【作者】 席胜军；

【导师】 杨廷忠；

【作者基本信息】 浙江大学 ， 社会医学与卫生事业管理， 2011， 硕士

【摘要】 背景：男男性行为人群,由于存在多性伴和无保护性肛交行为而成为感染艾滋病病毒的高危人群。1981年在美国报道的全球首例艾滋病病毒感染者和1989年我国报道的首例经性接触感染艾滋病病毒者均为男同性恋者。近年来,我国的艾滋病疫情出现新的特点,同性传播的比例呈快速上升趋势。2010年11月29日卫生部通报同性传播比例从2008年的5.9%上升到2009年的8.6%。在全国61个城市开展的男男性行为人群HIV大筛查显示,2008年HIV感染率为4.9%,2009年达到5.0%,西南片区感染率较高,贵阳、昆明、成都、重庆均超过10%。该人群由于同时存在异性性行为,起到了将艾滋病病毒传播给一般人群的桥梁作用,防治工作刻不容缓。杭州是浙江省会城市,男男性行为人群客观存在,且有固定的活动场所。因此,非常有必要开展宣传干预工作。目的：通过对本地男男性行为人群的调查,全面了解艾滋病防治知识、行为特征和HIV感染状况及其影响因素,为开展男男性行为人群艾滋病防治工作提供科学依据。方法：以年龄在18周岁及以上且近6个月内有同性肛交性行为的男性为研究对象。在志愿者的帮助下,于2009年6月～2010年6月,采用分类滚雪球法,招募在杭州主城区活动的各类型男男性行为人群,严格遵循“知情同意、保密”的原则,采用自行设计的健康调查问卷(MSM),调查基本人口学特征、艾滋病防治知识水平、行为特征和预防措施覆盖情况,并采集5ml静脉血,送下城区疾控中心艾滋病初筛实验室进行HIV、梅毒和HCV检测,掌握感染状况。采用Epidata3.02软件建立数据库,应用SPSS17.0统计分析软件采用单因素和多因素Logistic回归方法分析知识水平、咨询检测、性伴数、商业性行为、安全套使用率等因素对HIV感染状况的影响。结果：共有效调查530名男男性行为者,其中酒吧型占20.38%、浴池型占21.32%、公园型占4.90%、网络型占50.57%、其他型占2.83%；20～39岁占84.53%,流动人口占81.32%,文化程度大专及以上占33.77%,商业性服务占27.92%,同性恋占60.75%。艾滋病防治知识总知晓率为94.72%,其中传播途径等6个知识点的知晓率均在90%以上,而蚊虫叮咬不会传播的知晓率较低,为74.91%。在本市时间、文化程度和性取向的不同,以及是否发生过商业性行为或接受过咨询检测的男男性行为人群,艾滋病防治知识知晓率存在统计学差异。近6个月内,发生商业性行为占28.87%,有异性性行为占22.64%。发生同性肛交性行为时,最近一次安全套使用率为75.47%,近6个月每次安全套使用率为54.15%；不同人群类型、同性性行为类型和性伴性别不同,其安全套使用率存在统计学差异。有吸毒史占3.77%,有性病相关症状占7.74%。获得预防艾滋病措施中,宣传材料的比例最高,为75.85%。获得艾滋病防治知识信息的主要途径是互联网,占54.72%。HIV感染率为8.49%,梅毒感染率为11.89%,HIV和梅毒双重感染率为1.32%,HCV感染率为0.19%。HIV感染单因素和多因素Logistic回归分析显示,浴池型和网络型、近6个月性伴数≥10人是危险因素、每次发生同性性行为使用安全套是保护性因素,其中浴池型是酒吧型的6.599倍,网络型是酒吧型的3.422倍,性伴数≥10人是<10人的4.379倍,而每次使用安全套是从未使用或有时使用的0.403倍。结论：HIV已经在本地男男性行为人群中局部流行,需通过互联网、同伴教育和咨询检测等多种途径,加强对该人群的宣传干预力度,其中重点关注活动在浴室、网络和存在商业性行为的男男性行为人群。更多还原

【Abstract】 Background Due to multiple sex partners and unprotected anal intercourse, men who have sex with men(MSM) have a high risk to infect HIV. In the world, the first HIV infector who was reported in 1981 was gay in USA. The same situation happened in China in 1989. In recent years, China’s AIDS epidemic appears a several characteristics, and the rate of homosexual transmission presents a rapid rising trend. On November 29,2010, the Ministry of Health informed that ratio of male homosexual transmission raised from 5.9% in 2008 to 8.6% in 2009. In the 61 cities of China, the screening for HIV infection in MSM shows, the rate of HIV infection was 4.9% in 2008 and the figure reached 5.0% in 2009. There was a high rate of HIV infection in the southwest of China, which was over 10% in Guiyang, Kunming, Chengdu and Chongqing. The prevention does not permit of any delay because of heterosexual sex that may spread the HIV to other people. Hangzhou is the capital city of Zhejiang province. There is a certain number of MSM. Therefore, it is necessary to deveolp education and intervention to local MSM.Objective To investigate the prevention knowledge about AIDS, behavior characteristic and HIV infection situation of MSM, analyze the factors of HIV infection. Then, to provide scientific basis for AIDS prevention and control among MSM.Methods It is selected as sample that the man (older than 18 years old) had anal intercourse with another man in past 6 months. With the help of volunteers, we recruited various types of MSM in Hangzhou and used a snowball sampling method during June 2009 to June 2010. We strictly follow informed consent and privacy principle. Information regarding the basic Demographic characteristics, AIDS knowledge, behavior characteristics and coverage of preventive measures were surveyed through a self-design survey questionnaire.5ml venous blood was extracted which was send to the Xiacheng CDC HIV screening laboratory to detect HIV, syphilis and HCV infection. We had established a database using Epidata 3.02. Univariate and multivariate logistic regression analysis were done by SPSS 17.0 to analyze the association between HIV infection and knowledge, counseling, testing, number of sexual partners, commercial sex, using condom and other factorsResults 530 MSM participated effectively in the survey, in which 20.38% for bar type,21.32% for bathroom type,4.90% for park type,50.57% for network type and 2.83% for others. MSM ranged from 20 to 39 years old accounted for 84.53%.81.32% of MSM were floating population.33.77% received college or higher education. 27.92% took part in commercial sex services. Gay accounted for 60.75%.The average rate of awareness about AIDS prevention knowledge was 94.72%. Six points of them were over 90% including transmission, but the knowledge point that mosquito could not spread HIV, which was only 74.91%. The awareness of AIDS prevention knowledge was associated with time in this city, education, sexual orientation, commercial sex and accepting counseling and testing.In the past 6 months,28.87% of MSM existed commercial sex, and 22.64% reported having sex with a female. When having sex with male, the utilization of condom was 75.47% for the last one and 54.15% for last 6 months. Type of MSM, type of homosexual behavior and sex partner had relationship with condom using.3.77% of MSM had history of drugs addiction, and 7.74% had STD-related symptoms. The highest proportion was 75.85% for promotional materials among AIDS prevention measures. AIDS prevention knowledge mainly came from internet that accounted for 54.72%.8.49% of MSM were HIV-infected,11.89% were syphilis-infected,1.32% wereinfected with both and 0.19% were HCV-infected. Univariate and multivariate logistic regression analysis showed that bathroom type and network type, more than 10 sexual partners in past 6 months were risk factors for HIV infection. On the contrary, using condoms was a protective factor in every sex. Bathroom type was 6.599 times the bar type and network type was bar type 3.422 times. In addition, more than 10 sexual partners were 4.379 times more dangerous than less than 10 sexual partners. Each sex using condoms was 0.403 times compared to never or sometimes using.Conclusion HIV prevalence had existed in the local MSM. It should be done to strengthen the propaganda and intervention by Internet, peer education, counseli ng, testing and so on. Especially, in bathroom, Internet and existing commercial sex.更多还原