【作者】 韦所苏；

【导师】 梁浩；

【作者基本信息】 广西医科大学 ， 流行病与卫生统计学， 2012， 硕士

【摘要】 目的了解广西男男性行为者与女性性工作者对暴露前药物预防(Pre-exposure prophylaxis, PrEP) HIV感染的认知、态度、接受意愿及其影响因素,为探讨在广西男男性行为者与女性性工作者中推广PrEP的可行性提供参考依据。方法以广西男男性行为者(Men who have sex with men, MSM)和女性性工作者(Female sex workers, FS Ws)为研究对象,采用一对一面访的形式,由经培训的访谈员进行问卷调查,调查内容包括调查对象的年龄、民族、婚姻等社会人口学特征；性行为特征；对HIV预防措施的认知及使用情况,对PrEP的认知、接受意愿和影响因素等。将选择“肯定会”者作为愿意接受PrEP组,将选择“很可能会”、“不清楚”、“很可能不会”、“肯定不会”者作为不愿意接受PrEP组,以愿意接受组和不愿意接受组作为二分类因变量,分别采用卡方检验和多因素Logistic回归对PrEP接受意愿的影响因素进行分析。结果共调查650名MSM和405名FSWs。(1)MSM和FSWs接受PrEP的意愿分别为81.1%(527/650)和68.4%(277/405),经卡方检验,两类人群对PrEP的接受意愿差异有统计学意义(χ2=34.927,P=0.000)。(2)将卡方检验中P值小于0.10的变量纳入多因素Logistic回归分析,结果显示,在MSM中,“最近六个月与女性发生过性行为”(OR=2.294,95%CI=1.132-4.650)、“听说过杀微生物剂”(OR=3.066,95%CI=1.462-6.431)、“如HIV感染率高,会保持固定性伴,不再寻找临时性伴’’(OR=1.750,95%CI=1.096-2.792)、“认为应该推广PrEP"(OR=3.717,95%CI=1.694-8.157)是其愿意接受PrEP的有利因素；“使用过药物预防HIV感染’’(OR=0.223,95%CI=0.051-0.979)是其愿意接受PrEP的不利因素。(3)在FSWs中,多因素Logistic回归分析显示,“民族为汉族”(OR=1.813,95%CI=1.112-2.956)、“性行为时全程使用安全套”95%CI=1.103-3.344)、“使用过药物预防性病”(OR=4.006,95%CI=1.563-10.265)、“认为应该推广PrEP "(OR=5.157,95%CI=2.799-9.502)是其愿意接受PrEP的有利因素；“年龄≤28岁”(OR=0.588,95%CI=0.356-0.971)、“与家人关系好”(OR=0.434,95%CI=0.238-0.788)、“月收入≤3000元”(OR=0.373,95%CI=0.198-0.702)、“每星期接客数≥8个”(OR=0.553,95%CI=0.324-0.944)、“会主动提出使用安全套"(OR=0.283,95%CI=0.107-0.749)、“听说过暴露后药物预防HIV"(OR=0305,95%CI=1.130-4.704)是其愿意接受PrEP的不利因素。(4)当被问到每月愿意花费多少钱在PrEP上时,58%的MSM和54.6%的FSWs希望费用少于100元人民币。(5)在药物种类上,假设第一种药便宜但服药间隔短,第二种药较贵但服药间隔长,MSM和FSWs选择第二种药物的人分别为46.7%和70.4%；经卡方检验,结果显示两类人群在药物的种类选择上有统计学差异(χ2=50.590,P=0.000)。结论(1)相比于FSWs, MSM更愿意接受PrEP。(2)强烈的健康需求是MSM和FSWs接受PrEP的共同原因；药物的安全性、有效性及费用可能是影响MSM和FSWs接受PrEP的重要因素；此外,MSM和FSWs的社会人口学特征、对艾滋病的认知、对PrEP的认知均对PrEP的接受意愿产生影响。(3)为MSM和FSWs免费提供安全、有效且副作用小的药物可能是推广PrEP的较好方式；同时,以健康教育的方式宣传PrEP可能会提高其接受意愿。(4)相比于MSM,FSWs更倾向于服用价格较贵但间隔时间长的药物。更多还原

【Abstract】 Objective To investigate the knowledge, attitudes, willingness to pre-exposure prophylaxis (PrEP) and its relative factors among MSM and FSWs in Guangxi, in order to provide reference to promote PrEP in local MSM and FSWs in the coming future. Methods Men who have sex with men (MSM) and female sex workers (FSWs) in HIV high-prevalence areas were surveyed through the conversation and asking face to face by the qualified trained investigators, the contents of questionnaire included social demographic characteristics of subjects such as the age, ethnicity, marital status; AIDS knowledge and attitudes, willingness to use PrEP and its influential factors. Subjects who chose the options "Certainly willing" were classified as the group that had the willingness to use PrEP, subjects who chose the options "Likely willing","Unclear","Likely not be willing" and "Certainly not be willing" were classified as the group that hadn’t the willingness to use PrEP, With Willing and unwilling as binary dependent variable, various factors that would affect the acceptance of PrEP were analyzed by The chi-square test and multivariate Logistic regression. Results650MSM and405FSWs in HIV high-prevalence areas were investigated.(1) The rate of willingness to use PrEP in MSM and FSWs in HIV high-prevalence areas was81.1%(527/650),68.4%(277/405) respectively. After The chi-square test analysis, the difference was statistically significant (χ2=34.927, P=0.000).(2) Variables which P value was less than0.10in univariate analysis were analyzed by multivariate Logistic regression model. It was found that in MSM,"Men who had sex behavior with women in six month"(oR=2.294,95%CI=1.132-4.650),"Ever heard microbicides"(OR=3.066,95%CI=1.462-6.431),"If HIV infection is high, will find a fixed partner, do not find casual partners"(OR=1.750),95%CI=1.096-2.792),"Consider it should be to promote PrEP"(OR=3.717,95%CI=1.694-8.157) were the favorable factors which affect their willingness to use PrEP;"Ever use drug to prevent HIV infection"(OR=0.223,95%CI=0.051-0.979) was the unfavorable factors which affect their willingness to use PrEP.(3) In FSWs,"The Han nationality"(OR=1.813,95%CI=1.112-2.956),"Consistent use of condoms"(OR=1.921,95%CI=1.103-3.344),"Ever use drug to prevent venereal diseases"(OR=4.006,95%CI=1.563-10.265),"Consider it should be to promote PrEP"(OR=5.157,95%CI=2.799-9.502) were the favorable factors which affect their willingness to use PrEP;"Less than28years old"(OR=0.588,95%CI=0.356-0.971),"Have a well family relationship"(OR=0.434,95%CI=0.238-0.788),"Monthly income less than3000yuan"(OR=0.373,95%CI=0.198-0.702),"Have client more than8per week"(OR=0.553,95%CI=0.324-0.944),"Offered the use of condoms"(OR=0.283,95%CI=0.107-0.749),"Ever heard post-exposure prophylaxis"(OR=0.305,95%CI=1.130-4.704) were the unfavorable factors which affect their willingness to use PrEP.(4) When people were asked how much would you paid for PrEP every month, the answer less than100yuan in MSM and FSWs was58%,54.6%respectively.(5) When people were asked the question If there were two types of drug, one was cheap but was Short medication interval, the other was expensive but was long medication interval, which type is your Preference? Chose type2in MSM and FSWs was46.7%,70.4%respectively. After The chi-square test analysis, the difference was statistically significant(χ2=50.590, P=0.000). FSWs prefer drug type2more than MSM. Conclusions (1) MSM had a better PrEP willingness than FSWs.(2) The demand of health was the common reason to accept PrEP; the safety, effectiveness and free of charge were the key influential factors of the willingness; In addition, other factors such as the social demographic characteristics and their AIDS knowledge, cognition of PrEP are more or less influential on their willingness to use PrEP.(3) If we want to promote PrEP in MSM and FSWs, we must offer safe, effectiveness and less side effects drug. Meanwhile, heath education might improve the acceptability of PrEP.(4) FSWs prefer the expensive but long medication interval drug than MSM.更多还原