影响男性同性性行为人群艾滋病传播的社会文化因素定性研究

发布时间：2018-03-04 22:39

本文选题：艾滋病　切入点：男性性行为人群　出处：《中国疾病预防控制中心》2017年博士论文　论文类型：学位论文

【摘要】：背景我国的艾滋病防控工作取得明显进展,但经男性同性性行为传播艾滋病的形势依然严峻。尽管近年来提出和实施了一系列干预策略,但防治效果仍然不够理想。男性性行为人群是个典型的亚文化群体,其艾滋病传播不仅受到生物因素的影响,更受到社会文化因素的影响。回顾既往研究,对影响该人群艾滋病传播的社会文化因素认识不足,缺乏深入解读与分析,可能导致构建的策略缺乏文化方面的适宜性,使目标人群的可接受性降低。因此,对影响男性性行为人群艾滋病高危行为的社会文化影响因素进行深入探索,才可能提出更有效的策略与措施。目的了解社会文化因素和男性性行为人群的社区亚文化对该人群心理和行为的影响,以及对艾滋病传播产生的影响。探索影响艾滋病防治服务提供的社会文化因素,并提出改进干预效果的策略建议。方法本研究采用定性研究方法,于2015年6月至2016年8月,综合考虑男性性行为人群的规模、疫情和地理分布等因素,选取中国10个城市的男性性行为人群进行面对面的个人深入访谈。此外,还组织部分现场的艾滋病防治服务提供者(主要包括调查现场提供艾滋病防治服务的工作人员和社区组织成员)进行焦点小组访谈。由调查现场的疾病预防控制中心及社区组织根据开放性抽样的原则招募访谈对象。访谈内容主要围绕几方面:1)社会外部文化因素对男性性行为人群性观念、性行为和艾滋病传播的影响;2)男性性行为人群的社区亚文化及其特点,以及对某些高危行为的社会文化视角解读;3)探讨影响艾滋病防治服务效果、目标人群可接受性的社会文化影响因素。访谈资料采用现场录音的方式进行采集。应用Nvivo11软件对访谈资料进行编码,共形成477个初始编码,40个二级编码和8个主题。结果本研究共招募个人访谈对象81人。访谈对象的年龄主要集中在25-34岁(40.7%),入圈时间多为10年或以上(59.3%),文化程度多为大专及以上学历(62.9%),职业主要为服务业(21.0%)、NGO专职/兼职(27.2%)),婚姻状况以未婚为主(70.4%),户籍地以非本地为主(83.9%) , HIV抗体状态以阴性为主(84.0%)。另外,开展焦点小组访谈8次,共计70人参加。本研究发现主要围绕5个方面:1)社会规范与社会认同一方面使男性性行为人群的隐蔽性增加,阻碍亲密关系的构建,并对自我认同产生消极影响;另一方面,社会不认同所造成的歧视使得干预服务的覆盖面受到影响,也是造成艾滋病感染者故意传播的重要诱因。2)传统文化压力下男性性行为人群的异性婚姻,使该人群成为艾滋病传播的“桥梁人群”;传统文化对男性性行为人群行为缺乏约束,一定程度上促进了性行为的开放性和随意性;传统文化也在一定程度上阻碍了性教育的开展。3)社会文化发展对男性性行为人群的性观念和性行为产生了巨大影响,主要体现在交友格局的陌生人化和社会认同与自我认同的改善等。4)男性性行为人群社区亚文化中忽视性健康、享乐主义、性关系的多元化与开放性等特点对艾滋病的传播造成不利影响。5)目前艾滋病防治服务提供过程中存在着与目标人群亚文化相冲突和不适应之处,影响了防治服务的效果。以“从社区中来,到社区中去”为指导思想,本研究提出了提高艾滋病防治效果的创新策略建议。结论社会文化因素对男性性行为人群的心理和行为有着重要影响,与艾滋病传播有密切关联。社会规范、社会认同、传统文化及社会文化的发展变化等社会文化因素对MSM人群亚文化有着重要的建构作用。目前MSM人群的社区亚文化存在忽视健康需求、享乐主义和性关系的多元性与开放性等不利于艾滋病防治的特点。只有结合MSM人群的亚文化构建防治策略,在社区中形成“爱己、爱他、责任”的核心价值观,引导亚文化向积极、健康的方向发展,才能有效地减少高危行为,遏制艾滋病在MSM人群中的传播。
[Abstract]:Significant progress has been made in the background of China's AIDS prevention and control work, but the male same-sex sexual transmission of HIV / AIDS situation is still grim. Although in recent years, proposed and implemented a series of intervention strategies, but the control effect is still not ideal. Male behavior crowd is a typical Ya Wen group, the spread of AIDS is not only affected by biological factors that is more influenced by cultural factors. Review of previous studies, the lack of understanding of the social and cultural factors that influence the spread of AIDS in this population, the lack of in-depth interpretation and analysis, the suitability of construction strategies may lead to lack of culture, so that the acceptability of the target population is reduced. Therefore, in-depth exploration of social and cultural factors influencing on AIDS high-risk behavior influence male sexual behavior, can we propose strategies and measures more effective. To understand the social and cultural factors and male sex Influence of community subculture of crowd psychology and behavior of the crowd, and the influence on the spread of AIDS. To explore the social and cultural factors influencing the AIDS prevention and control services, and puts forward some strategic suggestions to improve the interventions. Methods this study used qualitative research methods, from June 2015 to August 2016, considering the size of the crowd of male sexual behavior the epidemic, and the geographical distribution of population and other factors, selection of male sexual behavior Chinese 10 city face-to-face personal interviews. In addition, also organized the scene of some of the AIDS prevention service providers (including the investigation site for AIDS prevention and control staff and community members) focus group interviews. By the on-site investigation center for Disease Control and prevention and community organizations according to the open recruitment interview object sampling principle mainly focuses on several interviews. : 1) the external cultural and social factors on male sexual behavior in sexual attitudes, sexual behavior and influence the spread of AIDS; 2) male sexual behavior among community sub culture and its characteristics, as well as some of the high-risk behavior social cultural perspective; 3) to investigate the effects of AIDS prevention and control effect of the target population, acceptable social and cultural factors the effect of the interview data. By recording the way acquisition. The interview data encoding using Nvivo11 software, a total of 477 initial encoding level two and 40, encoding 8 topics. The results of this study were recruited and interviewed 81 people. Personal interview objects are mainly concentrated in the age of 25-34 years old (40.7%). The time for 10 years or more (59.3%), education for college and above (62.9%), the main occupation for the service industry (21%), NGO (27.2%) full-time / Part-time), marital status unmarried. (70.4%), Hukou In the non local (83.9%), HIV antibody to negative bacilli (84%). In addition, carry out focus group interviews 8 times, a total of 70 people participated in this study. Found mainly around 5 aspects: 1) social norms and social identity on the one hand the male behavior crowd concealment increased, building block intimacy the relationship between, and have a negative impact on the self identity; on the other hand, social identity caused by the discrimination intervention coverage affected, also contributed to an important cause of.2 AIDS deliberately spread) crowd sexual behavior in traditional culture under the pressure of heterosexual marriage, so that the people become the spread of AIDS "bridge population" the traditional culture; the lack of constraints on male sexual behavior of crowd behavior, to a certain extent promoted the open sex and randomness; traditional culture also hindered the sex education to some extent.3 agency) Will have great influence on male sexual behavior in the cultural development and the concept of sexual behavior, mainly reflected in the pattern of the stranger and friends of social identity and self identity and improved.4) neglect of sexual health, sexual behavior in community population in the sub culture of hedonism, the relationship of the characteristics of diversity and openness of communication aids caused by the adverse effects of.5) at present AIDS prevention services exist in the process of conflict with the target population and sub cultural maladjustment, affect the control effect. In order to service "from the community, to the community" as the guiding ideology, this study proposes suggestions for improving the innovation strategy effect of AIDS prevention. There is an important social and cultural factors affecting the conclusion of psychology and behavior of male sexual behavior of the crowd, has a close relationship with the spread of AIDS. Social norms, social identity, traditional culture and society Social and cultural factors of cultural development change has an important role in the construction of the MSM population subculture. At present the sub culture of the community MSM people ignore health needs, hedonism and relationship between pluralism and openness is not conducive to the prevention and control of AIDS. Only the combination of characteristics of control strategies for the construction of sub culture MSM group, formed "love yourself, love him in the community, the core value of responsibility" concept, guide the sub culture to the positive and healthy direction, can effectively reduce high-risk behavior, curb the spread of AIDS in the MSM population.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R512.91

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