山东省青岛市男男性行为人群固定性伴无保护性肛交行为的通径分析
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摘要
目的了解山东省青岛市男男性行为者(MSM)艾滋病知识、自我认同及社会支持情况对固定性伴无保护性肛交(UAI)行为的作用方式及大小。方法采用滚雪球法招募MSM,调查其艾滋病知识、性行为特征等;采用同性恋态度量表和社会支持评定量表分别收集自我认同和社会支持信息。定量资料和计数资料比较分别采用t检验和χ2检验,采用Pearson相关和多重线性回归进行相关和影响因素分析;通径分析中参数估计方法为均数方差调整加权最小二乘法,中介效应检验采用Bootstrap法。结果共招募529人,66.54%有多个(≥2)同性固定性伴;多个固定性伴者的UAI发生比例(88.92%)高于单一固定性伴者(51.98%),P<0.001。单一固定性伴者中,有UAI行为的MSM艾滋病相关知识得分较低(t=–2.780),自我认同得分较低(t=–2.000),社会支持得分较高(t=2.670,P<0.05)。多个固定性伴者中,有UAI行为的MSM艾滋病相关知识得分较低(t=–3.550,P<0.001)。通径分析结果显示:单一固定性伴者中,社会支持和UAI诱发情境对固定性伴UAI行为有正向直接作用,作用大小分别为0.24和0.45;多个固定性伴者中,艾滋病相关知识对固定性伴UAI行为产生负向直接效应,作用大小为–0.42,同时通过UAI诱发情境对UAI行为产生正向间接效应,Bstd=0.04,经Bootstrap检验,P<0.05。结论青岛市MSM固定性伴无保护性肛交行为发生比例较高,缺乏艾滋病知识和社会支持得分高可增加无保护性肛交行为发生风险。
Objective To understand the effects of AIDS related knowledge awareness, self-identity and social support on unprotected anal intercourse(UAI) with regular male sexual partners in men who have sex with men(MSM) in Qingdao.Methods MSM were recruited in a snowball way. A face-to-face interview was conducted to collect the information about their AIDS related knowledge awareness and sexual behavior characteristics. The Short Recreation to Homosexuality Scale and Social Support Rating Scale were used to evaluate their self-identity and social support status respectively. Quantitative and qualitative variables were compared by using Student's t-test and χ2 test respectively. Pearson correlation and multiple linear regression analysis were used to identify the correlation and related factors of quantitative variables. In the process of path analysis, parameters were estimated by mean and variance-adjusted weighted least square(WLSMV), mediation effect was tested by bootstrapping. Results A total of 529 MSM were recruited, among them, 66.54% had ≥2 regular partners. The proportion of MSM having UAI with single regular male partner and with ≥2 regular male partners were 88.92% and 51.98%(P<0.001). MSM having UAI with single regular male partner reported lower mean scores for AIDS related knowledge awareness(t=-2.780) and self-identity score(t=-2.000), higher mean scores for social support(t=2.670, P<0.05). MSM having UAI with ≥2 regular male partner reported lower mean scores for AIDS related knowledge awareness(t=-3.550,P<0.001). The path analysis showed that social support and risk sexual situation had direct effects on UAI(social support:Bstd=0.24, risk sexual situation: Bstd=0.45) in MSM with single regular male partner. For MSM with ≥2 regular male partners, AIDS related knowledge awareness score had direct effects on UAI with regular male partners(Bs t d=-0.42). Meantime, AIDS related knowledge awareness score can influence UAI with regular partners indirectly through risk
sexual situation in MSM.(P<0.05).Conclusion The prevalence of unprotected anal intercourse with regular male sexual partners was high in MSM in Qingdao.Lacking AIDS related knowledge and having higher social support scores can result in high risk of having unprotected anal intercourse.
Objective To understand the effects of AIDS related knowledge awareness, self-identity and social support on unprotected anal intercourse(UAI) with regular male sexual partners in men who have sex with men(MSM) in Qingdao.Methods MSM were recruited in a snowball way. A face-to-face interview was conducted to collect the information about their AIDS related knowledge awareness and sexual behavior characteristics. The Short Recreation to Homosexuality Scale and Social Support Rating Scale were used to evaluate their self-identity and social support status respectively. Quantitative and qualitative variables were compared by using Student's t-test and χ2 test respectively. Pearson correlation and multiple linear regression analysis were used to identify the correlation and related factors of quantitative variables. In the process of path analysis, parameters were estimated by mean and variance-adjusted weighted least square(WLSMV), mediation effect was tested by bootstrapping. Results A total of 529 MSM were recruited, among them, 66.54% had ≥2 regular partners. The proportion of MSM having UAI with single regular male partner and with ≥2 regular male partners were 88.92% and 51.98%(P<0.001). MSM having UAI with single regular male partner reported lower mean scores for AIDS related knowledge awareness(t=-2.780) and self-identity score(t=-2.000), higher mean scores for social support(t=2.670, P<0.05). MSM having UAI with ≥2 regular male partner reported lower mean scores for AIDS related knowledge awareness(t=-3.550,P<0.001). The path analysis showed that social support and risk sexual situation had direct effects on UAI(social support:Bstd=0.24, risk sexual situation: Bstd=0.45) in MSM with single regular male partner. For MSM with ≥2 regular male partners, AIDS related knowledge awareness score had direct effects on UAI with regular male partners(Bs t d=-0.42). Meantime, AIDS related knowledge awareness score can influence UAI with regular partners indirectly through risk
sexual situation in MSM.(P<0.05).Conclusion The prevalence of unprotected anal intercourse with regular male sexual partners was high in MSM in Qingdao.Lacking AIDS related knowledge and having higher social support scores can result in high risk of having unprotected anal intercourse.
引文
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[11]Arnold EA,Sterrett-Hong E,Jonas A,et al.Social networks and social support among ball-attending African American men who have sex with men and transgender women are associated with HIV-related outcomes[J].Glob Public Health,2018,13(2):144-158.DOI:10.1080/17441692.2016.1180702.
[12]Kelly BC,Carpiano RM,Easterbrook A,et al.Sex and the community:the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men[J].Sociol Health Illn,2012,34(7):1085-1102.DOI:10.1111/j.1467-9566.2011.01446.x.
[13]Melrose KL,Brown GDA,Wood AM.When is received social support related to perceived support and well-being?When it is needed[J].Person Ind Diff,2015,77(4):97-105.DOI:10.1016/j.paid.2014.12.047.
[14]Tran H,Ross MW,Diamond PM,et al.Structural validation and multiple group assessment of the short internalized homonegativity scale in homosexual and bisexual men in 38 european countries:results from the european MSM internet survey[J].J Sex Res,2018,55(4/5):617-629.DOI:10.1080/00224499.2017.1380158.
[15]Newcomb ME,Mustanski B.Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men:a meta-analysis[J].Arch Sex Behav,2011,40(1):189-199.DOI:10.1007/s10508-009-9573-8.
[2]Wu J,Hu YF,Jia YJ,et al.Prevalence of unprotected anal intercourse among men who have sex with men in China:an updated meta-analysis[J].PLoS One,2014,9(5):e98366.DOI:10.1371/journal.pone.0098366.
[3]Huebner DM,Kegeles SM,Rebchook GM,et al.Social oppression,psychological vulnerability,and unprotected intercourse among young Black men who have sex with men[J].Health Psychol,2014,33(12):1568-1578.DOI:10.1037/hea0000031.
[4]Ross MW,Kajubi P,Mandel JS,et al.Internalized homonegativity/homophobia is associated with HIV-risk behaviours among Ugandan gay and bisexual men[J].Int J STDAIDS,2013,24(5):409-413.DOI:10.1177/0956462412472793.
[5]Persson KI,Tikkanen R,Bergstr?m J,et al.Experimentals,bottoms,risk-reducers and clubbers:exploring diverse sexual practice in an Internet-active high-risk behaviour group of men who have sex with men in Sweden[J].Cult Health Sex,2016,18(6):639-653.DOI:10.1080/13691058.2015.1103384.
[6]Smolenski DJ,Diamond PM,Ross MW,et al.Revision,criterion validity,and multigroup assessment of the reactions to homosexuality scale[J].J Pers Assess,2010,92(6):568-576.DOI:10.1080/00223891.2010.513300.
[7]汪向东,王希林,马弘.心理卫生评定量表手册[M].北京:中国心理卫生杂志社,1999.Wang XD,Wang XL,Ma H.Rating scales for mental health[M].Beijing:Chinese Mental Health Journal,1999.
[8]Díaz RM,Ayala G,Bein E.Sexual risk as an outcome of social oppression:data from a probability sample of Latino gay men in three U.S.cities[J].Cultur Divers Ethnic Minor Psychol,2004,10(3):255-267.DOI:10.1037/1099-9809.10.3.255.
[9]Hu J,Zhang MY,Ma JJ,et al.Characteristics and factors influencing unprotected anal intercourse among men who have sex with men in Fuyang,China[J].Southeast Asian J Trop Med Public Health,2015,46(4):680-688.
[10]Liu J,Qu B,Ezeakile MC,et al.Factors associated with unprotected anal intercourse among men who have sex with men in Liaoning Province,China[J].PLoS One,2012,7(11):e50493.DOI:10.1371/journal.pone.0050493.
[11]Arnold EA,Sterrett-Hong E,Jonas A,et al.Social networks and social support among ball-attending African American men who have sex with men and transgender women are associated with HIV-related outcomes[J].Glob Public Health,2018,13(2):144-158.DOI:10.1080/17441692.2016.1180702.
[12]Kelly BC,Carpiano RM,Easterbrook A,et al.Sex and the community:the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men[J].Sociol Health Illn,2012,34(7):1085-1102.DOI:10.1111/j.1467-9566.2011.01446.x.
[13]Melrose KL,Brown GDA,Wood AM.When is received social support related to perceived support and well-being?When it is needed[J].Person Ind Diff,2015,77(4):97-105.DOI:10.1016/j.paid.2014.12.047.
[14]Tran H,Ross MW,Diamond PM,et al.Structural validation and multiple group assessment of the short internalized homonegativity scale in homosexual and bisexual men in 38 european countries:results from the european MSM internet survey[J].J Sex Res,2018,55(4/5):617-629.DOI:10.1080/00224499.2017.1380158.
[15]Newcomb ME,Mustanski B.Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men:a meta-analysis[J].Arch Sex Behav,2011,40(1):189-199.DOI:10.1007/s10508-009-9573-8.