济南市男男性接触者艾滋病知识态度行为的调查与分析研究
摘要
背景：艾滋病的流行与传播已严重危害人类健康，影响社会经济的发展。到2005年底全球艾滋病病毒(HIV)感染人数总计为4030万(3670-4530万)。至今为止，艾滋病即没有有效疫苗预防，也没有有效药物治疗，对高危人群进行宣传教育和行为干预仍是最重要的防控措施。
MSM人群因为多性伴侣、无保护性插入性行为是艾滋病感染的高危人群。我国相当一部分男性同性恋者与异性组建了家庭或拥有异性性伴侣，成为将HIV向一般人群传播的“桥梁人群”(bridge population)，造成HIV/AIDS的进一步扩散。一项研究调查显示，处于性活跃期的中国男性同性恋者艾滋病感染率约达1.35％，高于全人群感染率0.05％。对MSM艾滋病防治具有重要意义。
目的：调查研究济南市部分MSM人群中艾滋病感染的现状；了解MSM对艾滋病的知识、态度和行为状况；调查研究MSM人群中干预措施对高危行为的影响，以便有针对性地开展相应干预措施；探索MSM中艾滋病控制的综合防治模式。
方法：MSM问卷调查：制订调查方案，成立调查组，培训调查人员，并组织实施。对通过各种方式收集了656人MSM，按全省统一制定的调查问卷、样本编号和数据库，统一标准，统一方法进行问卷调查。对全部调查对象采集血清标本，检测艾滋病抗体。
血清学调查：标本采集完成后进行血清分离，移至冷冻管内-20℃保存，由济南市艾滋病筛查中心实验室统一进行HIV抗体血清学检测。血清HIV抗体检测方法参照《全国艾滋病检测技术规范》并严格按照试剂使用说明书要求执行。
采用两次血清酶联免疫吸附试验(ELISA)的方法进行血清学HIV抗体初筛实验。第一次检测HIV抗体阳性时，再选用ELISA检测试剂进行复核，两次结果均呈阳性时报告HIV抗体阳性。
流行病学调查：对确认HIV抗体阳性者，全部进行流行病学个案调查，了解其可能的感染来源、途径以及可能的进一步传播的范围等。
资料处理：应用EpiData软件录入并建立数据库，运用spss11.5软件进行统计分析。
结果：从人口学特征来看，本次调查的MSM人群具有学历高(大专及以上学历者占75％)、年轻人为主(年龄均数为26.28岁，35％岁以下占90％)、在婚与同居约占一半、以学生和干部职员为主职业分布较广的特点。在所调查人员中自认为是男性同性恋者占63.9％，双性恋者占31.1％。对艾滋病知识的掌握情况还比较理想，正确率在80％以上的题目数占全部题目的62.5％。被调查者最近六个月与男性发生肛交性行为时每次都使用安全套的频率仅为28.5％，有18.1％的人从未使用安全套。在调查对象中，有10人为HIV感染者，感染率为1.52％。在相关联性分析中：初次性行为年龄在15岁以下与大于15岁之间，其性伴数之间的差异有统计学意义(p=0.022)，初次性行为越小呈性伴数越多趋势。艾滋病知识知晓率与高危行为之间的相关分析中，P＞0.05，说明知识与行为的分离现象还是比较明显的。将文化程序分成初中及以下组，高中组，大专及以上组，这三组之间在性伴数中有显著性差异，P=0.002。文化程度越高，性伴数越少。接受AIDS防治知识咨询与未接受咨询组，在使用安全套频率、最近一次是否使用、性伴数方面均有一定的差异，但无统计学意义的差异。从接同伴教育与否分组其性伴数之间虽然无统计学差异，但P值(0.08)接近0.05，其趋势为接受同伴教育性伴数减少。
结论：1、MSM人群对艾滋病的传播与流行有重要意义，是AIDS防治工作的重点。MSM群群体具有隐蔽性强、性伴侣多、安全性行为少等特点，起到了从高危人群向一般人群传播的“桥梁人群”，其HIV感染率高。
2、应加强对MSM的AIDS知识的健康教育。
3、多部门协作是防治MSM AIDS的前提由于MSM人群非常敏感，涉及道德、法制、健康等多个方面，如何在不违背国家政策法规及有关规定的情况下，开展有效的MSM中AIDS防治工作，是一个极具挑战的课题，必须由卫生、公安等多部门通力协作，共同完成。
4、行为干预是艾滋病防治的工作重点
MSM高危行为主要是多性伴与无保护插入性行为，行为干预的目的在于降低性行为的危险度，以达到防治目标。
5、AIDS在MSM中的流行不仅仅是一个生物医学问题，更是一个社会医学问题。正确认识MSM现象，客观对待MSM人群，进行综合治理，彻底防治MSM的HIV高感染率。
Background: The epidemic and spread of AIDS has been a great problem to the health of people, and has been affected the development of social economic. Till the end of 2005, the total number of HIV in the whole world was 40. 30 millions(36.70-45. 30 millions). As present, there is no vaccine to prevent it and no drug to cure it. The propaganda education and behavioral intervention are still the most important prevention measures.
MSM has been the high-risk group of AIDS because of their multiple sexual partners and unprotected intercourse. In our country, quite of MSM have set up their homes or have opposite sex partners. They have been the bridge population that make common people infected HIV. This has been made the further spread of AIDS. An investigation shows that the infection rate of AIDS has been 1.35% in sexual active MSM in China. So the prevention of AIDS to MSM is very important.
Objective: to investigate and study the infectious status of AIDS in MSM; to know the knowledge and attitude to AIDS and the behaviors of MSM. To study the influence of intervention measures to high-risk behaviors of MSM, so as to carry out some suitable intervention measures; to search for a mode of prevention and treatment of AIDS in MSM.
Measures: MSM questionnaire: to draw up investigation plan, and establish an investigation group. Investigators were trained. The survey was performed strictly according to the workplan. The sample size is 656. Using the unifying investigated questionnaires, identification serial number of sample and database. Serum specimen was collected for anti-HIV antibody detection. Serological investigations: The serum separation was carried out after the collection of serum specimen. And then freezing them in cooling tube of -20℃. Serological test was performed in central laboratory of HIV in Jinan. The method of anti-HIV antibody detection was carried out according to the 'National criterion of AIDS detection', and the instructions are strictly followed.
The screen test was performed employing ELISA. Every people with anti-HIV positive reaction in the first ELISA was confirmed in confirmation laboratory with ELISA again. When both of the two detections were anti-HIV positive, we can think that the person was confirmed anti-HIV positive.
Epidemiological investigation: specific epidemiological investigation was performed for every people with confirmed anti-HIV positive reaction, to survey the possible source of infection, infection routh and the possible area of transmission.
Data processing: EpiData was used for the data input and establishment of database. SPSS11.5 was used for data analysis.
Result: our investigation showed that in terms of demographical character , MSM had such features: higher educational background(75% with school degree or higher), younger( the average ages are 26.28, those below 35 account for 90%), half of whom were married or livein. Students and cadre constitute the majority. 63.9% are regarded as gay while 31.1% are bisexual of all the participants. In regard to the knowledge of AIDS, veracity of all the questions was 80%. Only 28. 5% used condom every time when they had anal intercouse with male in late six months, while 18. 1% never. 10 persons were infected by HIV and the infection rate was 1.52%. The correlation analysis results indicated that the earlier one has sexual behavior, the more playmates he has. In addition, the difference of playmate number between two groups was statistically significant (p=0.022). No statistical correlation was found between high risk behavior and knowledge of AIDS, which strongly implied disjunction. The research population was divided into three groups according to their educational degree, of which there was significant difference concerning their playmates (p=0.002). In other word, the higher their educational degree are, the less their playmates. The frequency of condom usage and the number of playmates of groups receiving AIDS consultation was different from those who didn't receive consultation to some extent, but there was no statistical difference. Certain Tendency between companion education and playmate number (p=0. 08). Conclusion:
1. As bridge population, MSM were characterized by high-convertness, more playmates, less safety intimacy, higher infectivity rate, so they should be the focus and emphasis in AIDS control and prevention.
2. Health education should be strengthened among MSM.
3. Since prevention and control of AIDS among MSM involved ethicality, legal system, health, etc, it is necessary for multiple sections to promote cooperation.
4. Behavior intervention was the emphasis concerning the prevention and control of AIDS, because it can reduce the infectivity risk among MSM.
5. AIDS Epidemic among MSM was not only a biological problem but also a social one. It is very important to perceive MSM phenomena objectively and take comprehensive measures to reduce the infection rate.
MSM人群因为多性伴侣、无保护性插入性行为是艾滋病感染的高危人群。我国相当一部分男性同性恋者与异性组建了家庭或拥有异性性伴侣，成为将HIV向一般人群传播的“桥梁人群”(bridge population)，造成HIV/AIDS的进一步扩散。一项研究调查显示，处于性活跃期的中国男性同性恋者艾滋病感染率约达1.35％，高于全人群感染率0.05％。对MSM艾滋病防治具有重要意义。
目的：调查研究济南市部分MSM人群中艾滋病感染的现状；了解MSM对艾滋病的知识、态度和行为状况；调查研究MSM人群中干预措施对高危行为的影响，以便有针对性地开展相应干预措施；探索MSM中艾滋病控制的综合防治模式。
方法：MSM问卷调查：制订调查方案，成立调查组，培训调查人员，并组织实施。对通过各种方式收集了656人MSM，按全省统一制定的调查问卷、样本编号和数据库，统一标准，统一方法进行问卷调查。对全部调查对象采集血清标本，检测艾滋病抗体。
血清学调查：标本采集完成后进行血清分离，移至冷冻管内-20℃保存，由济南市艾滋病筛查中心实验室统一进行HIV抗体血清学检测。血清HIV抗体检测方法参照《全国艾滋病检测技术规范》并严格按照试剂使用说明书要求执行。
采用两次血清酶联免疫吸附试验(ELISA)的方法进行血清学HIV抗体初筛实验。第一次检测HIV抗体阳性时，再选用ELISA检测试剂进行复核，两次结果均呈阳性时报告HIV抗体阳性。
流行病学调查：对确认HIV抗体阳性者，全部进行流行病学个案调查，了解其可能的感染来源、途径以及可能的进一步传播的范围等。
资料处理：应用EpiData软件录入并建立数据库，运用spss11.5软件进行统计分析。
结果：从人口学特征来看，本次调查的MSM人群具有学历高(大专及以上学历者占75％)、年轻人为主(年龄均数为26.28岁，35％岁以下占90％)、在婚与同居约占一半、以学生和干部职员为主职业分布较广的特点。在所调查人员中自认为是男性同性恋者占63.9％，双性恋者占31.1％。对艾滋病知识的掌握情况还比较理想，正确率在80％以上的题目数占全部题目的62.5％。被调查者最近六个月与男性发生肛交性行为时每次都使用安全套的频率仅为28.5％，有18.1％的人从未使用安全套。在调查对象中，有10人为HIV感染者，感染率为1.52％。在相关联性分析中：初次性行为年龄在15岁以下与大于15岁之间，其性伴数之间的差异有统计学意义(p=0.022)，初次性行为越小呈性伴数越多趋势。艾滋病知识知晓率与高危行为之间的相关分析中，P＞0.05，说明知识与行为的分离现象还是比较明显的。将文化程序分成初中及以下组，高中组，大专及以上组，这三组之间在性伴数中有显著性差异，P=0.002。文化程度越高，性伴数越少。接受AIDS防治知识咨询与未接受咨询组，在使用安全套频率、最近一次是否使用、性伴数方面均有一定的差异，但无统计学意义的差异。从接同伴教育与否分组其性伴数之间虽然无统计学差异，但P值(0.08)接近0.05，其趋势为接受同伴教育性伴数减少。
结论：1、MSM人群对艾滋病的传播与流行有重要意义，是AIDS防治工作的重点。MSM群群体具有隐蔽性强、性伴侣多、安全性行为少等特点，起到了从高危人群向一般人群传播的“桥梁人群”，其HIV感染率高。
2、应加强对MSM的AIDS知识的健康教育。
3、多部门协作是防治MSM AIDS的前提由于MSM人群非常敏感，涉及道德、法制、健康等多个方面，如何在不违背国家政策法规及有关规定的情况下，开展有效的MSM中AIDS防治工作，是一个极具挑战的课题，必须由卫生、公安等多部门通力协作，共同完成。
4、行为干预是艾滋病防治的工作重点
MSM高危行为主要是多性伴与无保护插入性行为，行为干预的目的在于降低性行为的危险度，以达到防治目标。
5、AIDS在MSM中的流行不仅仅是一个生物医学问题，更是一个社会医学问题。正确认识MSM现象，客观对待MSM人群，进行综合治理，彻底防治MSM的HIV高感染率。
Background: The epidemic and spread of AIDS has been a great problem to the health of people, and has been affected the development of social economic. Till the end of 2005, the total number of HIV in the whole world was 40. 30 millions(36.70-45. 30 millions). As present, there is no vaccine to prevent it and no drug to cure it. The propaganda education and behavioral intervention are still the most important prevention measures.
MSM has been the high-risk group of AIDS because of their multiple sexual partners and unprotected intercourse. In our country, quite of MSM have set up their homes or have opposite sex partners. They have been the bridge population that make common people infected HIV. This has been made the further spread of AIDS. An investigation shows that the infection rate of AIDS has been 1.35% in sexual active MSM in China. So the prevention of AIDS to MSM is very important.
Objective: to investigate and study the infectious status of AIDS in MSM; to know the knowledge and attitude to AIDS and the behaviors of MSM. To study the influence of intervention measures to high-risk behaviors of MSM, so as to carry out some suitable intervention measures; to search for a mode of prevention and treatment of AIDS in MSM.
Measures: MSM questionnaire: to draw up investigation plan, and establish an investigation group. Investigators were trained. The survey was performed strictly according to the workplan. The sample size is 656. Using the unifying investigated questionnaires, identification serial number of sample and database. Serum specimen was collected for anti-HIV antibody detection. Serological investigations: The serum separation was carried out after the collection of serum specimen. And then freezing them in cooling tube of -20℃. Serological test was performed in central laboratory of HIV in Jinan. The method of anti-HIV antibody detection was carried out according to the 'National criterion of AIDS detection', and the instructions are strictly followed.
The screen test was performed employing ELISA. Every people with anti-HIV positive reaction in the first ELISA was confirmed in confirmation laboratory with ELISA again. When both of the two detections were anti-HIV positive, we can think that the person was confirmed anti-HIV positive.
Epidemiological investigation: specific epidemiological investigation was performed for every people with confirmed anti-HIV positive reaction, to survey the possible source of infection, infection routh and the possible area of transmission.
Data processing: EpiData was used for the data input and establishment of database. SPSS11.5 was used for data analysis.
Result: our investigation showed that in terms of demographical character , MSM had such features: higher educational background(75% with school degree or higher), younger( the average ages are 26.28, those below 35 account for 90%), half of whom were married or livein. Students and cadre constitute the majority. 63.9% are regarded as gay while 31.1% are bisexual of all the participants. In regard to the knowledge of AIDS, veracity of all the questions was 80%. Only 28. 5% used condom every time when they had anal intercouse with male in late six months, while 18. 1% never. 10 persons were infected by HIV and the infection rate was 1.52%. The correlation analysis results indicated that the earlier one has sexual behavior, the more playmates he has. In addition, the difference of playmate number between two groups was statistically significant (p=0.022). No statistical correlation was found between high risk behavior and knowledge of AIDS, which strongly implied disjunction. The research population was divided into three groups according to their educational degree, of which there was significant difference concerning their playmates (p=0.002). In other word, the higher their educational degree are, the less their playmates. The frequency of condom usage and the number of playmates of groups receiving AIDS consultation was different from those who didn't receive consultation to some extent, but there was no statistical difference. Certain Tendency between companion education and playmate number (p=0. 08). Conclusion:
1. As bridge population, MSM were characterized by high-convertness, more playmates, less safety intimacy, higher infectivity rate, so they should be the focus and emphasis in AIDS control and prevention.
2. Health education should be strengthened among MSM.
3. Since prevention and control of AIDS among MSM involved ethicality, legal system, health, etc, it is necessary for multiple sections to promote cooperation.
4. Behavior intervention was the emphasis concerning the prevention and control of AIDS, because it can reduce the infectivity risk among MSM.
5. AIDS Epidemic among MSM was not only a biological problem but also a social one. It is very important to perceive MSM phenomena objectively and take comprehensive measures to reduce the infection rate.
引文
1 联合国艾滋病规划署和世界卫生组织《艾滋病流行最新报告》
2 中华人民共和国卫生部 联合国艾滋病规划署 世界卫生组织 2005年中国艾滋病疫情与防治工作进展 2006年1月
3 张北川．同性爱．济南：山东科学技术出版社．1994．40—124
4 UNAIDS world AIDS Campaign 2001: Men Who HaveSex with Men and Hiv/AIDS.
5 新华网 www.xinhuanet.com
6 Choi KH ,Liu H, Guo Y,et al. Emerging HIV-1 epidemic in China in men who have sex with men [J].Lancet, 2003,361(9375):2125-2126.)
7 杨振发等．男—男性接触者梅毒和HIV感染及性行为调查．中国公共卫生，2003，19(11)：1292—1293．
8 李金星等济南市首例HIV感染者调查报告 中国性病艾滋病防治2000，6
9 济南市艾滋病疫情总结报告 济南市疾病预防控制中心 2006年12月
10 张北川 中国男同性爱者儿童期状况对自身性别、性取向的态度及认识，少见经历和心理与艾滋病高危行为的关系(二)中国性病艾滋病防治2002年6月第8卷第3期
11 张北川 对中国男同／双性爱者人口数量与艾滋病病毒感染率的初步估测中国性病艾滋病防治2002年8月第8卷第4期
12 济南市疾病预防控制中心《济南市疾病预防控制中心2006年工作总结》，2007年1月
13 汪雁鹤 5市男男性接触者状况及影响其高危行为的因素 医学与社会2005年9月
14 史同新 对男男性接触者AIDS高危性行为健康干预研究 中国艾滋病性病2003年12月第9卷第6期
15 周红 某市同性恋者艾滋病感染状况分析及其性行为危险性探究 医学动物防制2003年10月第19卷第10期
16 朱明泉，张北川，李秀芳 男男性接触者艾滋病流行状况 中华实用中西医杂志2004年VOL．4(17)NO．7
2 中华人民共和国卫生部 联合国艾滋病规划署 世界卫生组织 2005年中国艾滋病疫情与防治工作进展 2006年1月
3 张北川．同性爱．济南：山东科学技术出版社．1994．40—124
4 UNAIDS world AIDS Campaign 2001: Men Who HaveSex with Men and Hiv/AIDS.
5 新华网 www.xinhuanet.com
6 Choi KH ,Liu H, Guo Y,et al. Emerging HIV-1 epidemic in China in men who have sex with men [J].Lancet, 2003,361(9375):2125-2126.)
7 杨振发等．男—男性接触者梅毒和HIV感染及性行为调查．中国公共卫生，2003，19(11)：1292—1293．
8 李金星等济南市首例HIV感染者调查报告 中国性病艾滋病防治2000，6
9 济南市艾滋病疫情总结报告 济南市疾病预防控制中心 2006年12月
10 张北川 中国男同性爱者儿童期状况对自身性别、性取向的态度及认识，少见经历和心理与艾滋病高危行为的关系(二)中国性病艾滋病防治2002年6月第8卷第3期
11 张北川 对中国男同／双性爱者人口数量与艾滋病病毒感染率的初步估测中国性病艾滋病防治2002年8月第8卷第4期
12 济南市疾病预防控制中心《济南市疾病预防控制中心2006年工作总结》，2007年1月
13 汪雁鹤 5市男男性接触者状况及影响其高危行为的因素 医学与社会2005年9月
14 史同新 对男男性接触者AIDS高危性行为健康干预研究 中国艾滋病性病2003年12月第9卷第6期
15 周红 某市同性恋者艾滋病感染状况分析及其性行为危险性探究 医学动物防制2003年10月第19卷第10期
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