本文關(guān)鍵詞：男性同性兼異性性行為者HIV感染狀況及性行為特征　出處：《安徽醫(yī)科大學》2013年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 男性同性兼異性性行為者 人類免疫缺陷病毒 無保護性行為 影響因素

【摘要】：目的了解男男性行為兼異性性行為（men who have sex with men and women,MSMW）人群HIV感染狀況及其男性和女性性伴種類和特征、男性同性性行為和異性性行為及安全套使用狀況，探索MSMW人群高危性行為的相關(guān)因素，探討MSMW人群在HIV從高危人群向普通人群的傳播中的作用，為發(fā)展預防控制HIV通過MSM人群向普通人群蔓延的政策和策略提供依據(jù)。 方法本研究采用橫斷面調(diào)查的方法，以廣州市和成都市為調(diào)查現(xiàn)場，以18歲及以上在婚或最近12個月有異性性行為的男男性行為者為調(diào)查對象，采用“滾雪球”的方法進行調(diào)查對象招募，在獲得調(diào)查對象知情同意后，采用一對一方式進行匿名問卷調(diào)查，，每個城市調(diào)查300人（共600人），調(diào)查內(nèi)容包括社會人口學特征、最近6個月男性性伴種類和特征、男男性行為及安全套使用狀況；最近12個月異性性伴種類和特征、異性性行為及安全套使用狀況，并采集調(diào)查對象靜脈血進行HIV抗體血清學檢測。調(diào)查資料采用EpiData3.0軟件建立數(shù)據(jù)庫，運用SPSS10.0軟件進行統(tǒng)計分析。統(tǒng)計分析方法主要包括頻數(shù)分布、2檢驗和多元Logistic回歸分析。 結(jié)果600名調(diào)查對象中，平均年齡為（34.31±9.50）歲，其中年齡為26~35歲者占38.5%；已婚者占62.5%；調(diào)查對象中文化程度為初中及以下、高中或中專、大專及以上者分別為123（20.5%），216（36.0%）和261（43.5%）；性取向為同性、雙性、異性或不確定者所占的比例分別為42.3%、50.0%和7.7%；58.3%調(diào)查對象為外地戶籍。 調(diào)查對象中，既往檢測確認HIV抗體陽性者116人，本次檢測HIV抗體確認陽性者41人，HIV感染率為26.2%（157/600），本次調(diào)查中HIV抗體陽性檢出率為8.5%（41/484）。其中，廣州市和成都市調(diào)查對象HIV感染率分別為13.0%（39/300）和39.3%（118/300）、本次調(diào)查HIV抗體陽性檢出率分別為3.0%（8/269）和15.3%（33/215），同性性取向和非同性性取向者HIV感染率分別為31.5%（80/254）和22.3%（77/346）。 最近6個月中，有28.0%的調(diào)查對象擁有5個及以上的男性性伴，與男性發(fā)生肛交行為時每次使用安全套者占44.2%，最近3次和最近1次男男肛交性行為使用安全套者分別為52.3%和63.0%；最近12個月有86.0%的調(diào)查對象與女性發(fā)生過性行為，最近12個月?lián)碛衅拮�、婚前女友、婚外情人、女性偶然性伴和女性商業(yè)性伴的比例分別為65.0%、27.2%、1.5%、12.7%、4.5%，約1/3的調(diào)查對象異性性行為時堅持每次使用安全套，36.5%的調(diào)查對象在最近3次異性性行為均未使用安全套。最近6個月成都市55.7%MSMW男男性行為時每次使用安全套，高于廣州市（32.7%），最近12個月成都市38.3%MSMW異性性行為時每次使用安全套，高于廣州市（25.3%）。 HIV陽性的調(diào)查對象中，最近6個月與男性發(fā)生過肛交性行為者為91.1%，與男性發(fā)生肛交行為時每次使用安全套者為49.7%，最近3次和最近1次男男肛交行為使用安全套者分別為60.5%和69.4%；最近12個月有82.8%陽性調(diào)查對象與異性發(fā)生過性行為，42.0%的調(diào)查對象每次性行為堅持使用安全套，最近3次性行為使用安全套者占47.8%。最近6個月，既往檢測確認HIV陽性的MSMW發(fā)生同性性行為時從不使用安全套的比例（4.3%）低于本次檢測確認HIV陽性者（22.0%）；最近12個月，有12.9%既往檢測確認HIV陽性的MSMW異性性行為時從不使用安全套，低于本次檢出HIV陽性的MSMW（46.3%）。 調(diào)查對象無保護肛交行為多因素Logistic回歸分析結(jié)果顯示，隨著年齡增長，發(fā)生無保護肛交行為的危險分別增加（1.8-3.6倍）；廣州市的調(diào)查對象發(fā)生無保護肛交行為的危險是成都的2.6倍（OR=2.557，95%CI：1.676～3.903）；擁有5個及以上者發(fā)生無保護肛交行為的危險增加至2.1倍（OR=2.114，95%CI：1.175～3.802）；最近12個月有無保護異性性行為者發(fā)生無保護肛交行為的危險增加2-4倍；本次檢出HIV陽性者最近6個月無保護性肛交行為的危險是既往檢出HIV陽性者的4倍（OR=4.107，95%CI：1.642～10.272），最近6個月有男性商業(yè)性伴的調(diào)查對象發(fā)生無保護性肛交行為的危險降低。 調(diào)查對象無保護異性性行為多因素Logistic回歸分析顯示，擁有5個及以上者男性性伴者發(fā)生無保護異性性行為的危險增加至2.4倍（OR=2.387，95%CI：1.370～4.157）；與同性性取向者相比，雙性和異性或不確定性取向者發(fā)生無保護性陰道性交的危險分別增加到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）；調(diào)查對象中，最近6個月有高危男男性行為者發(fā)生無保護異性性行為的危險增加2.6-3.3倍；與既往檢測HIV陽性調(diào)查對象相比，本次檢出HIV陽性（OR=2.383，95%CI：1.014～5.601）和HIV陰性（OR=2.466，95%CI：1.511～4.027）發(fā)生無保護異性性行為的危險增加。 多因素Logistic回歸分析結(jié)果表明，廣州市調(diào)查對象無保護肛交行為與擁有2以上同性性伴、月收入低、最近12個月異性性行為從不使用安全套和有男性偶然性伴相關(guān)聯(lián)；廣州市調(diào)查對象無保護異性性行為危險因素包括非同性性取向、肛交性角色為1和0.5、最近12個月有妻子。成都市調(diào)查對象無保護肛交行為與年齡在25歲以上、不知曉HIV感染狀況和有男朋友、最近12個月有無保護異性性行為相關(guān)聯(lián)。成都市調(diào)查對象無保護異性性行為危險因素包括非同性性取向、不知曉HIV感染狀況、有男性偶然性伴。 結(jié)論MSMW人群HIV感染率已經(jīng)處于高水平，且廣泛存在多性伴和高比例的無保護男性肛交性行為和女性陰道性交行為，該人群在HIV跨性別傳播中的橋梁作用可能加快HIV在普通人群中的擴散。因此，在制定MSMW人群的艾滋病預防干預策略時，需要在已知的高危性行為影響因素的基礎上，既要考慮遏制HIV在MSMW人群中快速擴散，又要考慮控制HIV通過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.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R512.91

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