【作者】 李雪华；

【导师】 聂绍发；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2009， 硕士

【摘要】 目的1.描述武汉市男男性行为人群(MSM)性病/艾滋病相关的知识与行为状况;2.掌握武汉市男男性行为人群艾滋病、梅毒及丙肝的感染状况;3.了解同伴推动抽样法在隐匿人群中应用的可行性及优缺点。方法1.通过回顾文献、关键知情人访谈等定性研究方法了解目标人群的有关情况,包括男男性行为人群社区网络的构成和规模、人群的可及性、不同类型种子确认等。2.应用同伴推动抽样法收集样本。采用国家统一编制的问卷对符合要求的对象进行一对一调查,并抽取5ml静脉血检测艾滋病病毒抗体、梅毒抗体及丙肝抗体。3.用RDSAT软件进行数据分析,对样本进行平衡性评价,然后对总体大小及构成进行点估计和区间估计。率的比较采用logistic回归。结果1.武汉市MSM对艾滋病防治知识有一定了解。估计总体中77.7%(70.3%～82.1%)近六个月与男性发生过肛交性行为,其中只有45.2%(36.4%～50.2%)每次都使用安全套。总体中最近六个月有买性和卖性行为的比例分别为4.5%(3.4%～7.6%)、12.6%(7.5%～16.2%),而近六个月与女性发生过性关系的比例为22.6%(18.0%～27.3%)。2. 456名MSM接受了血清学检测后发现HIV阳性感染者22人,梅毒确证阳性98人,丙肝初筛阳性11人。估计总体中HIV阳性率为6.5%(3.3%～9.7%),梅毒阳性率21.9%(16.9%～26.9%),丙肝初筛阳性率2.4%(0.6%～4.2%)。3.经过征募,样本的基本特征分别在5到8层达到平衡,计算各个特征实际样本构成和理论平衡样本构成之间的平均绝对差异,各组的平均绝对差异均小于2%。结论1.武汉市MSM出现知识与行为分离。他们中有相当比例与两性均有性行为,同时不安全性行为普遍存在。提示既往的干预工作粗浅,没能从根本上增强MSM的防艾意识。2.武汉市MSM的HIV和梅毒感染水平较高,将其传播到一般群体中的可能性大。提示这一群体应作为今后防治艾滋病工作的重点人群之一。3.RDS方法能够由少数种子开始成功地招募到一个人口学特征多样化的样本,并且只需要少数几轮招募就能达到样本平衡分布。但是它也有招募过程耗时长、调查人员工作量大等缺点,并且无法对样本的有效性进行直接评估。更多还原

【Abstract】 Objective1. To describe the knowledge and behavior related to sexually transmitted diseases/AIDS of men who have sex with men (MSM) in Wuhan city.2. To grip infected condition about HIV, syphilis and HCV in Wuhan MSM.3. To find out the feasibility, advantages and disadvantages of respondent driven sampling (RDS) when the method is applied in hidden populations.Method1. We have some qualitative investigations such as reviewing literature and talking to key men who know the inside story in order to understand related conditions of target population, including the composing and seize of MSM social network, their accessibility and confirmation of different seeds.2. We collect samples by RDS and have a face-to-face questionnaire survey to men who are accordant with demands, then draw 5 ml blood to detective HIV, syphilis and HCV antibody.3. RDSAT software is used to analyze data. It will evaluate the balance of sample, and have point and interval estimation to population composing and seize. Logistic Regression is used to compare ratios.Result1. MSM in Wuhan city know AIDS prevention and cure knowledge to some extent. We evaluate that 77.7%(70.3%～82.1%) MSM in population had anal sex in the latest 6 months, and only 45.2%(36.4%～50.2%) among them used condom every sexual behavior. The proportion of buying and selling sex in the latest 6 months is 4.5%(3.4%～7.6%), 12.6%(7.5%～16.2%) respectively. 22.6%(18.0%～27.3%) MSM had sex with at least one girl in the latest 6 months.2. Of all 456 MSM who detected blood, 22 are HIV positive. 98 are syphilis positive and 11 are HCV positive. It is estimated that positive rate of HIV, syphilis and HCV in population is 6.5%(3.3%～9.7%), 21.9%(16.9%～26.9%), 2.4%(0.6%～4.2%), respectively.3. After recruitment, sample’s basic characteristics get a balance between 5 and 8 waves. Calculate the mean absolute difference between actual sample composing and theoretical balancing composing. It turns out that the mean absolute differences of all characteristic groups are less than 2%.Conclusion1. MSM in Wuhan city have a separation of knowledge and behavior. Some of them have sex with both men and women, and unsafe sexual behavior is frequent. It indicates that previous interventions are superficial, which cannot radically enforce their consciousness to prevent AIDS.2. MSM in Wuhan city have a high infected rate in HIV and syphilis. And it is possible these diseases will spread into general population. It shows that MSM should be regarded as one of intensive groups in preventing and controlling AIDS.3. RDS can successfully recruit a sample with devise demographic characteristics from few seeds. The sample will get a balance after a few waves of recruitment. However, it is still have some disadvantages. For example, it takes long time to recruit MSM, and workload of investigators is large. Besides, it cannot directly evaluate the effectiveness of sample.更多还原