摘要
背景:男男性行为人群,由于存在多性伴和无保护性肛交行为而成为感染艾滋病病毒的高危人群。1981年在美国报道的全球首例艾滋病病毒感染者和1989年我国报道的首例经性接触感染艾滋病病毒者均为男同性恋者。近年来,我国的艾滋病疫情出现新的特点,同性传播的比例呈快速上升趋势。2010年11月29日卫生部通报同性传播比例从2008年的5.9%上升到2009年的8.6%。在全国61个城市开展的男男性行为人群HIV大筛查显示,2008年HIV感染率为4.9%,2009年达到5.0%,西南片区感染率较高,贵阳、昆明、成都、重庆均超过10%。该人群由于同时存在异性性行为,起到了将艾滋病病毒传播给一般人群的桥梁作用,防治工作刻不容缓。杭州是浙江省会城市,男男性行为人群客观存在,且有固定的活动场所。因此,非常有必要开展宣传干预工作。
目的:通过对本地男男性行为人群的调查,全面了解艾滋病防治知识、行为特征和HIV感染状况及其影响因素,为开展男男性行为人群艾滋病防治工作提供科学依据。
方法:以年龄在18周岁及以上且近6个月内有同性肛交性行为的男性为研究对象。在志愿者的帮助下,于2009年6月~2010年6月,采用分类滚雪球法,招募在杭州主城区活动的各类型男男性行为人群,严格遵循“知情同意、保密”的原则,采用自行设计的健康调查问卷(MSM),调查基本人口学特征、艾滋病防治知识水平、行为特征和预防措施覆盖情况,并采集5ml静脉血,送下城区疾控中心艾滋病初筛实验室进行HIV、梅毒和HCV检测,掌握感染状况。采用Epidata3.02软件建立数据库,应用SPSS17.0统计分析软件采用单因素和多因素Logistic回归方法分析知识水平、咨询检测、性伴数、商业性行为、安全套使用率等因素对HIV感染状况的影响。
结果:共有效调查530名男男性行为者,其中酒吧型占20.38%、浴池型占21.32%、公园型占4.90%、网络型占50.57%、其他型占2.83%;20~39岁占84.53%,流动人口占81.32%,文化程度大专及以上占33.77%,商业性服务占27.92%,同性恋占60.75%。
艾滋病防治知识总知晓率为94.72%,其中传播途径等6个知识点的知晓率均在90%以上,而蚊虫叮咬不会传播的知晓率较低,为74.91%。在本市时间、文化程度和性取向的不同,以及是否发生过商业性行为或接受过咨询检测的男男性行为人群,艾滋病防治知识知晓率存在统计学差异。
近6个月内,发生商业性行为占28.87%,有异性性行为占22.64%。发生同性肛交性行为时,最近一次安全套使用率为75.47%,近6个月每次安全套使用率为54.15%;不同人群类型、同性性行为类型和性伴性别不同,其安全套使用率存在统计学差异。有吸毒史占3.77%,有性病相关症状占7.74%。获得预防艾滋病措施中,宣传材料的比例最高,为75.85%。获得艾滋病防治知识信息的主要途径是互联网,占54.72%。
HIV感染率为8.49%,梅毒感染率为11.89%,HIV和梅毒双重感染率为1.32%,HCV感染率为0.19%。HIV感染单因素和多因素Logistic回归分析显示,浴池型和网络型、近6个月性伴数≥10人是危险因素、每次发生同性性行为使用安全套是保护性因素,其中浴池型是酒吧型的6.599倍,网络型是酒吧型的3.422倍,性伴数≥10人是<10人的4.379倍,而每次使用安全套是从未使用或有时使用的0.403倍。
结论:HIV已经在本地男男性行为人群中局部流行,需通过互联网、同伴教育和咨询检测等多种途径,加强对该人群的宣传干预力度,其中重点关注活动在浴室、网络和存在商业性行为的男男性行为人群。
Background Due to multiple sex partners and unprotected anal intercourse, men who have sex with men(MSM) have a high risk to infect HIV. In the world, the first HIV infector who was reported in 1981 was gay in USA. The same situation happened in China in 1989. In recent years, China's AIDS epidemic appears a several characteristics, and the rate of homosexual transmission presents a rapid rising trend. On November 29,2010, the Ministry of Health informed that ratio of male homosexual transmission raised from 5.9% in 2008 to 8.6% in 2009. In the 61 cities of China, the screening for HIV infection in MSM shows, the rate of HIV infection was 4.9% in 2008 and the figure reached 5.0% in 2009. There was a high rate of HIV infection in the southwest of China, which was over 10% in Guiyang, Kunming, Chengdu and Chongqing. The prevention does not permit of any delay because of heterosexual sex that may spread the HIV to other people. Hangzhou is the capital city of Zhejiang province. There is a certain number of MSM. Therefore, it is necessary to deveolp education and intervention to local MSM.
Objective To investigate the prevention knowledge about AIDS, behavior characteristic and HIV infection situation of MSM, analyze the factors of HIV infection. Then, to provide scientific basis for AIDS prevention and control among MSM.
Methods It is selected as sample that the man (older than 18 years old) had anal intercourse with another man in past 6 months. With the help of volunteers, we recruited various types of MSM in Hangzhou and used a snowball sampling method during June 2009 to June 2010. We strictly follow informed consent and privacy principle. Information regarding the basic Demographic characteristics, AIDS knowledge, behavior characteristics and coverage of preventive measures were surveyed through a self-design survey questionnaire.5ml venous blood was extracted which was send to the Xiacheng CDC HIV screening laboratory to detect HIV, syphilis and HCV infection. We had established a database using Epidata 3.02. Univariate and multivariate logistic regression analysis were done by SPSS 17.0 to analyze the association between HIV infection and knowledge, counseling, testing, number of sexual partners, commercial sex, using condom and other factors
Results 530 MSM participated effectively in the survey, in which 20.38% for bar type,21.32% for bathroom type,4.90% for park type,50.57% for network type and 2.83% for others. MSM ranged from 20 to 39 years old accounted for 84.53%.81.32% of MSM were floating population.33.77% received college or higher education. 27.92% took part in commercial sex services. Gay accounted for 60.75%.
The average rate of awareness about AIDS prevention knowledge was 94.72%. Six points of them were over 90% including transmission, but the knowledge point that mosquito could not spread HIV, which was only 74.91%. The awareness of AIDS prevention knowledge was associated with time in this city, education, sexual orientation, commercial sex and accepting counseling and testing.
In the past 6 months,28.87% of MSM existed commercial sex, and 22.64% reported having sex with a female. When having sex with male, the utilization of condom was 75.47% for the last one and 54.15% for last 6 months. Type of MSM, type of homosexual behavior and sex partner had relationship with condom using.3.77% of MSM had history of drugs addiction, and 7.74% had STD-related symptoms. The highest proportion was 75.85% for promotional materials among AIDS prevention measures. AIDS prevention knowledge mainly came from internet that accounted for 54.72%.8.49% of MSM were HIV-infected,11.89% were syphilis-infected,1.32% were
infected with both and 0.19% were HCV-infected. Univariate and multivariate logistic regression analysis showed that bathroom type and network type, more than 10 sexual partners in past 6 months were risk factors for HIV infection. On the contrary, using condoms was a protective factor in every sex. Bathroom type was 6.599 times the bar type and network type was bar type 3.422 times. In addition, more than 10 sexual partners were 4.379 times more dangerous than less than 10 sexual partners. Each sex using condoms was 0.403 times compared to never or sometimes using.
Conclusion HIV prevalence had existed in the local MSM. It should be done to strengthen the propaganda and intervention by Internet, peer education, counseli ng, testing and so on. Especially, in bathroom, Internet and existing commercial sex.
引文
[1]张北川,李秀芳,胡铁中,等.对男同性性接触者的艾滋病干预:(一)理论与实践[J].中国性病艾滋病防治,2000,6(3):155-157.
[2]杨介者,潘晓红,杨清.艾滋病高危人群基数估计方法在男性同性恋人群规模估计中的应用[J].中国艾滋病性病,2006,12(6):525-526.
[3]徐娟,李翠,张佳慧,等.男男同性恋人群间接规模估计方法的比较研究[J].医学与社会,2007,20(11):14-15.
[4]张北川,李秀芳,史同新,等.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[J].中国性病艾滋病防治,2002,(4):197-199.
[5]Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men [J]. AIDS,2006,20(5):731-739.
[6]汪雁鹤,汪宁,张北川,等.5市男男性接触者状况及影响其高危行为的因素[J].医学与社会,2005,18(9):1-2.
[7]周婷玉.中国累计报告6.8万余人死于艾滋病.新华网,2010,11.
[8]2009年全球艾滋病流行报告.卫生部、联合国艾滋病规划署和世界卫生组织.
[9]夏俊瑞,郑迎军,张洪波,等.中国大陆7城市MSM人群艾滋病知识知晓率调查[J].中国艾滋病性病,2009,15(3):285-287.
[10]萧燕,李春梅,吕繁,等.中国部分地区MSM人群安全套使用的变化情况及影响因素分析[J].中国艾滋病性病,2008,14(2):133-136.
[11]王岚,汤后林,张大鹏,等.不同性取向的男男性接触者行为特征分析[J].中国艾滋病性病,2007,3(2):123-126.
[12]卢正祥,葛宁,高红茹,等.2007~2008年盐城市男男同性恋人群艾滋病相关知识行为与感染状况调查[J].预防医学论坛,2009,15(8):702-703.
[13]席胜军,何玉芳,周晓红,等.杭州市小型服务场所女性商业性行为者安全套使用现状及其影响因素[J].卫生研究,2009,38(5):568-570.
[14]郭燕,朱效科,夏建晖,等.204例MSM人群HIV/梅毒感染状况及行为学特征分析[J].中国艾滋病性病,2009,5(1):50-51.
[15]李德钧,孙茂利,赵志杰,等.大连市401名MSM人群HIV、梅毒、丙型肝炎感染状况分析[J].中国卫生检验杂志.2009,19(3):693-694.
[16]张琰,张丹丹,李怀亮,等.宁波市女性性工作者艾滋病知识知晓情况及影响因素分析[J].浙江预防医学,2009,21(11):71-72.
[17]石健,林新勤,陈世海,等.吸毒人群艾滋病预防知识知晓及信息获取途径分析[J].现代预防医学,2010,37(15):2858-2859.
[18]程晓莉,肖永康,汪方华.性病门诊就诊者艾滋病相关知识行为调查分析[J].中国自然医学杂志,2010,12(3):180-182.
[19]陈树昶,罗艳,程洁,等.杭州市男男性接触者艾滋病风险监测结果分析[J].疾病监测,2007,22(3):175-177.
[20]方鹏骞,李翠.同伴教育在艾滋病高危人群中的应用[J].公共卫生与预防医学,2006,17(5):121-122.
[21]朱军礼,张洪波,吴红花.学生中122名男男性行为者HIV/STD高危行为及其感染状况分析[J].中国艾滋病性病,2007,13(4):350-352.
[22]Gutierrez JP, Molina-Yepez D·Correlates of condom use in a sample of MSM in Ecuador[J]. BMC Public Health,2006,6:152.
[23]蔡高峰,马瞧勤,潘晓红,等.浙江省两城市男男性接触者艾滋病相关知信行及HIV/STD感染状况调查[J].中国预防医学杂志,2009,9(6):482-485.
[24]郑迎军,张洪波.男男性接触者HIV/STD感染状况及其影响因素[J].国外医学皮肤性病学分册,2005,31(3):163-165.
[25]张曼,王新迪,杨阳.男男性接触者HIV、梅毒、丙肝感染及行为调查[J].中国公共卫生,2009,25(9):1075-1076.
[26]郑迎军,张洪波,许娟,等.男男性行为者艾滋病知识及高危性行为调查[J].中国公共卫生,2007,23(9):1050-1051.
[27]俸卫东,张英霞.250名MSM人群艾滋病监测情况分析[J].医学动物防制,2009,25(5):256-257.
[28]杨廷忠.健康教育理论与方法[M].杭州:浙江大学出版社,2004:48-52.
[29]曹淦,管文辉,吴小刚,等.某同性恋浴室男男性接触者HIV/梅毒感染状况 的研究[J].南京医科大学学报(自然科学版),2007,27(6):637-640.
[30]陈波,王颖,张建新,等.MB和一般同志人群安全套使用情况比较及影响因素的调查分析[J].现代预防医学,2007,34(19):3604-3605.
[31]刘惠,汪宁,张琴,等.416名男男性接触者HIV和梅毒感染状况及性行为特征[J].中国艾滋病性病,2007,13(3):230-234.
[32]蔡文德,冯铁建,谭京广,等.男同性恋者行为特征和STD/HIV感染的调查[J].现代预防医学,2005,34(4):328-330.
[33]修翠珍,刘明华,李秀芳,等.男男性行为人群的艾滋病知识行为干预与感染状况研究[J].预防医学论坛,2009,5(2):97-100.
[34]王晨,梁红元,杨烨,等.北京市男男性行为者HIV感染及影响因素的调查研究[J].中国艾滋病性病,2008,14(6):552-557.
[35]董秀平,李秀芳.新型毒品与HIV/AIDS相关性研究进展[J].中国艾滋病性病,2010,16(6):629-631.
[36]Colfax G, Guzman R. Club drugs and HIV infection:a review [J]. Clin Infect Dis, 2006,42(10):1463-1469.
[37]曲斌.啤酒——性乱——性病[J].医药世界,2000,11:62.
[38]Paz-Bailey G,Meyers A,Blank S,et al.A case-control study of syphilis among men who have sex with men in New York City:association With HIV infection[J]. Sex Transm Dis,2004,31(10):581-587.
[39]冯连贵,丁贤彬,卢戎戎,等.重庆市男男性接触人群高危行为和性病艾滋病感染率调查[J].热带医学杂志,2007,7(5):483-486.
[40]王陇德.中国艾滋病流行与控制[M].北京:北京出版社,2006:184-191.
[41]席胜军,何玉芳.杭州市不同活动场所MSM人群艾滋病病毒感染现况研究[J].浙江预防医学,2009,21(9):1-2.
[42]Hospers HJ,Kok G,Harterink P,et al-A new meeting place:chatting on the Internet,e-dating and sexual risk behaviour among Dutch men who have sex with men[J]. AIDS,2005,19:1097-1101.
[43]Mettey A,Crosby R,DiClemente RJ,et al-Associations between internet sex seeking and STI associated risk behaviours among men whohave sex with men[J]. Sex Transm Infect,2003,79(6):466-468.
[44]徐静,丁贤彬,冯连贵,等.重庆市192名在婚MSM人群HIV、梅毒感染调查[J].中国热带医学,2009,9(11):2096-2098.
[45]蔡于茂,刘惠,潘鹏,等.深圳市桑拿、酒吧场所男男性接触者HIV及梅毒流行病学调查[J].现代预防医学,2008,35(12):2203-2005.
[46]Buchacz K,Patel P,Taylor M,et al-Syphilis increases HIV viral load and decreases CD cell counts in HIV-infected patients with new syphilis infections[J]. AIDS, 2004,18(15):2075-2079.
[47]杨旭,易东,丁贤彬.某市1000名男男性接触者艾滋病高危行为及影响因素分析[J].第二军医大学报,2007,28(11):1223-1228.
[48]Ruan Y,Li D,Li X,et al-Relationship between syphilis and HIV in-fections among men who have sex with men in Beijing, China[J]. Sex Transm Dis,2007,34(8): 592-597.
[49]Royce RA, Sena A, Cates W, et al. Sexual transmission of HIV[J]. N Engl J Med, 1997,336(15):1072-1078.
[50]Rivers L. Recollections of bullying at school and their long-term im-plications for less,gay men,and bisexuals[J]. Crisis,2004,25(4):169-175.
[51]汤后林,吕繁.桥梁人群在艾滋病病毒传播中的作用[J].中华流行病学杂志,2007,28(2):192-194.
[1]2009年全球艾滋病流行报告.卫生部、联合国艾滋病规划署和世界卫生组织.
[2]Menza TW, Hughes JP, Celum CL, et al. Prediction of HIV acquisition among men who have sex with men[J]. Sexually Transmitted Diseases,2009,36(9):547-555.
[3]杨介者,潘晓红,杨清.艾滋病高危人群基数估计方法在男性同性恋人群规模估计中的应用[J].中国艾滋病性病,2006,12(6):525-526.
[4]徐娟,李翠,张佳慧,等.男男同性恋人群间接规模估计方法的比较研究[J].医学与社会,2007,20(11):14-15.
[5]张北川,李秀芳,史同新,等.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[J].中国性病艾滋病防治,2002,8(4):197-199.
[6]Bolding Q Davis M, Hart G, et al. Heterosexual men and women who seek sex through the internet[J]. Int J STD AIDS,2006,17(8):530-534.
[7]郑建东,庞琳,吴尊友.互联网对男男性接触者危险性行为的影响及在艾滋病防治中的应用[J].中国健康教育,2008,24(4):293-295.
[8]郭燕,朱效科,夏建晖,等.204例MSM人群HIV/梅毒感染状况及行为学特征分析[J].中国艾滋病性病,2009,15(1):50-51.
[9]蔡于茂,刘惠,潘鹏,等.深圳市桑拿、酒吧场所男男性接触者HIV及梅毒流行病学调查[J],现代预防医学,2008,35(12):2203-2005.
[10]席胜军,何玉芳.杭州市不同活动场所MSM人群艾滋病病毒感染现况研究[J]. 浙江预防医学,2009,21(9):1-2.
[11]张敬东,孙烨,王尚博,等.哈尔滨市经常活动于某浴池的121名MSM艾滋病和梅毒感染情况[J].中国艾滋病性病,2008,14(1):69.
[12]曹淦,管文辉,吴小刚,等.某同性恋浴室男男性接触者HIV/梅毒感染状况的研究[J].南京医科大学学报(自然科学版),2007,27(6):637-640.
[13]柳忠泉,朱效科,徐鹏,等.天津市性服务男孩的HIV和梅毒感染状况分析[J].中国艾滋病性病,2009,15(3):279-281.
[14]汤后林,张大鹏,吴玉华,等.男男性接触者性伴交往模式及行为特征研究[J].中华流行病学杂志,2007,28(2):144-147.
[15]Elford J, Bolding G, Davis M, et al. Web-based behavioral surveillance among men who have sex with men: a comparison of online and offline samples in London,UK[J]. J Acquir Immune Defic Syndr,2004,35(4):421-426.
[16]Amirkhanian YA, Kelly JA, Kukharsky AA, et al. Predictors of HIV risk behavior among Russian men who have sex with men:an emerging epidemic[J]. AIDS, 2001,15(3):407-412.
[17]陶小润,李士雪,徐爱强,等.山东省MSM和MB艾滋病感染现状、行为学及心理因素分析[M].山东大学硕士学位论文,2008.
[18]Weber AE, Craib KJ, Chan K, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men[J]. Int J Epidemiol,2001,30(6):1449-1454.
[19]Belza MJ. Risk of HIV infection among male sex workers in Spain[J]. Sex Transm Infect,2005,81(1):85-88.
[20]杨旭,易东,丁贤彬.某市1000名男男性接触者艾滋病高危行为及影响因素分析[J].第二军医大学学报,2007,28(11):1223-1228.
[21]王岚,汤后林,张大鹏,等.不同性取向的男男性接触者行为特征分析[J].中国艾滋病性病,2007,13(2):123-126.
[22]Somlai AM, kalichman SC, Bagnall A. HIV risk behaviour among men who have sex with men in public sex environments:an ecological evaluation[J]. AIDS Care, 2001,13(4):503-514.
[23]齐淑贞,张国成,曹宁校,等.男男性工作者血清HIV/STIs检测和相关危险因素分析[J].中国麻风皮肤病杂志,2005,12(21):934-936.
[24]Haley N, Roy E, Leclerc P, et al. HIV risk profile of male street youth involved in survival sex[J]. Sex Transm Infect,2004,80 (6):526-530.
[25]徐静,丁贤彬,冯连贵,等.重庆市192名在婚MSM人群HIV、梅毒感染调查[J].中国热带医学,2009,9(11):2096-2098.
[26]蔡文德,冯铁建,谭京广,等.男同性恋者行为特征和STD/HIV感染的调查[J].现代预防医学,2005,34(4):328-330.
[27]张北川,刘殿昌,李秀芳,等.中国大陆男同性性接触者的艾滋病高危性行为及影响因素研究(一)[J].中国性病艾滋病防治,2001,7(1):7-10.
[28]Royce RA, Sena A,Cates W, et al. Sexual transmission of HIV[J]. N Engl J Med, 1997,336(15):1072-1078.
[29]王路,谷渊,王晓丽,等.沈阳市男男性行为人群HIV感染率及其影响因素分析[J].中国艾滋病性病,2010,16(4):382-385.