【作者】 王硕；

【导师】 吴尊友；

【作者基本信息】 中国疾病预防控制中心 ， 流行病与卫生统计学， 2010， 博士

【摘要】 [背景]男男性行为(men who have sex with men, MSM)人群中快速上升的艾滋病病毒(human immunodeficiency virus, HIV)感染与其多性伴、高频次的无保护性行为密切相关,而HIV阳性MSM被阳性告知之后,性行为的特征是否会有不同?了解已知自身感染状况HIV阳性MSM的性行为特征,可以更有针对性的制定行为干预和心理支持措施,减少二代传播,改善其生活质量。[目的]1比较已知和未知自身感染状况的HIV阳性MSM的性行为特征差异2描述分析HIV阳性MSM被阳性告知后不同时期的性行为特征[方法]1以北京市佑安医院为研究现场,以参加HIV阳性者CD4检测随访的MSM(已知自身感染状况的HIV阳性MSM)和参加HIV筛查检测的MSM(HIV阴性和未知自身感染状况的HIV阳性MSM)为研究对象,收集其社会人口学和性行为特征,描述比较已知和未知自身感染状况的HIV阳性MSM性行为特征的差异。2对上述HIV筛查检测出的HIV阴性者每两个月随访检测一次,共观察一年。以问卷调查和深入访谈结合的研究方法,描述队列中新发HIV感染者阳性告知后心理应激期的性行为特征；将阳性告知的时间距离调查0.5-1.5年和1.5年以上的HIV阳性MSM分别定义为心理恢复中期和长期,描述分析其性行为的特征和卫生服务支持环境。连续性变量的统计分析采用均数和标准差描述,分类资料使用率和比例来描述,采用卡方检验或Fisher精确概率法进行组间比较。[结果]本研究招募参加HIV检测者866人,其中790例为HIV阴性者,76例HIV阳性者为“未知自身感染状况的HIV阳性MSM”；对790例HIV阴性者随访一年,观察到25例HIV新发感染。招募参加CD4检测随访的HIV阳性MSM 122例(“已知自身感染状况的HIV阳性MSM”),其中,调查对象被阳性告知距离本次调查的时间(已知自身HIV感染时间)0.5-1.5年的HIV阳性MSM共计73例,大于1.5年的HIV阳性MSM共计49例。比较已知和未知自身感染状况的两组HIV阳性MSM,已知组小于25岁的调查对象比例低(9.8% vs.23.7%,p=0.004)；有大学以上教育程度者比例高(54.9%vs.35.5%,p=0.017)；有31.1%最近6个月没有性伴；已知组最近6个月有性伴者,偶然性伴和商业性伴的比例均低于未知组(p<0.05)。已知自身感染状况的HIV阳性MSM组最近6个月有男男主动肛交和男男被动肛交的比例均高于未知组。主动肛交、被动肛交和口交三种性行为的安全套使用比例,已知组均高于未知组。已知自身感染状况者的不安全性行为比例相比未知感染状况者已有显著减小,但仍不安全性行为广泛存在。已知感染时间>1.5年组的男男被动肛交比例低于已知感染时间0.5-1.5年组(78.3% vs.95.7%),男男主动肛交和口交未见统计学差异；男男主动肛交中的安全套使用,已知感染时间>1.5年组从不使用和每次都用的比例均高于已知感染时间0.5-1.5年组(p=0.023)；男男被动肛交中的安全套使用,已知感染时间>1.5年组从不使用比例均高于已知感染时间0.5-1.5年组,而每次都用的比例低于已知感染时间0.5-1.5年组(p=0.039)。[结论]已知自身感染状况的HIV阳性MSM相对于未知自身感染状况的HIV阳性MSM,不安全性行为的比例降低,但绝对比例仍然很高。需要加强MSM人群的HIV检测力度,并应建立一套连续性的机制来正确引导和稳固HIV阳性者心理支持和行为干预的成果。更多还原

【Abstract】 [BACKGROUND]Men who have sex with men (MSM) have emerged as a high risk group and prevalence of HIV-1 have been increasing lately in China.[OBJECTIVE]1 To investigate sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men2 To describe sexual characteristics and support environment of HIV-positive men who known their HIV status[METHOD]Cross-sectional investigation was conducted among MSM. Participants in this cross-sectional study were divided into three groups:"Known group", HIV-positive men with known HIV status and "Unknown group", HIV-positive men with unknown HIV status and HIV-negative men group. Questionnaire-based interviews were conducted to provide information on demographic characteristics and sexual behaviors. To analyze sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men and to describe sexual characteristics and support environment of HIV-positive men who known their HIV status which were divided into two groups:"Time of known their status 0.5-1.5 years group" and "Time of known their status more than 1.5 years group". [RUSULTS]Of 122 HIV-positive men who known their HIV status, about 50% sought sexual partners on line. About 40% percentage of known group had risk anal intercourse, more than 70% had risk oral intercourse.40% of known group concealed their HIV status to sex partners. Of 198 individuals from known group (122 individuals) and unknown group (76 individuals), known group had significantly higher education and fewer partners than unknown group (P=0.017 and P<0.001). The known group had fewer casual partners (48.8% vs.65.3%,P=0.036) than the unknown group among individuals who had sex partners in the last 6 months. The known group was more likely to engage in insertive and receptive anal intercourse than the unknown group. The known group was more likely to use condoms than the unknown group regardless anal sex or oral sex with men.Percentage of receptive anal intercourse of more than 1.5 years group was lower than 0.5-1.5 years group (78.3% vs.95.7%). Percentage of insertive anal intercourse of more than 1.5 years group who never use condom and everytime use condom was higher than 0.5-1.5 years group (p=0.023). Percentage of receptive anal intercourse of more than 1.5 years group who never use condom was higher than 0.5-1.5 years group (p=0.039).[CONCLUSION]HIV-positive men who know their HIV status are more likely to practice safer sex than HIV-positive men who are unaware of their HIV status; however, high percentage of sexual risk behavior still exists among them. It is important to strengthen behavioral interventions among HIV-positive MSM.更多还原