不同告知时间的HIV感染者危险性行为及影响因素研究
发布时间：2018-08-08 20:07
【摘要】：危险性行为是指在所有同性或异性性生活过程中能够引起双方血液及体液交换的性行为。性传播已成为目前导致中国艾滋病病毒(HIV)流行的主要途径。HIV感染者的危险性行为除可能造成HIV二代传播外,也可能使本人感染性传播疾病和机会性感染病原体,或重复感染不同型别毒株或耐药毒株,影响抗病毒治疗效果。 到2007年10月底,全国累计报告HIV感染者和艾滋病病人223,501例,行为调查结果亦证明该人群危险性行为发生仍然存在。随着监测、流行病学调查、自愿咨询检测和感染者随访管理工作力度的不断加大,越来越多的感染者将被确认并告知阳性检测结果,同时抗病毒治疗可能使他们存活时间延长,增加了传播HIV的机会。良好有效的卫生服务和行为干预措施有助于减少HIV感染者危险性行为,从而有效控制HIV传播。 本研究通过了解不同告知时间的HIV感染者危险性行为发生情况,探讨个人性伴,家庭和社会环境以及医疗卫生服务因素对HIV感染者危险性行为的影响,建立基于健康行为理论的HIV感染者危险性行为路径模型,为疫情估计提供基础数据,为改进HIV感染者医疗卫生服务措施提供依据。 方法 本研究采用定量调查和定性调查相结合的方式,于2008年7月至12月对云南省德宏傣族景颇族自治州潞西市,盈江县,广西壮族自治区柳州市鹿寨县和贺州市八步区1120名HIV感染者通过面对面访谈进行了问卷调查,调查对象年龄18至49岁,于2006年1月至2008年12月HIV抗体确认阳性并被告知结果。同时对38名HIV感染者和20名工作人员分别进行了个人和小组访谈。 定量调查研究设计包括组间比较和组内比较,对于调查对象中的HIV感染者夫妇,随机选择其中一方作为研究对象。组间比较首先对974名新告知组和已告知组调查对象过去6个月危险性行为进行比较分析,探讨告知前后两组危险性行为的差异,以及个人、性伴和性行为因素的影响；其次对836名已告知组调查对象过去6个月危险性行为进行比较分析,探讨已告知不同时间组危险性行为的差异,以及个人、性伴和性行为、家庭和社会支持以及医疗卫生服务的影响,并建立基于健康行为理论的HIV感染者危险性行为预测模型。组内比较即对177名2008年1月至6月告知组告知前后危险性行为进行比较分析,探讨同一组调查对象告知前后危险性行为的差异,以及个人、性伴和性行为、家庭和社会支持以及医疗卫生服务等对告知后危险性行为的影响。 HIV感染者个人访谈内容包括接受医疗卫生服务情况,阳性结果通知和安全套使用行为等；工作人员小组访谈内容包括安全套推广工作现状、存在问题和建议以及工作人员需求等。 结果 974名调查对象中,新告知组138人(14.2%)；已告知组836人(85.8%),其中2008年1月至6月告知者174人(20.8%),2007年7月至12月告知者234人(28.0%),2007年1月至6月告知者242人(28.9%),2006年告知者186人(22.2%)；云南652人,占66.9%,其中潞西市322人(49.4%),盈江县330人(50.6%),广西322人,占33.1%,其中鹿寨县164人(50.9%),八步区158人(49.1%)；男性553人,占56.8%,女性421人,占43.2%；年龄最小18岁,最大49岁,平均年龄为32.5±7.2岁,年龄中位数为32岁。 974名调查对象中,704人过去6个月曾发生过性行为,占72.3%,其中仅与固定性伴发生性行为者623人,占88.5%,仅与非固定性伴发生性行为者50人,占7.1%,与固定和非固定性伴均发生过性行为者31人,占4.4%。 1.不同告知时间的HIV感染者危险性行为 组间比较结果显示,974名调查对象中,已告知组70.5%(549/836)过去6个月发生性行为,显著低于新告知组(83.3%)；发生性行为者中,已告知组坚持正确使用安全套(第三阶段)者所占比例(55.7%)高于新告知组(7.0%),而无安全套使用意向者(第一阶段)所占比例(9.3%)低于新告知组(18.3%),已告知组最近一次与固定和非固定性伴发生性行为时使用安全套的比例分别为72.7%和66.7%,而新告知组上述比例分别为16.2%和22.2%。 组内比较结果显示,177名调查对象中,未发生性行为者由告知前的27.7%上升到告知后的30.5%,安全套使用行为处于第三阶段者由13.6%上升到36.2%,而安全套使用行为处于第二阶段和第一阶段者分别由48.6%和10.2%下降至26.6%和6.8%,告知前后行为分布的状况有显著差异,且存在一致性。 已告知各组调查对象发生性行为的比例无明显差异,但是与2006年告知组相比,2007年1月至6月告知组无使用安全套意向(第一阶段)的概率较低,提示安全套使用意识和行为在被告知阳性结果后不同时间段有所不同。 2.影响因素 2.1个人基本情况 本研究发现,云南调查对象报告危险性行为发生率高于广西。省份为广西者感知的艾滋病易感性水平较高,其差异可能与调查偏倚以及环境因素有关；女性安全套使用自我效能低于男性,因此也更容易发生危险性行为；年龄较大组发生性行为的概率较低,但与安全套使用行为阶段无显著关联；与伴侣共同生活者(已婚/同居者)发生性行为概率以及坚持使用安全套的比例均较高；已告知各组调查对象中,小学文化程度者安全套使用行为处于第二阶段者的概率低于高中以上组；家庭人均月收入高者发生性行为比例较高,且更可能坚持使用安全套。组内比较结果显示,注射毒品传播和性传播者告知后不安全行为发生概率无显著差异,而其他途径传播者发生不安全行为的风险高于与注射毒品传播者,由于样本量较小,判断传播途径和不安全性行为之间的关联应谨慎。此外,本研究未发现吸毒和饮酒与危险性行为有显著关联。 调查对象感知的艾滋病严重性、易感性、安全套使用益处和障碍以及自我效能和社会规范等可能直接或通过其他认知态度因素间接影响安全套使用行为阶段,安全套使用障碍对于安全套使用行为阶段影响最为明显,其次是艾滋病易感性、自我效能和社会规范,而艾滋病严重性和安全使用益处对安全套使用行为阶段的影响较小,且为间接效应。艾滋病病人感知的易感性、安全套使用益处和社会规范水平均高于无症状感染者,艾滋病知识知晓者感知的艾滋病严重性、易感性和社会规范水平较高,因而上述两组坚持使用安全套的概率较高；负面情绪水平高者,感知的艾滋病严重性和安全套使用障碍水平较高,而感知的艾滋病易感性水平较低,容易发生不安全性行为。 2.2性伴和性行为 本研究发现,HIV感染者之间发生危险性行为的概率高于阴性性伴,而与阳性性伴和感染状况不明性伴发生危险性行为的差别无统计学意义。HIV感染者与固定性伴发生危险性行为的概率较低,尤其是保持性关系较长者。有非固定性伴者安全套使用行为处于第一阶段的概率较高,且同时有固定和非固定性伴者发生危险性行为的概率高于仅有非固定性伴者。定性访谈结果亦提示某些有固定性伴的HIV感染者因为不愿意使用安全套而与其他性伴发生性行为。本研究发现多数HIV感染者固定性伴知晓感染状况,而非固定性伴知晓率较低,但本研究未证明性伴知晓情况与危险性行为发生存在关联。HIV感染者安全套使用行为与性伴类型无关。性行为频率较低者,坚持使用安全套比例较高。 2.3家庭和社会支持 由于担忧被歧视,HIV感染者通常不愿意暴露本人感染状况,但愿意将结果告知关系密切者。已告知组调查对象中,78.7%亲人知晓感染状况,27.2%其他人知晓感染状况,72.7%获得支持,23.1%感到歧视。研究结果显示,未获得支持者无安全套使用意向的概率较高,感到歧视则增加了不坚持使用安全套的风险。此外,参与感染者小组活动者无安全套使用意向者比例较低,获得物质经济支持者发生性行为的比例略高,但对安全套使用行为阶段的影响不显著。 2.4医疗卫生服务 本研究结果显示,获得良好检测和告知服务者坚持使用安全套概率较高。良好检测和告知服务包括获得知情同意,由医生或者防疫人员单独告知本人结果以及检测前后获得充分信息等。 定性访谈结果显示,免费安全套在质量、性能、款式和包装等方面存在的问题可能影响其可接受性,部分HIV感染者由于担心身份泄露不愿意接受免费安全套。已告知组调查对象中,65.3%均获得了免费安全套,获得安全套者性行为发生概率较高,但危险性行为发生概率较低。这可能由于免费安全套发放改善了安全套可及性,也可能与样本选择偏倚或社会期望偏倚有关。 本研究结果表明,获得面对面信息交流者安全套使用行为处于第二阶段的概率高于第三阶段,而行为处于第一阶段的比例较低,提示面对面信息交流者有助于提高安全套使用意向,但促进坚持使用安全套的作用有限；获得公众艾滋病信息者和参加艾滋病预防宣传教育活动者发生危险性行为的可能性较高,可能与选择偏倚有关；是否获得安全套使用信息与过去6个月安全套使用行为阶段无关,但获得安全套使用信息者发生性行为比例较高,可能与发生性行为者更关注安全套使用信息有关。 已告知各组调查对象中,58.9%(492/836)接受抗病毒治疗。接受抗病毒治疗者安全套使用行为处于第三阶段的概率较高,而行为处于第一阶段的概率较低。多因素分析结果显示,接受抗病毒治疗与安全套使用行为阶段的关联未达显著性水平。 结论 在被告知阳性检测结果后,HIV感染者危险性行为较之前有所下降。HIV感染者的危险性行为与个人,性伴、家庭和社会支持以及医疗卫生服务等多种因素有关。建议进一步加强HIV检测咨询、告知和随访管理工作,改善卫生服务质量；根据干预对象特点和行为特征采取有针对的干预措施,干预过程中应重视认知态度的变化；以社区和家庭为单位开展有针对性的预防宣传工作,以减少歧视,促进针对HHIV感染者的社会支持。
[Abstract]:Dangerous sexual behavior refers to the sexual behavior that can cause the exchange of blood and body fluids in all sex or heterosexual life. Sexual transmission has become the main way of causing the epidemic of HIV virus (HIV) in China. The dangerous behavior of the.HIV infected person is likely to cause the two generation of sowing and the infection of sexually transmitted diseases. Opportunistic infections, or repeated infection of different types of strains or drug-resistant strains, affect the efficacy of antiviral treatment.
By the end of October 2007, 223501 cases of HIV infected and AIDS patients were reported throughout the country. The results of the behavior survey also proved that the risk of the population still existed. With the monitoring, epidemiological investigation, voluntary counseling and testing and follow-up management of the infected people, more and more infected people will be confirmed and informed. At the same time, antiviral therapy may prolong their survival time and increase the opportunity to spread HIV. Good health services and behavioral interventions help to reduce the risk of HIV infection and thus effectively control the spread of HIV.
In this study, the risk behavior of HIV infected people at different time of notification was investigated, and the effects of personal partners, family and social environment and medical service factors on the risk behavior of HIV infected people were investigated. The risk behavior of HIV infected persons based on the health behavior theory was established as the path model to provide basic data for the estimation of the epidemic situation. To provide evidence for improving health care measures for HIV infected persons.
Method
In this study, a questionnaire survey was conducted on 1120 HIV infected people in Luxi City, Yingjiang County, Luzhai County, the Guangxi Zhuang Autonomous Region Liuzhou city and Hezhou City, Dehong, Yunnan Province, Luxi City, Yingjiang County, Liuzhou City, the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region Province, from July 2008 to December. The respondents were aged from 18 to 49 years old. From January 2006 to December 2008, HIV antibodies were confirmed positive and informed of the results. Personal and group interviews were conducted with 38 HIV-infected persons and 20 staff members, respectively.
The quantitative investigation design includes the inter group comparison and the intra group comparison. For the HIV infected couples in the survey subjects, one of them is randomly selected as the research object. The comparison between the 974 new informing groups and the informed groups in the past 6 months is compared, and the two groups of dangerous sexual behaviors before and after the notification are discussed. The differences, as well as the effects of individuals, sexual partners and sexual behavior factors; secondly, a comparative analysis of the risk behaviors of the 836 participants in the past 6 months, and the differences in the risk behavior of different time groups, as well as the impact of individuals, sexual partners and sexual behavior, family and social support and health services, and based on the analysis of the effects of the risk behavior The risk behavior prediction model of HIV infection in the health behavior theory. The comparison of the dangerous sexual behaviors before and after the informing group of 177 to June was compared, and the differences in the risk behavior before and after the same group were discussed, as well as the individual, sexual partner and sexual behavior, family and social support and medical service. The influence on the dangerous sexual behavior after the notification.
Personal interviews with HIV infected people include medical and health services, positive results and condom use, and staff group interviews include the status of condom promotion, problems and suggestions, and staff needs.
Result
Of the 974 subjects, 138 (14.2%) were informed by the new group, and 836 (85.8%) were informed of the group from January 2008 to June (20.8%), 234 from July 2007 to December (28%), 242 (28.9%) in January 2007 to June, and 186 in 2006, and Yunnan Province, Yingjiang County 30 (50.6%), 322 in Guangxi, accounting for 33.1%, 164 (50.9%) in Luzhai county and 158 (49.1%) in the eight step area; 553 men, 56.8% and 421, accounting for 43.2%.
Of the 974 subjects, 704 had sexual behavior in the past 6 months, accounting for 72.3%, of which 623 had sex with fixed partners, accounting for 88.5%, 50 with non fixed partners, 7.1%, and 31 with both fixed and non fixed partners, accounting for 4.4%..
1. risk behavior of HIV infected people at different time of informing
The results of the group comparison showed that among the 974 subjects, 70.5% (549/836) had been informed of sexual behavior in the past 6 months, significantly lower than that of the new group (83.3%). Among the sex workers, the group had been informed that the proportion of the condom use (55.7%) was higher than the new informing group (7%), and the first order (first order). The proportion of the group (9.3%) was lower than that of the new informing group (18.3%). The proportion of the condoms was 72.7% and 66.7%, respectively, when the group was informed of the recent sexual behavior of fixed and non fixed partners, while the ratio of the new informing group was 16.2% and 22.2%., respectively.
The results of intra group comparison showed that among the 177 subjects, the non sex actors increased from 27.7% before notified to 30.5%, and the use of condom use increased from 13.6% to 36.2% from 13.6% to 36.2%, while the condom use behavior fell from 48.6% and 10.2% to 26.6% and 6.8%, respectively, to inform before and after. There are significant differences and consistency in distribution.
There was no significant difference in the proportion of the participants' sexual behavior, but compared with the 2006 informing group, the probabilities of the informing group without condom use (the first stage) from January 2007 to June were lower, suggesting that the condom use consciousness and behavior were different in different periods after the positive results of the defendant.
2. influencing factors
2.1 people's basic situation
The study found that Yunnan respondents reported a higher incidence of risk behavior than in Guangxi. The level of susceptibility to AIDS in Guangxi province was higher than that in Guangxi. The difference may be related to investigation bias and environmental factors; female condoms were less likely to use self-efficacy than men, and therefore were more likely to have dangerous sexual behavior; older groups were found to be in a larger group. The probability of sexual behavior was low, but there was no significant correlation with the behavior stage of condom use; the probability of sexual behavior and the proportion of condom use were higher in the common living (married / cohabitation). The probabilities of the second stages were lower than that of the primary school students. In the high school group, the proportion of people with high per capita monthly income was higher and more likely to insist on the use of condoms. The results showed that there was no significant difference in the probability of unsafe behavior between the drug transmission and the sexually transmitted people, while the risk of unsafe behavior in other channels was higher than that of the injection drug. In addition, there was no significant association between drug use and alcohol consumption and dangerous sexual behavior.
The perceived AIDS severity, susceptibility, condom use benefits and barriers, self efficacy and social norms may directly or indirectly affect the use of condom use behavior, and condom use barriers have the most significant impact on condom use behavior, followed by AIDS susceptibility. Sex, self-efficacy and social norms, and the impact of AIDS severity and safety on the use of condom use behavior stage less, and indirect effect. The perceived susceptibility to AIDS patients, condom use benefits and social standards are higher than asymptomatic infection, AIDS awareness awareness of AIDS severity, easy The level of perceptual and social norms is high, so the two groups are more likely to insist on condom use; those with high level of negative emotion have a higher level of perceived AIDS severity and condom use disorder, while the perceived level of AIDS susceptibility is low, and unsafe sex is easy to occur.
2.2 sexual partners and sexual behavior
The study found that the probability of risky sexual behavior among HIV infected people is higher than that of negative partners, and there is no statistically significant difference in the risk behavior between positive partners and unidentified partners. The risk of.HIV infection is lower than that of fixed partners, especially those with longer sexual relationship. The probability of full use behavior at the first stage is higher, and the risk behavior of both fixed and non fixed partners is higher than those with only non fixed partners. Qualitative interview results also suggest that some HIV infected persons with fixed partners have sex with other sex partners because they are not willing to use condoms. The number of HIV infected persons was fixed with awareness of infection, but the awareness rate of non fixed partners was low. However, this study did not prove that the use of condom use behavior of people with.HIV infection was not related to the type of sexual partners.
2.3 family and social support
Because of the fear of being discriminated, HIV infected people are usually reluctant to expose their infection status, but are willing to inform the close relationship. 78.7% of them have been told that relatives are aware of the infection, 27.2% other people know the infection, 72.7% support, and 23.1% feel discrimination. The results showed that no supporters did not use condoms. The risk of discrimination increased the risk of non use of condoms. In addition, the proportion of people who participated in the group with no condom use intention was low, and the proportion of material economic supporters to sexual behavior was slightly higher, but the effect on the use of condom behavior was not significant.
2.4 medical and health services
The results of this study show that good testing and informing operators are more likely to insist on using condoms. Good testing and notification services include informed consent, the doctor or the epidemic prevention personnel individually inform the results and obtain sufficient information before and after the test.
The results of qualitative interviews showed that the problems in the quality, performance, style and packaging of the free condoms might affect their acceptability. Some HIV infected people were not willing to accept free condoms for fear of identity leakage. In the group of respondents, 65.3% received a free condom and got the probability of condom sexual behavior. It is higher, but the probability of dangerous sexual behavior is low. This may be due to the free condom release that improves the condom accessibility, and may also be related to the selection bias of the sample or the social expectation bias.
The results of this study showed that the probability of receiving condom use behavior in the second stage was higher than the third stage, and the proportion of behavior in the first stage was low. It suggested that face-to-face information communicators help to improve condom use intention, but promote the limited use of condoms; obtain public AIDS. The likelihood of risky sexual behavior between the information and the persons participating in the AIDS prevention and education activities may be associated with the selection bias; whether the use of condom use information is not related to the use of condom use in the past 6 months, but the rate of sexual behavior in the use of condoms is higher and may be more likely to be associated with sexual actors. Pay attention to the use of condom information.
Among the participants, 58.9% (492/836) received antiviral therapy. The probability of being at the third stage was higher in the condom use behavior of the antiviral treatment, and the probability of the behavior at the first stage was lower. The results of multifactor analysis showed that the association between the antiviral treatment and the use of the condom use behavior was not significant.
conclusion
After being informed of the positive results, the risk behavior of HIV infected people decreased more than before, and the risk behavior of.HIV infected people was related to a variety of factors such as personal, sexual partners, family and social support, and medical service.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2009
【分类号】：R512.91;R181.3
[Abstract]:Dangerous sexual behavior refers to the sexual behavior that can cause the exchange of blood and body fluids in all sex or heterosexual life. Sexual transmission has become the main way of causing the epidemic of HIV virus (HIV) in China. The dangerous behavior of the.HIV infected person is likely to cause the two generation of sowing and the infection of sexually transmitted diseases. Opportunistic infections, or repeated infection of different types of strains or drug-resistant strains, affect the efficacy of antiviral treatment.
By the end of October 2007, 223501 cases of HIV infected and AIDS patients were reported throughout the country. The results of the behavior survey also proved that the risk of the population still existed. With the monitoring, epidemiological investigation, voluntary counseling and testing and follow-up management of the infected people, more and more infected people will be confirmed and informed. At the same time, antiviral therapy may prolong their survival time and increase the opportunity to spread HIV. Good health services and behavioral interventions help to reduce the risk of HIV infection and thus effectively control the spread of HIV.
In this study, the risk behavior of HIV infected people at different time of notification was investigated, and the effects of personal partners, family and social environment and medical service factors on the risk behavior of HIV infected people were investigated. The risk behavior of HIV infected persons based on the health behavior theory was established as the path model to provide basic data for the estimation of the epidemic situation. To provide evidence for improving health care measures for HIV infected persons.
Method
In this study, a questionnaire survey was conducted on 1120 HIV infected people in Luxi City, Yingjiang County, Luzhai County, the Guangxi Zhuang Autonomous Region Liuzhou city and Hezhou City, Dehong, Yunnan Province, Luxi City, Yingjiang County, Liuzhou City, the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region Province, from July 2008 to December. The respondents were aged from 18 to 49 years old. From January 2006 to December 2008, HIV antibodies were confirmed positive and informed of the results. Personal and group interviews were conducted with 38 HIV-infected persons and 20 staff members, respectively.
The quantitative investigation design includes the inter group comparison and the intra group comparison. For the HIV infected couples in the survey subjects, one of them is randomly selected as the research object. The comparison between the 974 new informing groups and the informed groups in the past 6 months is compared, and the two groups of dangerous sexual behaviors before and after the notification are discussed. The differences, as well as the effects of individuals, sexual partners and sexual behavior factors; secondly, a comparative analysis of the risk behaviors of the 836 participants in the past 6 months, and the differences in the risk behavior of different time groups, as well as the impact of individuals, sexual partners and sexual behavior, family and social support and health services, and based on the analysis of the effects of the risk behavior The risk behavior prediction model of HIV infection in the health behavior theory. The comparison of the dangerous sexual behaviors before and after the informing group of 177 to June was compared, and the differences in the risk behavior before and after the same group were discussed, as well as the individual, sexual partner and sexual behavior, family and social support and medical service. The influence on the dangerous sexual behavior after the notification.
Personal interviews with HIV infected people include medical and health services, positive results and condom use, and staff group interviews include the status of condom promotion, problems and suggestions, and staff needs.
Result
Of the 974 subjects, 138 (14.2%) were informed by the new group, and 836 (85.8%) were informed of the group from January 2008 to June (20.8%), 234 from July 2007 to December (28%), 242 (28.9%) in January 2007 to June, and 186 in 2006, and Yunnan Province, Yingjiang County 30 (50.6%), 322 in Guangxi, accounting for 33.1%, 164 (50.9%) in Luzhai county and 158 (49.1%) in the eight step area; 553 men, 56.8% and 421, accounting for 43.2%.
Of the 974 subjects, 704 had sexual behavior in the past 6 months, accounting for 72.3%, of which 623 had sex with fixed partners, accounting for 88.5%, 50 with non fixed partners, 7.1%, and 31 with both fixed and non fixed partners, accounting for 4.4%..
1. risk behavior of HIV infected people at different time of informing
The results of the group comparison showed that among the 974 subjects, 70.5% (549/836) had been informed of sexual behavior in the past 6 months, significantly lower than that of the new group (83.3%). Among the sex workers, the group had been informed that the proportion of the condom use (55.7%) was higher than the new informing group (7%), and the first order (first order). The proportion of the group (9.3%) was lower than that of the new informing group (18.3%). The proportion of the condoms was 72.7% and 66.7%, respectively, when the group was informed of the recent sexual behavior of fixed and non fixed partners, while the ratio of the new informing group was 16.2% and 22.2%., respectively.
The results of intra group comparison showed that among the 177 subjects, the non sex actors increased from 27.7% before notified to 30.5%, and the use of condom use increased from 13.6% to 36.2% from 13.6% to 36.2%, while the condom use behavior fell from 48.6% and 10.2% to 26.6% and 6.8%, respectively, to inform before and after. There are significant differences and consistency in distribution.
There was no significant difference in the proportion of the participants' sexual behavior, but compared with the 2006 informing group, the probabilities of the informing group without condom use (the first stage) from January 2007 to June were lower, suggesting that the condom use consciousness and behavior were different in different periods after the positive results of the defendant.
2. influencing factors
2.1 people's basic situation
The study found that Yunnan respondents reported a higher incidence of risk behavior than in Guangxi. The level of susceptibility to AIDS in Guangxi province was higher than that in Guangxi. The difference may be related to investigation bias and environmental factors; female condoms were less likely to use self-efficacy than men, and therefore were more likely to have dangerous sexual behavior; older groups were found to be in a larger group. The probability of sexual behavior was low, but there was no significant correlation with the behavior stage of condom use; the probability of sexual behavior and the proportion of condom use were higher in the common living (married / cohabitation). The probabilities of the second stages were lower than that of the primary school students. In the high school group, the proportion of people with high per capita monthly income was higher and more likely to insist on the use of condoms. The results showed that there was no significant difference in the probability of unsafe behavior between the drug transmission and the sexually transmitted people, while the risk of unsafe behavior in other channels was higher than that of the injection drug. In addition, there was no significant association between drug use and alcohol consumption and dangerous sexual behavior.
The perceived AIDS severity, susceptibility, condom use benefits and barriers, self efficacy and social norms may directly or indirectly affect the use of condom use behavior, and condom use barriers have the most significant impact on condom use behavior, followed by AIDS susceptibility. Sex, self-efficacy and social norms, and the impact of AIDS severity and safety on the use of condom use behavior stage less, and indirect effect. The perceived susceptibility to AIDS patients, condom use benefits and social standards are higher than asymptomatic infection, AIDS awareness awareness of AIDS severity, easy The level of perceptual and social norms is high, so the two groups are more likely to insist on condom use; those with high level of negative emotion have a higher level of perceived AIDS severity and condom use disorder, while the perceived level of AIDS susceptibility is low, and unsafe sex is easy to occur.
2.2 sexual partners and sexual behavior
The study found that the probability of risky sexual behavior among HIV infected people is higher than that of negative partners, and there is no statistically significant difference in the risk behavior between positive partners and unidentified partners. The risk of.HIV infection is lower than that of fixed partners, especially those with longer sexual relationship. The probability of full use behavior at the first stage is higher, and the risk behavior of both fixed and non fixed partners is higher than those with only non fixed partners. Qualitative interview results also suggest that some HIV infected persons with fixed partners have sex with other sex partners because they are not willing to use condoms. The number of HIV infected persons was fixed with awareness of infection, but the awareness rate of non fixed partners was low. However, this study did not prove that the use of condom use behavior of people with.HIV infection was not related to the type of sexual partners.
2.3 family and social support
Because of the fear of being discriminated, HIV infected people are usually reluctant to expose their infection status, but are willing to inform the close relationship. 78.7% of them have been told that relatives are aware of the infection, 27.2% other people know the infection, 72.7% support, and 23.1% feel discrimination. The results showed that no supporters did not use condoms. The risk of discrimination increased the risk of non use of condoms. In addition, the proportion of people who participated in the group with no condom use intention was low, and the proportion of material economic supporters to sexual behavior was slightly higher, but the effect on the use of condom behavior was not significant.
2.4 medical and health services
The results of this study show that good testing and informing operators are more likely to insist on using condoms. Good testing and notification services include informed consent, the doctor or the epidemic prevention personnel individually inform the results and obtain sufficient information before and after the test.
The results of qualitative interviews showed that the problems in the quality, performance, style and packaging of the free condoms might affect their acceptability. Some HIV infected people were not willing to accept free condoms for fear of identity leakage. In the group of respondents, 65.3% received a free condom and got the probability of condom sexual behavior. It is higher, but the probability of dangerous sexual behavior is low. This may be due to the free condom release that improves the condom accessibility, and may also be related to the selection bias of the sample or the social expectation bias.
The results of this study showed that the probability of receiving condom use behavior in the second stage was higher than the third stage, and the proportion of behavior in the first stage was low. It suggested that face-to-face information communicators help to improve condom use intention, but promote the limited use of condoms; obtain public AIDS. The likelihood of risky sexual behavior between the information and the persons participating in the AIDS prevention and education activities may be associated with the selection bias; whether the use of condom use information is not related to the use of condom use in the past 6 months, but the rate of sexual behavior in the use of condoms is higher and may be more likely to be associated with sexual actors. Pay attention to the use of condom information.
Among the participants, 58.9% (492/836) received antiviral therapy. The probability of being at the third stage was higher in the condom use behavior of the antiviral treatment, and the probability of the behavior at the first stage was lower. The results of multifactor analysis showed that the association between the antiviral treatment and the use of the condom use behavior was not significant.
conclusion
After being informed of the positive results, the risk behavior of HIV infected people decreased more than before, and the risk behavior of.HIV infected people was related to a variety of factors such as personal, sexual partners, family and social support, and medical service.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2009
【分类号】：R512.91;R181.3
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