为的危险性降低。结论 HIV阳性且有无保护性行为的MSM人群拥有性传播行为比例超过2/3,增加抗病毒治疗和促进性伴告知是降低HIV阳性的MSM人群继续传播的重要策略,确认HIV感染时间<6个月者是性传播行为干预的重点对象。

English Abstract:

Objective To investigate the sexual transmission behaviors among HIV-positive MSM population engaging in unprotected sexual behaviors,as well as the relationship with health conditions and partner notification. Methods A total of 308 HIV-positive MSM participants engaged in unprotected sexual behaviors were recruited by “snowballing” sampling in Shanghai and Chengdu. The questionnaire covered such items as the time of HIV infection diagnosis,CD₄⁺ T cells count,viral load,antiviral therapy,anxiety and depressive symptoms,sexual partner types and sexual behaviors in the past six months,disclosure to fixed sexual partners and casual sexual partners among others. Results Of the 308 participants surveyed,the report rate of those having at least one-time sexual transmission behaviors during the past 6 months was 70.1%(216/308). Participants who had primary sexual partners and casual sexual partners following their HIV infection diagnosis accounted for 89.0%(274/308) and 68.2%(210/308) respectively. Of the aforementioned participants,59.1%(162/274) and 94.3%(198/210) respectively had not disclosed their HIV infection to primary and casual sexual partners. Of thoes who did not disclose their HIV infection to primary sexual partners,91.9%(147/162) reported sexual transmission behaviors. Of thoes who did not disclose their HIV infection to casual sexual partners,89.9%(178/198) continue sexual transmission. As found in a multi-factor analysis,the infection risk exposure of those with heterosexual sexual orientation and engagement in sexual transmission behaviors was six times higher than those with homosexual orientation (aOR=5.896,95%CI:1.808-19.232). For those who did not,or partially disclose their HIV infection to male casual sexual partners or commercial sexual partners,the risk exposure of further transmission was 29 times and 19 times higher than those disclose it to their sexual partners(no disclosure:aOR=28.957,95%CI:7.511-65.004;partial disclosure:aOR=18.956,95%CI:6.995-57.417). The highest risk came from those who continue their sexual transmission behavior within six months of their HIV infection diagnosis; the lowest risk came from those continue such behavior more than one year and within two years of their diagnosis(aOR=0.048,95%CI:0.033-0.788);such risk rose to some extent for those continue such behavior over two years of their diagnosis. Compared to those without antiviral therapy,participants with the therapy pose less risk in sexual transmission behaviors. Conclusion More than two-thirds of HIV-positive MSM population who engage in unprotected sexual behaviors reported sexual transmission behaviors. In this regard,increasing antiviral therapy and promoting sexual partner disclosure constituted an effective strategy to minimize further transmission among HIV-positive MSM population. Intervention of sexual transmission behaviors should be addressed to those diagnosed of HIV infection within six months.

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