长沙市区男同性恋人群生存状况研究
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摘要
研究背景
在过去的30年,同性恋现象得到了社会越来越广泛的关注,自上个世纪80年代发现艾滋病病毒(human immunodeficiency virus, HIV)并明确了男同性恋人群是艾滋病高危行为人群之后,对男同性恋的研究受到了前所未有的重视,同性恋及其对社会、对同性恋者自身的影响成为了社会科学、公共卫生的一个热点研究领域,涉及的研究主要包括：同性恋的成因,同性恋者的生活方式和生存状况,亲密关系暴力行为,同性恋者的心身健康,同性性行为与艾滋病、性病传播的关系、社会对同性恋的态度等方面。
但是,已有的相关研究存在两个主要的方法学问题：①样本的代表性问题。男同性恋人群是“难以接近的人群”(hard-to-reach population),目前抽取男同性恋研究样本的策略主要有两类：研究人员利用与调查对象的个人联系收集样本,经常被称之为“友谊网络”(friendship networks)或“滚雪球”(snowballing);通过GLB (gay men, lesbians and bisexuality)社区的社会活动、组织机构、商业活动、或是新闻事件等进行公开招募。用这两类方法获得是非概率样本,其代表性不理想。目前,也有一些涉及难以接近人群的相关研究开始采用一种新的抽样方法——同伴推动抽样法(Respondent-driven Sampling, RDS),这种方法是滚雪球抽样法的升级,近似概率抽样方法,但这种新方法也仍有许多局限,有待于进一步应用和完善。②多数涉及同性恋研究基本上没有一个对照组,单组样本的描述和分析在许多方面并不能很深刻地阐述问题。
在当前中国社会文化背景下,我国同性恋人群的生存现状主要存在以下几个方面的问题：①同性恋者的性关系松散,性对象多变,容易感染各种性传播疾病(包括艾滋病)；②同性恋者自身大多具有道德罪恶感,其心理压力大,承受能力不佳,一旦遇到一些情感问题,容易表现出一些失控行为,如自杀、自伤等；③同性恋本身给自己及其家属带来很大的精神痛苦,同性恋者所缔结的异性婚姻则更为不幸。同性恋人群作为客观存在一个亚文化群体,急需社会的关心和帮助,但事实上主流社会的排斥却使得同性恋人群的生存状况更加艰难。
本研究采用对照设计横断面调查,对长沙市区男同性恋人群的社会人口学特征、恋爱关系、性行为特征、自杀、生活事件、社会支持、亲密关系暴力和生活质量等多项指标进行测定,并与异性恋对照组进行比较分析,为提高城市男同性恋人群的身心健康水平,预防男人同性恋人群性病、艾滋病的传播提供了科学的依据。
目的
本研究的总目标是在中国当前社会文化背景下,来了解城市男同性恋人群的生活、工作、健康、社会交往等生存状况,分析影响男同性恋人群生理健康和心理健康的影响因素,为提高男同性恋人群身、心健康水平以及预防男同性恋人群性病、艾滋病传播提供科学依据。具体目的包括：
①描述男同性恋人群的社会人口学特征；②描述男同性恋人群的性行为特征及患性传播疾病情况；③描绘男同性恋人群的恋爱关系、自杀意念、亲密关系暴力、负性生活事件、社会支持水平以及生活质量；④分析影响男同性恋人群生理健康、心理健康的影响因素；⑤了解社会公众对同性恋的态度并分析其主要社会人口学影响因素；⑥翻译、修订同性恋态度量表,并在中国的社会文化背景下检验其信度和效度。
方法
本研究中,所有调查对象的性取向以自我报告为准。在调查过程中首先要求调查对象对自己的性取向做一个简单的自我鉴定,在同性恋、双性恋、异性恋、易性癖四者中做出选择,如受试性取向不符合调查要求,则结束该次调查访谈。
前期,研究者参加了各种男同性恋聚会活动,对参与聚会的共105名男同性恋者进行了问卷调查。结果显示,96.2%经常利用网络来进行互动。因此,本研究决定通过网络随机抽样选取男同性恋样本。目前,中国国内最有影响、且注册人数最多的男同性恋交友网站主要有以下5家：朋友别哭(www.pybk.com),阳光地带(www.boysky.com),Bf99华人同志交友网站(www.bf99.com),同志朋友网(www.94gay.com),69PY交友网(www.69py.com)共5家。截至2009年6月,长沙男同性恋者在这5个同性恋网站上注册近1,2000人次,长沙市男同性恋QQ群将近100个,约6,000人次,初步确定样本抽样框为18,000人次。
在参考了世界卫生组织以及中国疾病预防控制中心推荐的性传播感染高危人群哨点监测的样本量标准(一般在250-400人)的基础上,最终确定抽取样本500人。收集所有网络注册及QQ群用户男同性恋者的QQ号码、Email地址或电话号码等资料,而后从抽样框中随机抽取男同性恋样本500人,排除有一部分男同性恋者在几个网站重复注册的可能,因此在抽样过程中剔除QQ号码、Email地址、电话号码等资料重复者,直至抽满500人为止。
对照组异性恋样本来自湘雅医院体检中心的体检人员,为了提高研究的均衡可比性,按年龄、性别和学历选择对照。对照组异性恋者与同性恋者同性别、同学历,年龄相差在1岁以内,而高校学生样本则按年级匹配。所有样本以面对面访谈的调查方式,在取得知情同意的条件下,以定式访谈问卷对调查对象进行现场调查,具体调查内容包括：
①社会人口学特征：采用自编一般情况调查表进行调查；②性行为特征及患性传播疾病的情况：采用自编问卷进行调查；③恋爱情况、异性婚姻意愿等：采用自编调查表进行调查；④自杀意念以及自杀行为：采用Kessler设计的自杀问卷调查；⑤亲密关系暴力：采用马萨诸塞青年危险行为调查问卷；⑥负性生活事件：采用Rosser和Ross构建的男同性恋生活事件量表(Gay Affect and Life Events Scale, GALES)来进行评估。⑦社会支持水平采用肖水源制定的社会支持评定量表(Social Support Rating Scale, SSRS)来评价；⑧生活质量：采用中文版SF-36 v2 (the version 2 of the SF-36 health survey)量表来测试；⑨社会公众对同性恋的态度：采用Gregory M. Herek设计男、女同性恋态度量表(ATLG, Gregory M. Herek,1994)来评估
资料分析方法：采用EpiData 3.0建立数据库,用SPSS 17.0进行统计学分析,取检验水准(α)为0.05,不同组间阳性率的比较采用χ2检验(Pearson Chi-Square Test)。不同组间计量指标的比较采用t检验或方差分析,对不符合参数检验条件的采用Mann-Whitney Test或Kruskal-Wallis Test等非参数检验方法。多因素分析采用Ordinal等级回归分析。
通过网络抽样,于2009年3月5日-2009年12月31日进行了男同性恋者的调查,有60人在网上注册的QQ号码或手机号已经停止使用而无法联系,有11人拒绝调查,最终完成调查的男同性恋人数为429人,应答率为85.8%,剔除有大量遗漏或是逻辑严重混乱的无效问卷11份,最终获得418名有效样本；于2009年11月1日-12月31日进行了对照组样本的调查,最终共取得有效样本330人。
1.社会人口学特征
418名有效男同性恋样本中,年龄最小为16岁,最大为44岁,中位数年龄为24岁(P25=21.8,P75=26.0)；94.5%汉族,少数民族占5.5%；72.0%原户籍为城市,28.0%为农村；独生子女占57.9%；91.4%未婚,7.9%已婚,离异3人(0.7%)；在读学生159人(38.0%)；39人(9.3%)未读大学,专科学历111人(26.6%),本科学历207人(49.5%),硕士及硕士以上学历60人(14.4%),1人未报告学历情况。
58.9%(246／418)的男同性恋者目前正式在职。53.8%(225／418)的男同性恋者月收入在2000以下,25.6%(107／418)月收入在2000-4000之间,15.3%(64／418)月收入4001-6000之间,4.8%(20／418)月收入在6001-8000之间,2人(0.5%)月收入在8000以上。
2.在同性性关系中的角色
本研究根据实际情况,将男同性恋者在同性性关系中扮演的角色从纯0到纯1划分为10段共11个点,由被调查者根据自身情况进行选择。纯0意指在男同性恋者之间的阴茎-肛门插入式性行为中只扮演被插入方的角色,没有过阴茎-肛门的插入式性行为；纯1意指在男同性恋者之间的阴茎-肛门插入式性行为中只扮演插入方的角色,没有过阴茎-肛门的被插入式性行为。本研究在分析过程中将纯0,0.1,0.2,0.3界定为被动组,共125人(29.9%),0.4,0.5,0.6界定为中间组,共137人(32.8%),0.7,0.8,0.9,1界定为主动组,共156人(37.3%)。
3.出柜
出柜(Coming-Out),是指LGBT (lesbian, gay, bisexual, transsexual)在自己的生活、工作圈子里公开自己的性取向。本研究男同性恋样本中,57.3%有出柜史。其中,5.0%(12／241)将自己的性取向告诉了父亲,7.9%(19／241)告诉了母亲,12.9%(31／241)告诉了兄弟姐妹,63.1%(152／241)曾将自己的性取向告诉过同学,49.4%(119／241)告诉过同事或朋友。而在已婚的33人中,未有1人将他们的性取向告诉过他们的妻子。
4.恋爱关系、异性婚姻及生育意愿
与异性恋者相比,男同性恋者当中目前有稳定恋爱关系者较少(χ2=21.671,P=0.001)；44.0%的男同性恋者与同性伴侣维持恋爱关系时间最长不足7个月,时间短暂(χ2=57.391,P=0.000)。除已婚的33人和离异的3人之外,其余382人当中,13.6%(52／382)明确表示将不会和异性结婚,37.1%(155／418)的男同性恋者希望能找女同性恋者缔结形式婚姻；74.9%(313／418)希望生育或抚养小孩。
5.男同性恋人群性行为特征
(1)利用网络寻找性伙伴。与异性恋者相比,男同性恋者更多地利用网络来寻找同性性伙伴(χ2=322.883,P=0.000),85.6%(358／418)的男同性恋者表示曾通过网络来寻找同性性伙伴。而在最近6个月内,有利用网络寻找性伙伴的调查对象性伙伴个数明显高于那些未利用过网络寻找性伙伴的调查对象(Z=-4.220,P=0.000)。
(2)第1次性接触。418名男同性恋者发生第一次性行为的年龄最小11岁,最大30岁,中位数年龄为19岁,四分位距为4,有6人从来没有过性接触,两组间凡是有过性接触者第一次性接触的年龄无差异。82.3%(344／418)的男同性恋者第一个性伙伴为男性,16.3%(68／418)为女性；对照组当中,有119人(36.1%)从未有过性接触,第一个性伙伴为男性者13人(3.9%),198人(60.0%)第1个性伙伴为女性,两组差异有统计学意义(χ2=485.122,P=0.000)。
(3)和女性的性接触。所有男同性恋样本中共有126人(30.1%)与女性有过性接触,9.8%(40／418)的男同性恋者过去6个月内与女性有过性接触。
(4)固定性伙伴。90.7%(379／418)的男同性恋者在过去6个月内与同性有过性接触,性伙伴个数中位数为3,四分位距为4,最少1人,最多38人。对照组中,53.0%(175／330)在最近6个月内有性接触,性伙伴个数中位数为1,四分位距为1,最少1人,最多22人。在过去6个月内,男同性恋组性伙伴个数相对较多(Z=-10.878,P=0.000)。
到目前为止,有344名(82.3%)男同性恋者表示曾有过固定性伙伴,固定性伙伴中位数为3,四分位距为2；其中。53.1%(222／418)在过去半年内有过固定性伙伴,中位数为1,四分位距为0。
(5)临时性伙伴。过去6个月内,73.0%(305／418)的男同性恋者有过临时性伙伴,临时性伙伴中位数为4,四分位距为4,其中有28人临时性伙伴数大于或等于10人。有152名(36.4%)男同性恋者在过去半年内既有固定性伙伴也有过临时性伙伴。
(6)商业性性行为。在过去半年内,有16人(3.8%)有购买过商业性性行为,有22人(5.3%)有提供过商业性性行为,有6人在购买商业性性行为时有无保护肛交,有7人在提供商业性性行为时有无保护肛交。
6.性病、艾滋病
418名男同性恋样本中,在过去一年内,共有73人(17.5%)得过一种或一种以上性病,对照组男异性恋者当中有20人,差异有统计学意义(χ2=22.026,P=0.000)；418名男同性恋样本中,共有206人(49.3%)曾做过HIV检测,而在过去一年中做过HIV检测的有159人(38.0%),4人检测结果呈阳性,检出率2.5%。
7.负性生活事件
418名男同性恋者负性生活事件刺激量得分在0-99分之间,得分中位数为10分,四分位间距=13分(P25=5,P75=18)。对照组负性生活事件刺激量得分在0-64分之间,得分中位数为5分,四分位间距为7分。Mann-Whitney U检验结果显示两组负性生活事件刺激量差异有统计学意义(Z=-5.272,P=0.017),男同性恋组一年内负性生活事件刺激量大。
将男同性恋主要负性生活事件按相对危险度大小排序,前5位依次是：“您从内心接受了自己很可能是或曾是同性恋者”,“您有轻度的经济困难”,“您和您爱人的恋人关系结束了(并非由于出国、爱人去世等外部因素导致)”,“因为小病、小伤需要看医生或者休息几天不工作”,“您和您爱人争吵越来越多”。
8.社会支持
418名男同性恋者SSRS得分范围为16-54分,平均得分32.17±6.69。t检验结果显示,男同性恋组在主观支持、客观支持、支持利用度三个维度及SSRS总分均低于异性恋者(t=-8.914-14.826,P=0.000)。
9.自杀
在过去一年内,30.6%的男同性恋者有自杀意念,对照组中,7.9%有自杀意念,两组差异有统计学意义(χ2=58.385,P=0.000)。24名男同性恋者有自杀的计划,9人做了自杀准备,在过去12个月中有10人采取过自杀行为。而到目前为止,有19人(4.5%)因为自杀而被救治过。
单因素分析结果显示,负性生活刺激量、出柜是男同性恋者自杀的危险因素,在控制了其他因素后,负性生活刺激量、出柜仍然是男同性恋者自杀的危险因素,OR值分别为,2.17(P=0.001),1.63(P=0.037)。
10.亲密关系暴力
34.7%的男同性恋者曾遭遇过亲密关系暴力。32.3%遭遇过精神暴力,7.9%遭遇过躯体暴力,9.6%遭遇过性侵害,与对照组异性恋者相比差异有统计学意义(Z=-7.543,P=0.000)。
11.生理健康、心理健康及其影响因素分析
SF-36 v2量表通过因子分析方差最大旋转法产生了两个主成分,分别代表生理健康(PCS)和心理健康(MCS),解释了57.12%的总方差。Mann-Whitney U检验结果显示,男同性恋组生理健康、心理健康得分均低于异性恋组,差异有统计学意义(Z值分别为-7.140,-13.075,P值均为0.000)。在控制了年龄、学历、原户籍、婚姻状况、性病史、社会支持、自杀意念、亲密关系暴力等因素后,两组生理健康(OR=8.454,95%CI：3.983-17.945)、心理健康(OR=26.345,95%CI：11.359-61.103)差异仍然明显(P=0.000)。
多因素Ordinal回归分析结果显示,影响男同性恋人群生理健康的因素有性角色(Χ3)、出柜(Χ6)、性病史(Χ7)、自杀意念(Χ9)和亲密关系暴力(Χ10),logit模型为：
Logit1=-2.583+0.444X3+0.779X6+0.835X7+1.032X9+0.723X10;
影响男同性恋人群心理健康的因素有性角色(Χ3)、社会支持(Χ8)、自杀意念(Χ9)和亲密关系暴力(Χ10),logit模型为：
Logit1=-4.136+0.621X3+0.897X8+1.324X9+1.033X10
本部分研究共收回有效样本2202人。男1208人(54.9%),女994人(45.1%)；年龄16-71岁,平均(33.13±16.47)岁；820人(37.2%)来自城市,1275人(57.9%)来自农村,107人(4.9%)未报告此项资料；182人(8.3%)学历为初中、高中或中专,大专学历1057人(48.0%),本科学历904人(41.1%),硕士及以上59人(2.7%)；未婚1806人(82.0%),已婚396人(18.0%)；在职569人(25.8%),27人(1.2%)待业,学生1606人(72.9%)。
2202名社会公众ATLG量表平均得分为60.26±12.71,得分范围从24-99分,全距75分,将得分分成三段,显示：17.6%的调查对象得分位于24-48分,69.1%得分位于49-74分,13.2%得分位于75-99分。
①社会公众男同性恋态度子量表(ATG)得分(33.43±7.25)高于女同性恋态度子量表(ATL)得分(26.84±6.64)(t=-40.555,P=0.000)；②男性ATLG得分(63.60±12.94)高于女性得分(56.15±11.14)(t=12.638,P<0.001)；③未婚者ATLG得分(59.75±12.34)低于已婚者得分(75.98±14.05)(t=-9.385,P<0.001)；④来自于农村的样本ATLG得分(62.64±12.26)高于来自城市样本得分(55.57±13.91)(t=-11.917,P<0.001)；⑤在职人员ATLG得分(68.91±16.03)高于学生得分(59.30±11.91)(t=7.52,P<0.001)；⑥初中、高中、及中专学历组ATLG得分为65.17±13.30,大专组ATLG得分为62.38±11.44,本科及以上学历组得分(57.89±13.53)(F=28.32,P<0.001)。⑦此外,20个条目中,条目17.“如果我的儿子是同性恋者,我不会感到非常难过”得分最高(3.85±1.102)。
Ordinal多因素分析结果显示：影响社会公众同性恋态度的因素主要有：年龄(Χ1)、性别(Χ2)、原户籍(Χ3)、婚姻状况(Χ4)、学生或在职(Χ5)、学历(Χ6)。logit模型为：
Logit1=-7.074+0.431X1+1.195X2+0.297X3+1.680X4+0.833X5+0.818 X6
该部分研究共收回有效样本701人。其中大学生样本404人,男生210人,女生194人,年龄17-25岁,平均(19.66±1.03)岁,193名学生10天后接受了重测；社区居民297人,男性144人,女性153人；年龄18-71岁,平均年龄45.54±15.24岁。
ATLG量表的重测相关系数为0.967,子量表ATL、ATG的重测相关系数分别为：0.941,0.952；20个条目与总分的相关系数在0.415-0.738之间；ATLG总量表的Cronbach'sα系数为0.913,两个子量表ATL和ATG的Cronbach'sα系数分别为0.867和0.879；将总量表与各子量表分半为奇数项和偶数项,ATLG的分半信度为0.934。ATL分半信度为0.868,ATG分半信度为0.878。
因子分析结果显示,ATLG量表抽取了3个公因子,累计方差解释率为53.788%。因子1是对女同性恋的信念,包括条目3、5、6、8、9、10；因子2是对男同性恋的信念,主要涉及男同性恋的权利和固有模式,包括条目ATG子量表所有条目；因子3是社会制裁,包括条目2、4、7；ATL子量表有1个因子,累计方差解释率的46.221%,为对女同性恋的信念；ATG子量表有1个因子,累计方差解释率的48.676%,是对男同性恋的信念。
结论
1.男同性恋人群恋爱关系不稳定、维持时间较短,且绝大多数在与伴侣生活时对未来没有规划。多数男同性恋者表示会选择和异性结婚,并希望有孩子。形式婚姻(即男同和女同结婚)成为男同性恋者考虑的一种新的婚姻形式。
2.男同性恋人群更多地依赖与网络来寻找性伙伴,性关系松散,危险性行为严重,患性病、艾滋病的可能性较大。
3.男同性恋人群经历的负性生活事件刺激量大,亲密关系暴力比例较高,社会支持水平较低,自杀现象严重。
4.男同性恋人群生存状况较差,生理健康和心理健康水平较低。在同性性关系中被动,出柜,有性病史,有自杀意念,有亲密关系暴力是男同性恋者生理健康差的主要危险因素；在同性性关中主动,社会支持水平高,没有自杀意念,没有亲密关系暴力则是男同性恋者心理健康差的主要保护因素。
5.社会公众对男同性恋者态度比对女同性恋的态度更严厉,17.6%的社会公众对同性恋持接受态度,最难以接受自己的儿子是男同性恋者。社会公众对同性恋的态度与年龄、性别、原户籍、婚姻状况、学生或在职、学历有关。
6.Gregory M. Herek编制的ATLG量表具有良好的信度和效度,可以作为国内同性恋态度及其相关研究的测评工具。
本研究以长沙市区男同性恋人群为研究对象,采用对照设计横断面调查,从社会人口学变量、恋爱关系、性行为特征、自杀、负性生活事件、社会支持水平、生理健康、心理健康等方面,清晰、详实地描述了这一人群的生存状况,为今后城市男同性恋人群的危机干预提供了科学依据。
本研究采取网络随机抽样选取男同性恋样本,并最终收回有效样本418人。这种利用网络选取男同性恋样本的方法,是男同性恋研究方法学上的一个新尝试。
本研究首次采用了同性恋态度量表评估了社会公众对同性恋的态度,研究中采用的同性恋态度量表是首次国内使用,此次研究对其进行了修订并检验了其信度和效度,为今后相关的研究提供了一个较为科学的研究工具。
Background
The homosexual phenomenon has been being gained much more attentions over the past 30 years. In the 1980s, human immunodeficiency virus (HIV) was found, and gay men was identified as high-risk group of AIDS. Since then, more efforts were spent in the field of gay men. Research on the influence of homosexual behaviors to themselves and our society has become hot issues in social science and public health. The relevant research subjects are as follows:the cause of homosexuality, lifestyles and living conditions of homosexuals, intimate relationship and violence, their psychosomatic health, homosexual behavsiors and AIDS/STDs, attitude towards homosexual, and so on.
However, there are two major methodology problems in those research:①the representation of samples. Gay man was a hard-to-reach population. At present, there are two basic sampling strategies:one is using personal contacts of the researchers or other participants, which is usually described as "friendship networks" or "snowballing" procedures; The other is to recruite samples through organizations, newsletters, businesses, or social events of lesbian, gay, or bisexual communities. The samples selected through these two strategies are lack of diversity and representativeness. Currently, there is a new sampling method, Respondent-driven Sampling (RDS), in some relevant researches among hard-to-reach population. The RDS is the improvement of "snowballing", and similar to the probability sampling. However, it still has many limitations, and needs to be further applied and improved.②Most of studies on homosexual had no control group. Usually, the descriptions and analyses of a single group sample could not explain the phenomenon very deeply.
Under the current circumstance of Chinese social culture, the characteristics and problems of the homosexual group's living conditions are:①Homosexual relationship is unstable, and their sex partners is changeful. There is no doubt that they are more vulnerable to be infected by various STDs (include AIDS);②Most lesbians and gay men have moral guilty and psychological stress. Once they meet some emotional problems, they may lose control and conduct suicide, self-mutilation, and so on;③Lesbians and gay men may bring themselves and their family members heavy mental distress. Further more, it is miserable if they get married with a heterosexual people. As an objective subculture, the homosexual population is in great need of social support, but the truth is that their living conditions are getting much worse than before by the exclusion of major society.
This study was a cross-sectional research to outline the gay men's living conditions in Changsha. We measured some important issues, such as:socio-demographic features, dating relationships, sexual behavior features, suicide behaviors, life events, social support, dating-violence and life quality. Then, these datas were compared with a heterosexual control group. Results from this study could provide a scientific basis to improve the gay men's physical and psychological health and give evidence to take measures to combat the spread of AIDS and STDs.
Goals and Objectives
The goal of the study is to learn about the urban gay men's living conditions, including livelihood, occupations, health status, social communication, etc., analyze the related factors of gay men's PCS (Physical Component Scale) and MCS (Mental Component Scale),and then to provide a scientific basis to improve the gay men's physical and psychological health and give evidence to take measures to combat the spread of AIDS and STDs. The specific objectives include:
①To summarize the gay populations'socio-demographic features;
②To describe the relationship between their sexul behaviors and STDs;
③To explore the suicide ideation and behaviors, dating violence, dating relationship, negative life events, social support, and quality of life.
④To analyze the related factors of gay men's PCS and MCS.
⑤To describe the public's attitudes toward lesbians and gay men, and analyze the main related socio-demographic factors.
⑥To translate and revise the Attitudes toward Lesbians and Gay Men Scale(ATLG, Gregory M. Herek,1994) to Chinese, and examine its reliability and validity under China's social-culture background.
Methods
In this study, we identified all respondents'sexual orientation according to their self-reports. Before the formal investigation, all respondents were asked to report their sexual orientation (homosexual, bisexual, heterosexual or transsexual). If the answer was not homosexual,then the investigation would be stopped immediately.
In early stage, researchers had joined in many gay men parties and investigated 105 gay men. The results showed that 96.2% people usually used homosexual forum and QQ to interact with others. So we decided to sample gay men on internet randomly. In mainland, there are 5 famous gay websites:www.pybk.com, www.boysky.com, www.bf99.com, www.94gay.com and www.69py.com. Up to June,2009, the number of gay men in Changsha who registered on the 5 websites was nearly 12,000 person times, and, there were about 100 gay QQ groups, nearly 6,000 person-times. Therefore, the sampling frame included about 18,000 person-times. Then as considering the criterion (250-400) especially for STDs high risk group which recommended by the World Health Organization, we finally decided to investigate 500 samples.
All subjects in control group were come from Physical Examination Center of XiangYa Hospital. In order to improve the balance of comparability, we selected the control subjects matached gender, educational background and age (±1) to the gay men. If they are college students, then the grade should be matached. With the permition of the sample, face-to-face interviews were conducted in all respondents.The content of investigation includes:
①Social demography characteristics (with self-designed questionnaires);②characteristics of sexual behaviors and status of STDs (with self-designed questionnaires);③dating relationships and desire of heterosexual marriage (with self-designed questionnaires);④suicide ideation and behaviors (with Ronald C. Kessler's suicide questionnaire);⑤dating violence (with the Massachusetts Youth Risk Behavior Survey);⑥negative life event (Gay Affect and Life Events Scale, GALES);⑦social support (Social Support Rating Scale, SSRS);⑧quality of life (the version 2 of the SF-36 health survey);⑨public attitudes toward lesbians and gay men (ATLG, Gregory M. Herek,1994).
Data Analysis:Established the database with EpiData 3.0, and then the data were processed with SPSS 17.0. A P-value of less than 0.05 was considered statistically significant. Bivariate analyses included chi-square tests. The mean scores on the different groups were compared with each other using the T square test, Analysis of Variance, Mann-Whitney Test or Kruskal-Wallis Test. Multiple Ordinal regression was used to examine the influence of PCS, MCS and public attitudes toward lesbians and gay men.
Results:
The study was conducted from March 5 to December 31,2009. Sixty gay subjects were unable to be contacted because their email, QQ, or phone numbers were all out of service, and 11 gay men rejected to be interviewed. The final number of the investigations is 429, and the response rate was 85.8%. Moreover,11 invalid questionnaires with incomplete answers or confused logic were eliminated. So, finally we got 418 valid gay samples. Addtionally, from November 1st to December 31st of 2009. we collected 330 straight men samples.
1. Basic features
In total, the present study used a convenience sample consisting of 418 subjects whose age ranged from 16 to 44 years old (median age= 24, P25=21.8, P75=26.0); Han Chinese accounted for 94.5%; ethnic minorities accounted for 5.5%; 72.0% came from cites and 28.0% were rural population; the only child accounted for 57.9%; 91.4% of the participants were single,7.9% were married, and 3(0.7%) were divorced; 159(38.0%) were students; 39(9.3%) people's education level was less than college, 111(26.6%) were junior college degree,207(49.5%) were bachelor degree, 60(14.4%) were master degree or above, and 1 person did not report.
Fifty eight point nine percent(246/418) had a job. Fifty three point eight percent(225/418) of respondents'payment was less than￥2000/month,25.6%(107/418) were between￥2000 and￥4000/month,15.3%(64/418) were￥4001-6000/month,4.8% (20/418) were￥6001-8000/month, and 2 (0.5%) persons were more than￥8000/month.
2. Sex role in homosexul relations
According to the practical situations, the study divided the sex role in homo-sex relations in 10 sections (from 0 to 1). "Zero" means never have penetrative sex, and on the contrary, "1" means only have penetrative sex. The respondents were asked to make a choice according to their true situations. In this study,0,0.1,0.2,0.3 were defined passive group, which included 125 subjects (29.9%); 0.4,0.5,0.6 were defined moderate group, which included 137 respondents (32.8%); and 0.7,0.8, 0.9,1 were defined active group which included 156 (37.3%)subjects.
3. Coming-Out
Coming-Out means that LGBT (lesbians, gay, bisexual, transsexual) discloses their sexual orientation in their life and work. In this study, 57.3% had ever come out. In those persons,5.0%(12/241) came out to their fathers,7.9%(19/241) came out to mothers,12.9%(31/241) once came out to their brothers and/or sisters,63.1%(152/241) came out to classmates,and 49.4%(119/241) came out to workmates or friends. It is noteworthy that none of 33 married gay men disclosed the sexual orientation to their wives.
4. Dating relationships, desire of heterosexual marriage and procreation
Compared to the control group, fewer gay man had stable love relationship during the research (χ2=21.671, P=0.001); their love duration was relatively short (x2=57.391, P=0.000), and 44.0% was less than 7 months. Among 385 unmarried gay men,13.5%(52/385) expressed definitely that they would not get married with women, and 37.1%(155/418) expected to marry a lesbian; additionally,74.9% (313/418) of gay men were eager for bearing or raising a child.
5. Characteritics of gay men's sexual behaviors
(1) Looking for sex partner by internet. Compared with the control group, gay men were even more likely to look for sex partners by internet (χ2=322.883, P=0.000), and 85.6% of subjects reported they ever looked for a sex partner in internet. Obviously, over the last six months, the number of sexual partners of subjects who often look for sex partners in internet was more than others (Z=-4.220, P=0.000)
(2) First sexual experience:among 418 gay men,6 men never had sex behaviors; as to others, the age of first sex ranged from 11 to 30 years old (median age=19, QR=4); and there were no significant difference between gay men and straight men; For the experience of first sex partner, 344 (82.3%) gay men's were male, and other 68 (16.3%) were female; in control group, there were 119 man never had sex behaviors,7(2.1%) subjects'first sex partners were male, and other 198 (60.0%) straight men's were female; and there was statistical difference between the two groups (χ2=485.122, P=0.000)
(3) Sexual contact with female. There were 126(30.1%) gay men ever had sex with female, and in the last six months,9.8%(40/418) had sexual contacts with female.
(4) Regular sexual partners. In the last 6 months,90.7%(379/418) gay subjects had sex with other men. The median number of the sexual partners was 3, QR=4, and 1 at least and 38 at most. In the control group, 53.0%(175/330) had sex behaviors over the last 6 months. As for the number of sexual partners, the median was 1, QR=1, and the smallest was 1 and the maximum was 22. There was a significant difference between the two groups(Z=-10.878, P=0.000).
Up to now,82.3%(344/418) ever had regular sex partners. The median was 3, QR=2. And,53.1%(222/418) had regular sex partners in the last 6 months, and the median is 1, QR=0.
(5) Casual sex partners. In the last 6 months,73.0%(305/418) of gay men at least had one casual sex partner; the median was 4, QR=4; 6.7% of them had equal to or more than 10 casual sex partners; and 36.4% of them not only had regular sex partners but also had casual sex partners in the last 6 months.
(6) Commercial sex partners:In the latest 6 months,3.8%(16/418) had ever purchased commercial sexual behaviors; 5.3%(22/418) had ever provided commercial sexual behaviors; 6 respondents had unprotected sexual behavior when was purchased commercial sexual behaviors, and 7 respondents had unprotected sexual behaviors when provided commercial sexual behaviors.
6. STDs and AIDS
In the past year,73 (17.5%) respondents were infected with at least one kind of STDs, and there were 20 people in control group; there was a signigicant difference (χ2=22.026, P=0.000). Among the 418 gay men, 49.3%(206/418) had ever taken a HIV antibody test; in the past year,159 (38.0%) persons had taken a HIV antibody test, and 4 respondents were proved positive.
7. Negative life events
The negative life events stimulating quantity of gay men group were scored from 0 to 99. The median score is 10, QR=13(P25=5, P75=18). In the control group, the scores was 0 to 64, and the median was 5, QR=7. Mann-Whitney U test showed that there was a significant statistical difference between the two groups (Z=-5.272, P=0.017), and the gay men's quantity of stimulus from negative life events were higher.
Sorted these gay negative life events by danger level, the top five were: "You admitted to yourself that you could be/were gay", "you had moderate financial difficulties", "Your relationship with your lover ended(not because of outside factors like having to leave the country or death)", "You had a minor illness or injury like one needing a visit to the doctor or a couple of days off work", "There have been increasing serious arguments with you your lover"
8. Social support
The scores of SSRS of 418 gay men were ranged from 16 to 54, and the mean was 32.17±6.69. T-test showed that there were significant differences between gay men and straight men (t=-8.914-14.826, P=0.000) in subjective support, objective support and utilization of social supports.
9. Suicide
Tirty point six percent of the gay subjects ever had suicide ideation during the past year, and there were 7.9% in the control group. There was stastistical significant difference between two groups (χ2=58.385, P=0.000). Twenty four (5.7%) gay men had a suicide plan,9 gay men were ready to suicide,10 gay men had ever commit suicide during the past year, and 19 gay respondents (4.5%) were treated because of suicide.
Single factor analysis showed that quantity of stimulus from negative life events and coming out are main risk factors of gay men suicide. After controlling other risk factors, these two are still important risk factors, OR was 2.17(P=0.001),1.63(P=0.037)respectively.
10. Dating violence
Gay men who ever suffered from dating violence was 34.7%, mental violence was 32.3%, physical violence was 7.9%, and sexual violencewas 9.6%. Compared to the control group, there were signigicant differences (Z=-7.543, P=0.000).
11. PCS, MCS and related factors
For SF-36 v2, an extraction procedure was used for main components with VARIMAX command. The scale factor structure illustrated the presence of 2 factors explaining 57.12%% of the total variance; one was PCS, and the other was MCS. Mann-Whitney U test showed that the scores of gay men's PSC and MCS were less than the control group(Z=-7.140,-13.075, P=0.000). After controlling other risk factors(age, education background, original household registration, marital status, history of STDs, suicide ideation, dating violence), there was still a notable difference between the two groups in PCS(OR=8.454, 95%CI:3.983-17.945) and MCS(OR=26.35,95%CI:11.359-61.103).
Multifactor retrospective Ordinal analysis showed that sex role in same-sex sexual relations(X3), coming-out(X6), history of STDs(X7), suicide ideation(X9) and dating violence(X10) were the major related factors of PCS. The regression model was as follows:
Logit1=-2.583+0.444X3+0.779X6+0.835X7+1.032X9+0.723X1o
In Addition, sex role in same-sex sexual relations(X3)、social support(X8)、suicide ideation(X9)and dating violence(X10)were the major related factors of MPCS. The regression model was as follows:
Logit1=-4.136+0.621X3+0.897X8+1.324X9+1.033X10
In total,2202 effective subjects were recruited into this study,1208 men (54.9%) and 994 women (45.1%) whose ages ranged from 16 to 71 years old (M=33.13, SD=16.47); 820(37.2%) came from cities and 1275(57.9%) were rural population, other 107 (4.9%) did not report this data; 182 (8.3%) were less than college,1050 (48.0%) were junior college degree,904 (41.1%) were bachelor degree, and 59 (2.7%) were master or doctor degree; 1806 (82.0%) of the participants were single, 396 (18.0%) were married; 569 (25.8%) were reported to have a job,27 (1.2%) were unemployed, and 1606 (72.9%) were students.
The scores of ATLG of all the 2202 straight subjects were ranged from 24 to 99, the mean score was 60.26±12.71. The full range is 75; after dividing the full range into three sections, the results showed that 17.6%respondents'scores were 24-48,69.1%were 49-74, and 13.2% were 75-99.
All 2202 subjects'scores of ATG (33.43±7.25) were higher than ATL (26.84±6.64) (t=-40.555, P=0.000);②The male's ATG scores (63.60±12.94) were higher than female's (56.15±11.14) (t=12.638, P＜0.001);③The unmarried subjects'ATLG scores (59.75±12.34) were less than the married subjects'(75.98±14.05) (t=-9.385, P＜0.001).④The rural subjects'ATLG scores (62.64±12.26) were higher than urban subjects'(55.57±13.91) (t=-11.917, P＜0.001).⑤The employed subjects' ATLG scores (68.91±16.03) were higher than unemployed subjects' (59.30±11.91)(t=7.52, P＜0.001);⑥The ATLG scores of those subjects less than college was 65.17±13.30, subjects of junior college degree was 62.38±11.44, and those subjects higher than bachelor degree was (57.89±13.53) (F=28.32, P<0.001);⑦The best ranking item was "I would not be too upset if I learned that my son were a homosexual." (3.85±1.102).
Multifactor retrospective Ordinal analysis showed that age (X1), gender (X2), original household registration (X3), marital status (X4), employed or unemployed (X5) and education background (X6) were the major related factors to the attitudes toward lesbians and gay men. The regression model was as follows:
Logit1=-7.074+0.431X1+1.195X2+0.297X3+1.680X4+0.833X5+0.818 X6
In total,701 effective subjects were recruited into this study,; they were consisted of two parts:①404 college students:210 men and 194 women whose ages ranged from 17 to 25 years old(M=19.66, SD= 1.03); 10 days after the first test,193 students were re-tested;②297 community residents:144 men and 153 women whose ages ranged from 18 to 71 years old(M=45.54, SD=15.24).
The test-retest coefficients of subscales were 0.941,0.952, and of total-scale,0.967; Correlation coefficients between each item and the total ATLG score ranged from 0.415 to 0.738; Cronbach's a coefficient of the total-scale and two sub-scales were 0.913,0.867 and 0.879, respectively; the split-half reliability of the scales ranged from 0.868 to 0.934.
The ATLG scale factor structure illustrated the presence of 3 factors explaining 53.788% of the total variance. The items 1,3,5,6,8,9,10 were the first cluster of factors, which conceptually represented beliefs toward lesbians. All items of the ATG scale were the second cluster of factors, which conceptually represented beliefs toward gay men. The items 2,4,7 were the third cluster of factors, which conceptually represented social sanction. For the ATL subscale, the factor structure showed one main factor that would explain 46.221% of the variance, which conceptually represented beliefs toward lesbians. And for the ATG subscale, the factor structure also showed one main factor that would explain 48.676% of the variance, which conceptually represented beliefs toward gay men.
Conclusions:
1. Gay men's dating relationships are unstable and short duration, and most gay men have no plan for their future when they fall in love; most gay men will marry a heterosexual woman, and want to have children; the form marriage (a gay marry a lesbian) has became a new marriage way in gay men population.
2. Gay men are even more likely to look for sex partners through internet; the sexual relationships are unstable; dangerous sex behavior are common; and there are a great possibility to be infected with STDs and AIDS.
3. The negative life events stimulating quantity of gay men are great; there are higher rates of dating violence; they have low social support; and suicide has become a serious social problem among them.
4. The Gay men's living conditions are relatively poor, and the level of their physiological and psychological health conditions are relatively low. Playing a passive role in homosexual relations, suffering from STDs, suicide ideation and dating violence were main risk factors to gay men's poor PCS; playing an active role in homosexual relations, higher SSRS, no suicide ideation and dating violence were main protective factors to gay men's poor MCS.
5. Seventeen point six percent of publics hold positive attitudes toward lesbians and gay men; all publics hold more negative attitudes toward gay men than lesbians; for all subjects, the most intolerable thing is their own son is a gay.
6. The attitudes toward lesbians and gay men were related to age, gender, original household registration, marital status, employment status, and education background.
7. The Attitudes toward Lesbians and Gay Men Scale designed by Gregory M. Herek has a good reliability and validity in Chinese, and can be used in research of attitudes toward lesbians and gay men in the social cultural context of China.
Significances and innovations
This research has taken gay men in Changsha as the research subjects. A cross-sectional and case-control study was conducted to describ their sociodemographic features, romantic relationships, features of their sexual behaviors, suicide, life events, social support, dating-violence and quality of life clearly and detailedly. The scientific basis has been provided to improve the gay men's living conditions and take a more targeted crisis intervention。
The study recruited samples through internet randomly, and 418 effective samples were included at last. Research about gay men are very difficult, and this study has provided a new way to solve this problem. It's a totally new try of methodology.
This study was the first attempt to test the reliability and validity of Herek's Attitudes toward Lesbians and Gay Men Scale (ATLG) in China. It provided a more scientific tool to study the attitudes toward homosexuality. Then, we used the ATLG scale to assess the public's attitudes toward lesbians and gay men.
在过去的30年,同性恋现象得到了社会越来越广泛的关注,自上个世纪80年代发现艾滋病病毒(human immunodeficiency virus, HIV)并明确了男同性恋人群是艾滋病高危行为人群之后,对男同性恋的研究受到了前所未有的重视,同性恋及其对社会、对同性恋者自身的影响成为了社会科学、公共卫生的一个热点研究领域,涉及的研究主要包括：同性恋的成因,同性恋者的生活方式和生存状况,亲密关系暴力行为,同性恋者的心身健康,同性性行为与艾滋病、性病传播的关系、社会对同性恋的态度等方面。
但是,已有的相关研究存在两个主要的方法学问题：①样本的代表性问题。男同性恋人群是“难以接近的人群”(hard-to-reach population),目前抽取男同性恋研究样本的策略主要有两类：研究人员利用与调查对象的个人联系收集样本,经常被称之为“友谊网络”(friendship networks)或“滚雪球”(snowballing);通过GLB (gay men, lesbians and bisexuality)社区的社会活动、组织机构、商业活动、或是新闻事件等进行公开招募。用这两类方法获得是非概率样本,其代表性不理想。目前,也有一些涉及难以接近人群的相关研究开始采用一种新的抽样方法——同伴推动抽样法(Respondent-driven Sampling, RDS),这种方法是滚雪球抽样法的升级,近似概率抽样方法,但这种新方法也仍有许多局限,有待于进一步应用和完善。②多数涉及同性恋研究基本上没有一个对照组,单组样本的描述和分析在许多方面并不能很深刻地阐述问题。
在当前中国社会文化背景下,我国同性恋人群的生存现状主要存在以下几个方面的问题：①同性恋者的性关系松散,性对象多变,容易感染各种性传播疾病(包括艾滋病)；②同性恋者自身大多具有道德罪恶感,其心理压力大,承受能力不佳,一旦遇到一些情感问题,容易表现出一些失控行为,如自杀、自伤等；③同性恋本身给自己及其家属带来很大的精神痛苦,同性恋者所缔结的异性婚姻则更为不幸。同性恋人群作为客观存在一个亚文化群体,急需社会的关心和帮助,但事实上主流社会的排斥却使得同性恋人群的生存状况更加艰难。
本研究采用对照设计横断面调查,对长沙市区男同性恋人群的社会人口学特征、恋爱关系、性行为特征、自杀、生活事件、社会支持、亲密关系暴力和生活质量等多项指标进行测定,并与异性恋对照组进行比较分析,为提高城市男同性恋人群的身心健康水平,预防男人同性恋人群性病、艾滋病的传播提供了科学的依据。
目的
本研究的总目标是在中国当前社会文化背景下,来了解城市男同性恋人群的生活、工作、健康、社会交往等生存状况,分析影响男同性恋人群生理健康和心理健康的影响因素,为提高男同性恋人群身、心健康水平以及预防男同性恋人群性病、艾滋病传播提供科学依据。具体目的包括：
①描述男同性恋人群的社会人口学特征；②描述男同性恋人群的性行为特征及患性传播疾病情况；③描绘男同性恋人群的恋爱关系、自杀意念、亲密关系暴力、负性生活事件、社会支持水平以及生活质量；④分析影响男同性恋人群生理健康、心理健康的影响因素；⑤了解社会公众对同性恋的态度并分析其主要社会人口学影响因素；⑥翻译、修订同性恋态度量表,并在中国的社会文化背景下检验其信度和效度。
方法
本研究中,所有调查对象的性取向以自我报告为准。在调查过程中首先要求调查对象对自己的性取向做一个简单的自我鉴定,在同性恋、双性恋、异性恋、易性癖四者中做出选择,如受试性取向不符合调查要求,则结束该次调查访谈。
前期,研究者参加了各种男同性恋聚会活动,对参与聚会的共105名男同性恋者进行了问卷调查。结果显示,96.2%经常利用网络来进行互动。因此,本研究决定通过网络随机抽样选取男同性恋样本。目前,中国国内最有影响、且注册人数最多的男同性恋交友网站主要有以下5家：朋友别哭(www.pybk.com),阳光地带(www.boysky.com),Bf99华人同志交友网站(www.bf99.com),同志朋友网(www.94gay.com),69PY交友网(www.69py.com)共5家。截至2009年6月,长沙男同性恋者在这5个同性恋网站上注册近1,2000人次,长沙市男同性恋QQ群将近100个,约6,000人次,初步确定样本抽样框为18,000人次。
在参考了世界卫生组织以及中国疾病预防控制中心推荐的性传播感染高危人群哨点监测的样本量标准(一般在250-400人)的基础上,最终确定抽取样本500人。收集所有网络注册及QQ群用户男同性恋者的QQ号码、Email地址或电话号码等资料,而后从抽样框中随机抽取男同性恋样本500人,排除有一部分男同性恋者在几个网站重复注册的可能,因此在抽样过程中剔除QQ号码、Email地址、电话号码等资料重复者,直至抽满500人为止。
对照组异性恋样本来自湘雅医院体检中心的体检人员,为了提高研究的均衡可比性,按年龄、性别和学历选择对照。对照组异性恋者与同性恋者同性别、同学历,年龄相差在1岁以内,而高校学生样本则按年级匹配。所有样本以面对面访谈的调查方式,在取得知情同意的条件下,以定式访谈问卷对调查对象进行现场调查,具体调查内容包括：
①社会人口学特征：采用自编一般情况调查表进行调查；②性行为特征及患性传播疾病的情况：采用自编问卷进行调查；③恋爱情况、异性婚姻意愿等：采用自编调查表进行调查；④自杀意念以及自杀行为：采用Kessler设计的自杀问卷调查；⑤亲密关系暴力：采用马萨诸塞青年危险行为调查问卷；⑥负性生活事件：采用Rosser和Ross构建的男同性恋生活事件量表(Gay Affect and Life Events Scale, GALES)来进行评估。⑦社会支持水平采用肖水源制定的社会支持评定量表(Social Support Rating Scale, SSRS)来评价；⑧生活质量：采用中文版SF-36 v2 (the version 2 of the SF-36 health survey)量表来测试；⑨社会公众对同性恋的态度：采用Gregory M. Herek设计男、女同性恋态度量表(ATLG, Gregory M. Herek,1994)来评估
资料分析方法：采用EpiData 3.0建立数据库,用SPSS 17.0进行统计学分析,取检验水准(α)为0.05,不同组间阳性率的比较采用χ2检验(Pearson Chi-Square Test)。不同组间计量指标的比较采用t检验或方差分析,对不符合参数检验条件的采用Mann-Whitney Test或Kruskal-Wallis Test等非参数检验方法。多因素分析采用Ordinal等级回归分析。
通过网络抽样,于2009年3月5日-2009年12月31日进行了男同性恋者的调查,有60人在网上注册的QQ号码或手机号已经停止使用而无法联系,有11人拒绝调查,最终完成调查的男同性恋人数为429人,应答率为85.8%,剔除有大量遗漏或是逻辑严重混乱的无效问卷11份,最终获得418名有效样本；于2009年11月1日-12月31日进行了对照组样本的调查,最终共取得有效样本330人。
1.社会人口学特征
418名有效男同性恋样本中,年龄最小为16岁,最大为44岁,中位数年龄为24岁(P25=21.8,P75=26.0)；94.5%汉族,少数民族占5.5%；72.0%原户籍为城市,28.0%为农村；独生子女占57.9%；91.4%未婚,7.9%已婚,离异3人(0.7%)；在读学生159人(38.0%)；39人(9.3%)未读大学,专科学历111人(26.6%),本科学历207人(49.5%),硕士及硕士以上学历60人(14.4%),1人未报告学历情况。
58.9%(246／418)的男同性恋者目前正式在职。53.8%(225／418)的男同性恋者月收入在2000以下,25.6%(107／418)月收入在2000-4000之间,15.3%(64／418)月收入4001-6000之间,4.8%(20／418)月收入在6001-8000之间,2人(0.5%)月收入在8000以上。
2.在同性性关系中的角色
本研究根据实际情况,将男同性恋者在同性性关系中扮演的角色从纯0到纯1划分为10段共11个点,由被调查者根据自身情况进行选择。纯0意指在男同性恋者之间的阴茎-肛门插入式性行为中只扮演被插入方的角色,没有过阴茎-肛门的插入式性行为；纯1意指在男同性恋者之间的阴茎-肛门插入式性行为中只扮演插入方的角色,没有过阴茎-肛门的被插入式性行为。本研究在分析过程中将纯0,0.1,0.2,0.3界定为被动组,共125人(29.9%),0.4,0.5,0.6界定为中间组,共137人(32.8%),0.7,0.8,0.9,1界定为主动组,共156人(37.3%)。
3.出柜
出柜(Coming-Out),是指LGBT (lesbian, gay, bisexual, transsexual)在自己的生活、工作圈子里公开自己的性取向。本研究男同性恋样本中,57.3%有出柜史。其中,5.0%(12／241)将自己的性取向告诉了父亲,7.9%(19／241)告诉了母亲,12.9%(31／241)告诉了兄弟姐妹,63.1%(152／241)曾将自己的性取向告诉过同学,49.4%(119／241)告诉过同事或朋友。而在已婚的33人中,未有1人将他们的性取向告诉过他们的妻子。
4.恋爱关系、异性婚姻及生育意愿
与异性恋者相比,男同性恋者当中目前有稳定恋爱关系者较少(χ2=21.671,P=0.001)；44.0%的男同性恋者与同性伴侣维持恋爱关系时间最长不足7个月,时间短暂(χ2=57.391,P=0.000)。除已婚的33人和离异的3人之外,其余382人当中,13.6%(52／382)明确表示将不会和异性结婚,37.1%(155／418)的男同性恋者希望能找女同性恋者缔结形式婚姻；74.9%(313／418)希望生育或抚养小孩。
5.男同性恋人群性行为特征
(1)利用网络寻找性伙伴。与异性恋者相比,男同性恋者更多地利用网络来寻找同性性伙伴(χ2=322.883,P=0.000),85.6%(358／418)的男同性恋者表示曾通过网络来寻找同性性伙伴。而在最近6个月内,有利用网络寻找性伙伴的调查对象性伙伴个数明显高于那些未利用过网络寻找性伙伴的调查对象(Z=-4.220,P=0.000)。
(2)第1次性接触。418名男同性恋者发生第一次性行为的年龄最小11岁,最大30岁,中位数年龄为19岁,四分位距为4,有6人从来没有过性接触,两组间凡是有过性接触者第一次性接触的年龄无差异。82.3%(344／418)的男同性恋者第一个性伙伴为男性,16.3%(68／418)为女性；对照组当中,有119人(36.1%)从未有过性接触,第一个性伙伴为男性者13人(3.9%),198人(60.0%)第1个性伙伴为女性,两组差异有统计学意义(χ2=485.122,P=0.000)。
(3)和女性的性接触。所有男同性恋样本中共有126人(30.1%)与女性有过性接触,9.8%(40／418)的男同性恋者过去6个月内与女性有过性接触。
(4)固定性伙伴。90.7%(379／418)的男同性恋者在过去6个月内与同性有过性接触,性伙伴个数中位数为3,四分位距为4,最少1人,最多38人。对照组中,53.0%(175／330)在最近6个月内有性接触,性伙伴个数中位数为1,四分位距为1,最少1人,最多22人。在过去6个月内,男同性恋组性伙伴个数相对较多(Z=-10.878,P=0.000)。
到目前为止,有344名(82.3%)男同性恋者表示曾有过固定性伙伴,固定性伙伴中位数为3,四分位距为2；其中。53.1%(222／418)在过去半年内有过固定性伙伴,中位数为1,四分位距为0。
(5)临时性伙伴。过去6个月内,73.0%(305／418)的男同性恋者有过临时性伙伴,临时性伙伴中位数为4,四分位距为4,其中有28人临时性伙伴数大于或等于10人。有152名(36.4%)男同性恋者在过去半年内既有固定性伙伴也有过临时性伙伴。
(6)商业性性行为。在过去半年内,有16人(3.8%)有购买过商业性性行为,有22人(5.3%)有提供过商业性性行为,有6人在购买商业性性行为时有无保护肛交,有7人在提供商业性性行为时有无保护肛交。
6.性病、艾滋病
418名男同性恋样本中,在过去一年内,共有73人(17.5%)得过一种或一种以上性病,对照组男异性恋者当中有20人,差异有统计学意义(χ2=22.026,P=0.000)；418名男同性恋样本中,共有206人(49.3%)曾做过HIV检测,而在过去一年中做过HIV检测的有159人(38.0%),4人检测结果呈阳性,检出率2.5%。
7.负性生活事件
418名男同性恋者负性生活事件刺激量得分在0-99分之间,得分中位数为10分,四分位间距=13分(P25=5,P75=18)。对照组负性生活事件刺激量得分在0-64分之间,得分中位数为5分,四分位间距为7分。Mann-Whitney U检验结果显示两组负性生活事件刺激量差异有统计学意义(Z=-5.272,P=0.017),男同性恋组一年内负性生活事件刺激量大。
将男同性恋主要负性生活事件按相对危险度大小排序,前5位依次是：“您从内心接受了自己很可能是或曾是同性恋者”,“您有轻度的经济困难”,“您和您爱人的恋人关系结束了(并非由于出国、爱人去世等外部因素导致)”,“因为小病、小伤需要看医生或者休息几天不工作”,“您和您爱人争吵越来越多”。
8.社会支持
418名男同性恋者SSRS得分范围为16-54分,平均得分32.17±6.69。t检验结果显示,男同性恋组在主观支持、客观支持、支持利用度三个维度及SSRS总分均低于异性恋者(t=-8.914-14.826,P=0.000)。
9.自杀
在过去一年内,30.6%的男同性恋者有自杀意念,对照组中,7.9%有自杀意念,两组差异有统计学意义(χ2=58.385,P=0.000)。24名男同性恋者有自杀的计划,9人做了自杀准备,在过去12个月中有10人采取过自杀行为。而到目前为止,有19人(4.5%)因为自杀而被救治过。
单因素分析结果显示,负性生活刺激量、出柜是男同性恋者自杀的危险因素,在控制了其他因素后,负性生活刺激量、出柜仍然是男同性恋者自杀的危险因素,OR值分别为,2.17(P=0.001),1.63(P=0.037)。
10.亲密关系暴力
34.7%的男同性恋者曾遭遇过亲密关系暴力。32.3%遭遇过精神暴力,7.9%遭遇过躯体暴力,9.6%遭遇过性侵害,与对照组异性恋者相比差异有统计学意义(Z=-7.543,P=0.000)。
11.生理健康、心理健康及其影响因素分析
SF-36 v2量表通过因子分析方差最大旋转法产生了两个主成分,分别代表生理健康(PCS)和心理健康(MCS),解释了57.12%的总方差。Mann-Whitney U检验结果显示,男同性恋组生理健康、心理健康得分均低于异性恋组,差异有统计学意义(Z值分别为-7.140,-13.075,P值均为0.000)。在控制了年龄、学历、原户籍、婚姻状况、性病史、社会支持、自杀意念、亲密关系暴力等因素后,两组生理健康(OR=8.454,95%CI：3.983-17.945)、心理健康(OR=26.345,95%CI：11.359-61.103)差异仍然明显(P=0.000)。
多因素Ordinal回归分析结果显示,影响男同性恋人群生理健康的因素有性角色(Χ3)、出柜(Χ6)、性病史(Χ7)、自杀意念(Χ9)和亲密关系暴力(Χ10),logit模型为：
Logit1=-2.583+0.444X3+0.779X6+0.835X7+1.032X9+0.723X10;
影响男同性恋人群心理健康的因素有性角色(Χ3)、社会支持(Χ8)、自杀意念(Χ9)和亲密关系暴力(Χ10),logit模型为：
Logit1=-4.136+0.621X3+0.897X8+1.324X9+1.033X10
本部分研究共收回有效样本2202人。男1208人(54.9%),女994人(45.1%)；年龄16-71岁,平均(33.13±16.47)岁；820人(37.2%)来自城市,1275人(57.9%)来自农村,107人(4.9%)未报告此项资料；182人(8.3%)学历为初中、高中或中专,大专学历1057人(48.0%),本科学历904人(41.1%),硕士及以上59人(2.7%)；未婚1806人(82.0%),已婚396人(18.0%)；在职569人(25.8%),27人(1.2%)待业,学生1606人(72.9%)。
2202名社会公众ATLG量表平均得分为60.26±12.71,得分范围从24-99分,全距75分,将得分分成三段,显示：17.6%的调查对象得分位于24-48分,69.1%得分位于49-74分,13.2%得分位于75-99分。
①社会公众男同性恋态度子量表(ATG)得分(33.43±7.25)高于女同性恋态度子量表(ATL)得分(26.84±6.64)(t=-40.555,P=0.000)；②男性ATLG得分(63.60±12.94)高于女性得分(56.15±11.14)(t=12.638,P<0.001)；③未婚者ATLG得分(59.75±12.34)低于已婚者得分(75.98±14.05)(t=-9.385,P<0.001)；④来自于农村的样本ATLG得分(62.64±12.26)高于来自城市样本得分(55.57±13.91)(t=-11.917,P<0.001)；⑤在职人员ATLG得分(68.91±16.03)高于学生得分(59.30±11.91)(t=7.52,P<0.001)；⑥初中、高中、及中专学历组ATLG得分为65.17±13.30,大专组ATLG得分为62.38±11.44,本科及以上学历组得分(57.89±13.53)(F=28.32,P<0.001)。⑦此外,20个条目中,条目17.“如果我的儿子是同性恋者,我不会感到非常难过”得分最高(3.85±1.102)。
Ordinal多因素分析结果显示：影响社会公众同性恋态度的因素主要有：年龄(Χ1)、性别(Χ2)、原户籍(Χ3)、婚姻状况(Χ4)、学生或在职(Χ5)、学历(Χ6)。logit模型为：
Logit1=-7.074+0.431X1+1.195X2+0.297X3+1.680X4+0.833X5+0.818 X6
该部分研究共收回有效样本701人。其中大学生样本404人,男生210人,女生194人,年龄17-25岁,平均(19.66±1.03)岁,193名学生10天后接受了重测；社区居民297人,男性144人,女性153人；年龄18-71岁,平均年龄45.54±15.24岁。
ATLG量表的重测相关系数为0.967,子量表ATL、ATG的重测相关系数分别为：0.941,0.952；20个条目与总分的相关系数在0.415-0.738之间；ATLG总量表的Cronbach'sα系数为0.913,两个子量表ATL和ATG的Cronbach'sα系数分别为0.867和0.879；将总量表与各子量表分半为奇数项和偶数项,ATLG的分半信度为0.934。ATL分半信度为0.868,ATG分半信度为0.878。
因子分析结果显示,ATLG量表抽取了3个公因子,累计方差解释率为53.788%。因子1是对女同性恋的信念,包括条目3、5、6、8、9、10；因子2是对男同性恋的信念,主要涉及男同性恋的权利和固有模式,包括条目ATG子量表所有条目；因子3是社会制裁,包括条目2、4、7；ATL子量表有1个因子,累计方差解释率的46.221%,为对女同性恋的信念；ATG子量表有1个因子,累计方差解释率的48.676%,是对男同性恋的信念。
结论
1.男同性恋人群恋爱关系不稳定、维持时间较短,且绝大多数在与伴侣生活时对未来没有规划。多数男同性恋者表示会选择和异性结婚,并希望有孩子。形式婚姻(即男同和女同结婚)成为男同性恋者考虑的一种新的婚姻形式。
2.男同性恋人群更多地依赖与网络来寻找性伙伴,性关系松散,危险性行为严重,患性病、艾滋病的可能性较大。
3.男同性恋人群经历的负性生活事件刺激量大,亲密关系暴力比例较高,社会支持水平较低,自杀现象严重。
4.男同性恋人群生存状况较差,生理健康和心理健康水平较低。在同性性关系中被动,出柜,有性病史,有自杀意念,有亲密关系暴力是男同性恋者生理健康差的主要危险因素；在同性性关中主动,社会支持水平高,没有自杀意念,没有亲密关系暴力则是男同性恋者心理健康差的主要保护因素。
5.社会公众对男同性恋者态度比对女同性恋的态度更严厉,17.6%的社会公众对同性恋持接受态度,最难以接受自己的儿子是男同性恋者。社会公众对同性恋的态度与年龄、性别、原户籍、婚姻状况、学生或在职、学历有关。
6.Gregory M. Herek编制的ATLG量表具有良好的信度和效度,可以作为国内同性恋态度及其相关研究的测评工具。
本研究以长沙市区男同性恋人群为研究对象,采用对照设计横断面调查,从社会人口学变量、恋爱关系、性行为特征、自杀、负性生活事件、社会支持水平、生理健康、心理健康等方面,清晰、详实地描述了这一人群的生存状况,为今后城市男同性恋人群的危机干预提供了科学依据。
本研究采取网络随机抽样选取男同性恋样本,并最终收回有效样本418人。这种利用网络选取男同性恋样本的方法,是男同性恋研究方法学上的一个新尝试。
本研究首次采用了同性恋态度量表评估了社会公众对同性恋的态度,研究中采用的同性恋态度量表是首次国内使用,此次研究对其进行了修订并检验了其信度和效度,为今后相关的研究提供了一个较为科学的研究工具。
Background
The homosexual phenomenon has been being gained much more attentions over the past 30 years. In the 1980s, human immunodeficiency virus (HIV) was found, and gay men was identified as high-risk group of AIDS. Since then, more efforts were spent in the field of gay men. Research on the influence of homosexual behaviors to themselves and our society has become hot issues in social science and public health. The relevant research subjects are as follows:the cause of homosexuality, lifestyles and living conditions of homosexuals, intimate relationship and violence, their psychosomatic health, homosexual behavsiors and AIDS/STDs, attitude towards homosexual, and so on.
However, there are two major methodology problems in those research:①the representation of samples. Gay man was a hard-to-reach population. At present, there are two basic sampling strategies:one is using personal contacts of the researchers or other participants, which is usually described as "friendship networks" or "snowballing" procedures; The other is to recruite samples through organizations, newsletters, businesses, or social events of lesbian, gay, or bisexual communities. The samples selected through these two strategies are lack of diversity and representativeness. Currently, there is a new sampling method, Respondent-driven Sampling (RDS), in some relevant researches among hard-to-reach population. The RDS is the improvement of "snowballing", and similar to the probability sampling. However, it still has many limitations, and needs to be further applied and improved.②Most of studies on homosexual had no control group. Usually, the descriptions and analyses of a single group sample could not explain the phenomenon very deeply.
Under the current circumstance of Chinese social culture, the characteristics and problems of the homosexual group's living conditions are:①Homosexual relationship is unstable, and their sex partners is changeful. There is no doubt that they are more vulnerable to be infected by various STDs (include AIDS);②Most lesbians and gay men have moral guilty and psychological stress. Once they meet some emotional problems, they may lose control and conduct suicide, self-mutilation, and so on;③Lesbians and gay men may bring themselves and their family members heavy mental distress. Further more, it is miserable if they get married with a heterosexual people. As an objective subculture, the homosexual population is in great need of social support, but the truth is that their living conditions are getting much worse than before by the exclusion of major society.
This study was a cross-sectional research to outline the gay men's living conditions in Changsha. We measured some important issues, such as:socio-demographic features, dating relationships, sexual behavior features, suicide behaviors, life events, social support, dating-violence and life quality. Then, these datas were compared with a heterosexual control group. Results from this study could provide a scientific basis to improve the gay men's physical and psychological health and give evidence to take measures to combat the spread of AIDS and STDs.
Goals and Objectives
The goal of the study is to learn about the urban gay men's living conditions, including livelihood, occupations, health status, social communication, etc., analyze the related factors of gay men's PCS (Physical Component Scale) and MCS (Mental Component Scale),and then to provide a scientific basis to improve the gay men's physical and psychological health and give evidence to take measures to combat the spread of AIDS and STDs. The specific objectives include:
①To summarize the gay populations'socio-demographic features;
②To describe the relationship between their sexul behaviors and STDs;
③To explore the suicide ideation and behaviors, dating violence, dating relationship, negative life events, social support, and quality of life.
④To analyze the related factors of gay men's PCS and MCS.
⑤To describe the public's attitudes toward lesbians and gay men, and analyze the main related socio-demographic factors.
⑥To translate and revise the Attitudes toward Lesbians and Gay Men Scale(ATLG, Gregory M. Herek,1994) to Chinese, and examine its reliability and validity under China's social-culture background.
Methods
In this study, we identified all respondents'sexual orientation according to their self-reports. Before the formal investigation, all respondents were asked to report their sexual orientation (homosexual, bisexual, heterosexual or transsexual). If the answer was not homosexual,then the investigation would be stopped immediately.
In early stage, researchers had joined in many gay men parties and investigated 105 gay men. The results showed that 96.2% people usually used homosexual forum and QQ to interact with others. So we decided to sample gay men on internet randomly. In mainland, there are 5 famous gay websites:www.pybk.com, www.boysky.com, www.bf99.com, www.94gay.com and www.69py.com. Up to June,2009, the number of gay men in Changsha who registered on the 5 websites was nearly 12,000 person times, and, there were about 100 gay QQ groups, nearly 6,000 person-times. Therefore, the sampling frame included about 18,000 person-times. Then as considering the criterion (250-400) especially for STDs high risk group which recommended by the World Health Organization, we finally decided to investigate 500 samples.
All subjects in control group were come from Physical Examination Center of XiangYa Hospital. In order to improve the balance of comparability, we selected the control subjects matached gender, educational background and age (±1) to the gay men. If they are college students, then the grade should be matached. With the permition of the sample, face-to-face interviews were conducted in all respondents.The content of investigation includes:
①Social demography characteristics (with self-designed questionnaires);②characteristics of sexual behaviors and status of STDs (with self-designed questionnaires);③dating relationships and desire of heterosexual marriage (with self-designed questionnaires);④suicide ideation and behaviors (with Ronald C. Kessler's suicide questionnaire);⑤dating violence (with the Massachusetts Youth Risk Behavior Survey);⑥negative life event (Gay Affect and Life Events Scale, GALES);⑦social support (Social Support Rating Scale, SSRS);⑧quality of life (the version 2 of the SF-36 health survey);⑨public attitudes toward lesbians and gay men (ATLG, Gregory M. Herek,1994).
Data Analysis:Established the database with EpiData 3.0, and then the data were processed with SPSS 17.0. A P-value of less than 0.05 was considered statistically significant. Bivariate analyses included chi-square tests. The mean scores on the different groups were compared with each other using the T square test, Analysis of Variance, Mann-Whitney Test or Kruskal-Wallis Test. Multiple Ordinal regression was used to examine the influence of PCS, MCS and public attitudes toward lesbians and gay men.
Results:
The study was conducted from March 5 to December 31,2009. Sixty gay subjects were unable to be contacted because their email, QQ, or phone numbers were all out of service, and 11 gay men rejected to be interviewed. The final number of the investigations is 429, and the response rate was 85.8%. Moreover,11 invalid questionnaires with incomplete answers or confused logic were eliminated. So, finally we got 418 valid gay samples. Addtionally, from November 1st to December 31st of 2009. we collected 330 straight men samples.
1. Basic features
In total, the present study used a convenience sample consisting of 418 subjects whose age ranged from 16 to 44 years old (median age= 24, P25=21.8, P75=26.0); Han Chinese accounted for 94.5%; ethnic minorities accounted for 5.5%; 72.0% came from cites and 28.0% were rural population; the only child accounted for 57.9%; 91.4% of the participants were single,7.9% were married, and 3(0.7%) were divorced; 159(38.0%) were students; 39(9.3%) people's education level was less than college, 111(26.6%) were junior college degree,207(49.5%) were bachelor degree, 60(14.4%) were master degree or above, and 1 person did not report.
Fifty eight point nine percent(246/418) had a job. Fifty three point eight percent(225/418) of respondents'payment was less than￥2000/month,25.6%(107/418) were between￥2000 and￥4000/month,15.3%(64/418) were￥4001-6000/month,4.8% (20/418) were￥6001-8000/month, and 2 (0.5%) persons were more than￥8000/month.
2. Sex role in homosexul relations
According to the practical situations, the study divided the sex role in homo-sex relations in 10 sections (from 0 to 1). "Zero" means never have penetrative sex, and on the contrary, "1" means only have penetrative sex. The respondents were asked to make a choice according to their true situations. In this study,0,0.1,0.2,0.3 were defined passive group, which included 125 subjects (29.9%); 0.4,0.5,0.6 were defined moderate group, which included 137 respondents (32.8%); and 0.7,0.8, 0.9,1 were defined active group which included 156 (37.3%)subjects.
3. Coming-Out
Coming-Out means that LGBT (lesbians, gay, bisexual, transsexual) discloses their sexual orientation in their life and work. In this study, 57.3% had ever come out. In those persons,5.0%(12/241) came out to their fathers,7.9%(19/241) came out to mothers,12.9%(31/241) once came out to their brothers and/or sisters,63.1%(152/241) came out to classmates,and 49.4%(119/241) came out to workmates or friends. It is noteworthy that none of 33 married gay men disclosed the sexual orientation to their wives.
4. Dating relationships, desire of heterosexual marriage and procreation
Compared to the control group, fewer gay man had stable love relationship during the research (χ2=21.671, P=0.001); their love duration was relatively short (x2=57.391, P=0.000), and 44.0% was less than 7 months. Among 385 unmarried gay men,13.5%(52/385) expressed definitely that they would not get married with women, and 37.1%(155/418) expected to marry a lesbian; additionally,74.9% (313/418) of gay men were eager for bearing or raising a child.
5. Characteritics of gay men's sexual behaviors
(1) Looking for sex partner by internet. Compared with the control group, gay men were even more likely to look for sex partners by internet (χ2=322.883, P=0.000), and 85.6% of subjects reported they ever looked for a sex partner in internet. Obviously, over the last six months, the number of sexual partners of subjects who often look for sex partners in internet was more than others (Z=-4.220, P=0.000)
(2) First sexual experience:among 418 gay men,6 men never had sex behaviors; as to others, the age of first sex ranged from 11 to 30 years old (median age=19, QR=4); and there were no significant difference between gay men and straight men; For the experience of first sex partner, 344 (82.3%) gay men's were male, and other 68 (16.3%) were female; in control group, there were 119 man never had sex behaviors,7(2.1%) subjects'first sex partners were male, and other 198 (60.0%) straight men's were female; and there was statistical difference between the two groups (χ2=485.122, P=0.000)
(3) Sexual contact with female. There were 126(30.1%) gay men ever had sex with female, and in the last six months,9.8%(40/418) had sexual contacts with female.
(4) Regular sexual partners. In the last 6 months,90.7%(379/418) gay subjects had sex with other men. The median number of the sexual partners was 3, QR=4, and 1 at least and 38 at most. In the control group, 53.0%(175/330) had sex behaviors over the last 6 months. As for the number of sexual partners, the median was 1, QR=1, and the smallest was 1 and the maximum was 22. There was a significant difference between the two groups(Z=-10.878, P=0.000).
Up to now,82.3%(344/418) ever had regular sex partners. The median was 3, QR=2. And,53.1%(222/418) had regular sex partners in the last 6 months, and the median is 1, QR=0.
(5) Casual sex partners. In the last 6 months,73.0%(305/418) of gay men at least had one casual sex partner; the median was 4, QR=4; 6.7% of them had equal to or more than 10 casual sex partners; and 36.4% of them not only had regular sex partners but also had casual sex partners in the last 6 months.
(6) Commercial sex partners:In the latest 6 months,3.8%(16/418) had ever purchased commercial sexual behaviors; 5.3%(22/418) had ever provided commercial sexual behaviors; 6 respondents had unprotected sexual behavior when was purchased commercial sexual behaviors, and 7 respondents had unprotected sexual behaviors when provided commercial sexual behaviors.
6. STDs and AIDS
In the past year,73 (17.5%) respondents were infected with at least one kind of STDs, and there were 20 people in control group; there was a signigicant difference (χ2=22.026, P=0.000). Among the 418 gay men, 49.3%(206/418) had ever taken a HIV antibody test; in the past year,159 (38.0%) persons had taken a HIV antibody test, and 4 respondents were proved positive.
7. Negative life events
The negative life events stimulating quantity of gay men group were scored from 0 to 99. The median score is 10, QR=13(P25=5, P75=18). In the control group, the scores was 0 to 64, and the median was 5, QR=7. Mann-Whitney U test showed that there was a significant statistical difference between the two groups (Z=-5.272, P=0.017), and the gay men's quantity of stimulus from negative life events were higher.
Sorted these gay negative life events by danger level, the top five were: "You admitted to yourself that you could be/were gay", "you had moderate financial difficulties", "Your relationship with your lover ended(not because of outside factors like having to leave the country or death)", "You had a minor illness or injury like one needing a visit to the doctor or a couple of days off work", "There have been increasing serious arguments with you your lover"
8. Social support
The scores of SSRS of 418 gay men were ranged from 16 to 54, and the mean was 32.17±6.69. T-test showed that there were significant differences between gay men and straight men (t=-8.914-14.826, P=0.000) in subjective support, objective support and utilization of social supports.
9. Suicide
Tirty point six percent of the gay subjects ever had suicide ideation during the past year, and there were 7.9% in the control group. There was stastistical significant difference between two groups (χ2=58.385, P=0.000). Twenty four (5.7%) gay men had a suicide plan,9 gay men were ready to suicide,10 gay men had ever commit suicide during the past year, and 19 gay respondents (4.5%) were treated because of suicide.
Single factor analysis showed that quantity of stimulus from negative life events and coming out are main risk factors of gay men suicide. After controlling other risk factors, these two are still important risk factors, OR was 2.17(P=0.001),1.63(P=0.037)respectively.
10. Dating violence
Gay men who ever suffered from dating violence was 34.7%, mental violence was 32.3%, physical violence was 7.9%, and sexual violencewas 9.6%. Compared to the control group, there were signigicant differences (Z=-7.543, P=0.000).
11. PCS, MCS and related factors
For SF-36 v2, an extraction procedure was used for main components with VARIMAX command. The scale factor structure illustrated the presence of 2 factors explaining 57.12%% of the total variance; one was PCS, and the other was MCS. Mann-Whitney U test showed that the scores of gay men's PSC and MCS were less than the control group(Z=-7.140,-13.075, P=0.000). After controlling other risk factors(age, education background, original household registration, marital status, history of STDs, suicide ideation, dating violence), there was still a notable difference between the two groups in PCS(OR=8.454, 95%CI:3.983-17.945) and MCS(OR=26.35,95%CI:11.359-61.103).
Multifactor retrospective Ordinal analysis showed that sex role in same-sex sexual relations(X3), coming-out(X6), history of STDs(X7), suicide ideation(X9) and dating violence(X10) were the major related factors of PCS. The regression model was as follows:
Logit1=-2.583+0.444X3+0.779X6+0.835X7+1.032X9+0.723X1o
In Addition, sex role in same-sex sexual relations(X3)、social support(X8)、suicide ideation(X9)and dating violence(X10)were the major related factors of MPCS. The regression model was as follows:
Logit1=-4.136+0.621X3+0.897X8+1.324X9+1.033X10
In total,2202 effective subjects were recruited into this study,1208 men (54.9%) and 994 women (45.1%) whose ages ranged from 16 to 71 years old (M=33.13, SD=16.47); 820(37.2%) came from cities and 1275(57.9%) were rural population, other 107 (4.9%) did not report this data; 182 (8.3%) were less than college,1050 (48.0%) were junior college degree,904 (41.1%) were bachelor degree, and 59 (2.7%) were master or doctor degree; 1806 (82.0%) of the participants were single, 396 (18.0%) were married; 569 (25.8%) were reported to have a job,27 (1.2%) were unemployed, and 1606 (72.9%) were students.
The scores of ATLG of all the 2202 straight subjects were ranged from 24 to 99, the mean score was 60.26±12.71. The full range is 75; after dividing the full range into three sections, the results showed that 17.6%respondents'scores were 24-48,69.1%were 49-74, and 13.2% were 75-99.
All 2202 subjects'scores of ATG (33.43±7.25) were higher than ATL (26.84±6.64) (t=-40.555, P=0.000);②The male's ATG scores (63.60±12.94) were higher than female's (56.15±11.14) (t=12.638, P＜0.001);③The unmarried subjects'ATLG scores (59.75±12.34) were less than the married subjects'(75.98±14.05) (t=-9.385, P＜0.001).④The rural subjects'ATLG scores (62.64±12.26) were higher than urban subjects'(55.57±13.91) (t=-11.917, P＜0.001).⑤The employed subjects' ATLG scores (68.91±16.03) were higher than unemployed subjects' (59.30±11.91)(t=7.52, P＜0.001);⑥The ATLG scores of those subjects less than college was 65.17±13.30, subjects of junior college degree was 62.38±11.44, and those subjects higher than bachelor degree was (57.89±13.53) (F=28.32, P<0.001);⑦The best ranking item was "I would not be too upset if I learned that my son were a homosexual." (3.85±1.102).
Multifactor retrospective Ordinal analysis showed that age (X1), gender (X2), original household registration (X3), marital status (X4), employed or unemployed (X5) and education background (X6) were the major related factors to the attitudes toward lesbians and gay men. The regression model was as follows:
Logit1=-7.074+0.431X1+1.195X2+0.297X3+1.680X4+0.833X5+0.818 X6
In total,701 effective subjects were recruited into this study,; they were consisted of two parts:①404 college students:210 men and 194 women whose ages ranged from 17 to 25 years old(M=19.66, SD= 1.03); 10 days after the first test,193 students were re-tested;②297 community residents:144 men and 153 women whose ages ranged from 18 to 71 years old(M=45.54, SD=15.24).
The test-retest coefficients of subscales were 0.941,0.952, and of total-scale,0.967; Correlation coefficients between each item and the total ATLG score ranged from 0.415 to 0.738; Cronbach's a coefficient of the total-scale and two sub-scales were 0.913,0.867 and 0.879, respectively; the split-half reliability of the scales ranged from 0.868 to 0.934.
The ATLG scale factor structure illustrated the presence of 3 factors explaining 53.788% of the total variance. The items 1,3,5,6,8,9,10 were the first cluster of factors, which conceptually represented beliefs toward lesbians. All items of the ATG scale were the second cluster of factors, which conceptually represented beliefs toward gay men. The items 2,4,7 were the third cluster of factors, which conceptually represented social sanction. For the ATL subscale, the factor structure showed one main factor that would explain 46.221% of the variance, which conceptually represented beliefs toward lesbians. And for the ATG subscale, the factor structure also showed one main factor that would explain 48.676% of the variance, which conceptually represented beliefs toward gay men.
Conclusions:
1. Gay men's dating relationships are unstable and short duration, and most gay men have no plan for their future when they fall in love; most gay men will marry a heterosexual woman, and want to have children; the form marriage (a gay marry a lesbian) has became a new marriage way in gay men population.
2. Gay men are even more likely to look for sex partners through internet; the sexual relationships are unstable; dangerous sex behavior are common; and there are a great possibility to be infected with STDs and AIDS.
3. The negative life events stimulating quantity of gay men are great; there are higher rates of dating violence; they have low social support; and suicide has become a serious social problem among them.
4. The Gay men's living conditions are relatively poor, and the level of their physiological and psychological health conditions are relatively low. Playing a passive role in homosexual relations, suffering from STDs, suicide ideation and dating violence were main risk factors to gay men's poor PCS; playing an active role in homosexual relations, higher SSRS, no suicide ideation and dating violence were main protective factors to gay men's poor MCS.
5. Seventeen point six percent of publics hold positive attitudes toward lesbians and gay men; all publics hold more negative attitudes toward gay men than lesbians; for all subjects, the most intolerable thing is their own son is a gay.
6. The attitudes toward lesbians and gay men were related to age, gender, original household registration, marital status, employment status, and education background.
7. The Attitudes toward Lesbians and Gay Men Scale designed by Gregory M. Herek has a good reliability and validity in Chinese, and can be used in research of attitudes toward lesbians and gay men in the social cultural context of China.
Significances and innovations
This research has taken gay men in Changsha as the research subjects. A cross-sectional and case-control study was conducted to describ their sociodemographic features, romantic relationships, features of their sexual behaviors, suicide, life events, social support, dating-violence and quality of life clearly and detailedly. The scientific basis has been provided to improve the gay men's living conditions and take a more targeted crisis intervention。
The study recruited samples through internet randomly, and 418 effective samples were included at last. Research about gay men are very difficult, and this study has provided a new way to solve this problem. It's a totally new try of methodology.
This study was the first attempt to test the reliability and validity of Herek's Attitudes toward Lesbians and Gay Men Scale (ATLG) in China. It provided a more scientific tool to study the attitudes toward homosexuality. Then, we used the ATLG scale to assess the public's attitudes toward lesbians and gay men.
引文
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