男性同性兼异性性行为者HIV感染状况及性行为特征

发布时间：2018-01-17 19:31

本文关键词：男性同性兼异性性行为者HIV感染状况及性行为特征　出处：《安徽医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的了解男男性行为兼异性性行为（men who have sex with men and women,MSMW）人群HIV感染状况及其男性和女性性伴种类和特征、男性同性性行为和异性性行为及安全套使用状况，探索MSMW人群高危性行为的相关因素，探讨MSMW人群在HIV从高危人群向普通人群的传播中的作用，为发展预防控制HIV通过MSM人群向普通人群蔓延的政策和策略提供依据。方法本研究采用横断面调查的方法，以广州市和成都市为调查现场，以18岁及以上在婚或最近12个月有异性性行为的男男性行为者为调查对象，采用“滚雪球”的方法进行调查对象招募，在获得调查对象知情同意后，采用一对一方式进行匿名问卷调查，，每个城市调查300人（共600人），调查内容包括社会人口学特征、最近6个月男性性伴种类和特征、男男性行为及安全套使用状况；最近12个月异性性伴种类和特征、异性性行为及安全套使用状况，并采集调查对象静脉血进行HIV抗体血清学检测。调查资料采用EpiData3.0软件建立数据库，运用SPSS10.0软件进行统计分析。统计分析方法主要包括频数分布、2检验和多元Logistic回归分析。结果600名调查对象中，平均年龄为（34.31±9.50）岁，其中年龄为26~35岁者占38.5%；已婚者占62.5%；调查对象中文化程度为初中及以下、高中或中专、大专及以上者分别为123（20.5%），216（36.0%）和261（43.5%）；性取向为同性、双性、异性或不确定者所占的比例分别为42.3%、50.0%和7.7%；58.3%调查对象为外地户籍。调查对象中，既往检测确认HIV抗体阳性者116人，本次检测HIV抗体确认阳性者41人，HIV感染率为26.2%（157/600），本次调查中HIV抗体阳性检出率为8.5%（41/484）。其中，广州市和成都市调查对象HIV感染率分别为13.0%（39/300）和39.3%（118/300）、本次调查HIV抗体阳性检出率分别为3.0%（8/269）和15.3%（33/215），同性性取向和非同性性取向者HIV感染率分别为31.5%（80/254）和22.3%（77/346）。最近6个月中，有28.0%的调查对象拥有5个及以上的男性性伴，与男性发生肛交行为时每次使用安全套者占44.2%，最近3次和最近1次男男肛交性行为使用安全套者分别为52.3%和63.0%；最近12个月有86.0%的调查对象与女性发生过性行为，最近12个月拥有妻子、婚前女友、婚外情人、女性偶然性伴和女性商业性伴的比例分别为65.0%、27.2%、1.5%、12.7%、4.5%，约1/3的调查对象异性性行为时坚持每次使用安全套，36.5%的调查对象在最近3次异性性行为均未使用安全套。最近6个月成都市55.7%MSMW男男性行为时每次使用安全套，高于广州市（32.7%），最近12个月成都市38.3%MSMW异性性行为时每次使用安全套，高于广州市（25.3%）。 HIV阳性的调查对象中，最近6个月与男性发生过肛交性行为者为91.1%，与男性发生肛交行为时每次使用安全套者为49.7%，最近3次和最近1次男男肛交行为使用安全套者分别为60.5%和69.4%；最近12个月有82.8%阳性调查对象与异性发生过性行为，42.0%的调查对象每次性行为坚持使用安全套，最近3次性行为使用安全套者占47.8%。最近6个月，既往检测确认HIV阳性的MSMW发生同性性行为时从不使用安全套的比例（4.3%）低于本次检测确认HIV阳性者（22.0%）；最近12个月，有12.9%既往检测确认HIV阳性的MSMW异性性行为时从不使用安全套，低于本次检出HIV阳性的MSMW（46.3%）。调查对象无保护肛交行为多因素Logistic回归分析结果显示，随着年龄增长，发生无保护肛交行为的危险分别增加（1.8-3.6倍）；广州市的调查对象发生无保护肛交行为的危险是成都的2.6倍（OR=2.557，95%CI：1.676～3.903）；拥有5个及以上者发生无保护肛交行为的危险增加至2.1倍（OR=2.114，95%CI：1.175～3.802）；最近12个月有无保护异性性行为者发生无保护肛交行为的危险增加2-4倍；本次检出HIV阳性者最近6个月无保护性肛交行为的危险是既往检出HIV阳性者的4倍（OR=4.107，95%CI：1.642～10.272），最近6个月有男性商业性伴的调查对象发生无保护性肛交行为的危险降低。调查对象无保护异性性行为多因素Logistic回归分析显示，拥有5个及以上者男性性伴者发生无保护异性性行为的危险增加至2.4倍（OR=2.387，95%CI：1.370～4.157）；与同性性取向者相比，双性和异性或不确定性取向者发生无保护性阴道性交的危险分别增加到2.6倍（OR=2.591，95%CI：1.746～3.845）和3.5倍（OR=3.484，95%CI：1.618～7.501）；调查对象中，最近6个月有高危男男性行为者发生无保护异性性行为的危险增加2.6-3.3倍；与既往检测HIV阳性调查对象相比，本次检出HIV阳性（OR=2.383，95%CI：1.014～5.601）和HIV阴性（OR=2.466，95%CI：1.511～4.027）发生无保护异性性行为的危险增加。多因素Logistic回归分析结果表明，广州市调查对象无保护肛交行为与拥有2以上同性性伴、月收入低、最近12个月异性性行为从不使用安全套和有男性偶然性伴相关联；广州市调查对象无保护异性性行为危险因素包括非同性性取向、肛交性角色为1和0.5、最近12个月有妻子。成都市调查对象无保护肛交行为与年龄在25岁以上、不知晓HIV感染状况和有男朋友、最近12个月有无保护异性性行为相关联。成都市调查对象无保护异性性行为危险因素包括非同性性取向、不知晓HIV感染状况、有男性偶然性伴。结论MSMW人群HIV感染率已经处于高水平，且广泛存在多性伴和高比例的无保护男性肛交性行为和女性阴道性交行为，该人群在HIV跨性别传播中的桥梁作用可能加快HIV在普通人群中的扩散。因此，在制定MSMW人群的艾滋病预防干预策略时，需要在已知的高危性行为影响因素的基础上，既要考虑遏制HIV在MSMW人群中快速扩散，又要考虑控制HIV通过MSMW人群向普通人群蔓延。
[Abstract]:Objective to investigate the MSM and heterosexual behavior (men who have sex with men and women, MSMW) HIV infection among the types and characteristics of male and female sexual partners, the status of male homosexual or heterosexual behavior and condom, explore the related factors for the high risk population of MSMW, to investigate the effect of MSMW from the crowd the spread of high-risk groups to the general population in HIV, provide the basis for the development of prevention policies and strategies for the control of HIV MSM through the crowd and spread to the general population.
Methods: This study used a cross-sectional survey, with Guangzhou city and Chengdu city as the investigation site, with 18 years of age and older in men who have sex with men in marriage or the last 12 months have sex behavior as the research object, with the method of "snowball" investigation object in the survey for recruitment, informed consent, by one way of anonymous questionnaire survey of 300 people, each city (600 people), the questionnaire including demographic characteristics, the last 6 months male partner types and characteristics, status of male behavior and condom use; the last 12 months of heterosexual type and feature of heterosexual sexual behavior and condom use status, and collected the venous blood samples to detect HIV antibody serum. EpiData3.0 software was used to establish database survey data, using SPSS10.0 software for statistical analysis. Statistical analysis methods include frequency division Cloth, 2 test and multiple Logistic regression analysis.
Results among 600 subjects, mean age (34.31 + 9.50) years old, the age of 26~35 years of age accounted for 38.5%; 62.5% of them were married; cultural degree survey for the junior middle school and below, high school or secondary school, college and above were 123 (20.5%), 216 (36%) and 261 (43.5%); sexual orientation as gay, bisexual, heterosexual or not determine the proportion were 42.3%, 50% and 7.7%; 58.3% subjects in the field of household registration.
The survey, previous testing confirmed HIV antibody positive 116, the detection of HIV antibody confirmed positive were 41, the infection rate of HIV was 26.2% (157/600), the survey of HIV antibody positive rate was 8.5% (41/484). Among them, Guangzhou city and Chengdu city survey of HIV infection rate was 13% (39/300) and 39.3% (118/300), the investigation of HIV antibody positive rates were 3% (8/269) and 15.3% (33/215), gay and non gay HIV infection rates were 31.5% (80/254) and 22.3% (77/346).
The past 6 months, 28% of the respondents have more than 5 and male sexual partners, and using condoms every time the behavior of male sexual partners accounted for 44.2%, the last 3 times and the latest 1 male male anal sex using condoms were 52.3% and 63%; 86% of the respondents with female sex the recent 12 months, the last 12 months have a wife, girlfriend premarital, extramarital lover, women's casual sexual partners and female commercial sexual partners accounted for 65%, 27.2%, 1.5%, 12.7%, 4.5%, the survey about sex 1/3 to use condoms every time, 36.5% of the respondents in a recent 3 heterosexual sex condom use were not using condoms. The last 6 months in Chengdu city 55.7%MSMW male behavior at a time, higher than Guangzhou (32.7%), the last 12 months in Chengdu city 38.3%MSMW sex every time to use condoms, higher than Guangzhou (25 .3%).
Survey of positive HIV in the last 6 months with a male who had anal sex sex was 91.1%, and male sexual partners when using condoms every time is 49.7%, the last 3 times and the latest 1 male male anal sex using condoms were 60.5% and 69.4%; 82.8% positive subjects and heterosexual sex the recent 12 months, the survey each sex 42% condom use, 3 recent sex condom use accounted for 47.8%. of the last 6 months, the previous testing confirmed that HIV positive MSMW gay sex is never used condom proportion (4.3%) lower than the test confirmed HIV positive (22%); the last 12 months, have never used condoms 12.9% previous confirmed HIV MSMW sex positive, less than the positive rate of HIV MSMW (46.3%).
The survey of unprotected anal sex with multi factor Logistic regression analysis showed that with the increase of age, the risk of unprotected anal sex were increased (1.8-3.6 times); the survey of Guangzhou City risk unprotected anal sex is 2.6 times that of Chengdu (OR= 2.557,95%CI:1.676 3.903); with 5 or more dangerous unprotected anal sex increased to 2.1 times (OR=2.114,95%CI:1.175 ~ 3.802); the last 12 months have unprotected heterosexual sex risk unprotected anal sex increased 2-4 times; the risk of detection of HIV positive in recent 6 months of unprotected sex anal sex is 4 times the previous detection of HIV positive persons (OR=4.107,95%CI:1.642 ~ 10.272), a survey of male commercial sexual partners, the risk of unprotected anal sex decreased in recent 6 months.
The survey of unprotected sex behavior, Logistic regression analysis showed that with 5 or more male sexual partners risk of unprotected sex increases to 2.4 times (OR=2.387,95%CI:1.370 ~ 4.157); compared with homosexual, bisexual or heterosexual orientation and uncertainty of risk of unprotected vaginal intercourse were increased to 2.6 times (OR=2.591,95%CI:1.746 ~ 3.845) and 3.5 times (OR=3.484,95%CI:1.618 ~ 7.501); survey, with high-risk MSM risk of unprotected sex increased 2.6-3.3 times in the last 6 months; compared with the previous detection of HIV positive subjects, the positive HIV (OR=2.383,95%CI:1.014 ~ 5.601) and HIV negative (OR=2.466,95%CI:1.511 ~ 4.027) the risk of unprotected sex.
Multivariate Logistic regression analysis showed that the survey of Guangzhou City unprotected anal sex and have more than 2 sexual partners, low income, the last 12 months of heterosexual men never used condoms and casual sexual partners associated; survey of Guangzhou City unprotected heterosexual behavior risk factors including non homosexual orientation. 1 and 0.5 for anal sex role, with his wife 12 months recently. The survey of Chengdu City unprotected anal sex with over 25 years of age, do not know the status of HIV infection and to have a boyfriend, the last 12 months have unprotected sex associated. The survey of Chengdu City unprotected sex behavior, risk factors including non homosexual orientation, unaware of the status of HIV infection, male casual sexual partners.
Conclusion MSMW HIV infection rate has been at a high level, without the protection of male sexual behavior and sexual behavior of female vagina and widespread sexual partners and a high proportion of the population in the HIV diffusion bridge cross gender communication in HIV may accelerate in the general population. Therefore, prevention and intervention strategies in the development of MSMW population AIDS, in high-risk sexual behavior known on the basis of factors, it is necessary to consider the containment of HIV spread rapidly in the MSMW population, HIV spread to the general population through the MSMW population but also consider.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91

【共引文献】