中国16个城区男男性行为人群梅毒感染情况及影响因素分析

Prevalence and risk factors of syphilis in men who have sex with men in 16 districts in China

目的了解中国6个省（自治区、直辖市）的16个城区的男男性行为人群（MSM）的梅毒感染情况及其影响因素。方法于2007年在开展绘制MSM活动场所地理分布图及人群规模估计的基础上，用分类的非概率抽样方法在MSM中开展横断面调查；通过问卷调查收集人口学、危险行为以及梅毒感染等信息。用SPSS软件对数据进行单因素及多因素Logistic回归分析。结果2007年共收集4211份有效问卷。所调查的MSM平均年龄为28岁，自报为同性恋占66．7％，未婚占72．5％，高中及其以上教育程度占76.4％。近6个月MSM的性行为调查结果显示：8．7％有10个以上的男性性伴，5．6％曾买男性性服务，11.3％曾为男性提供商业性服务，18．9％曾与女性发生过性关系，与男性肛交性行为中的安全套坚持使用率仅为36．3％。所调查MSM的梅毒感染率为10．6％。多因素Logistic回归分析结果显示：年龄〉25岁[调整OR（AOR）=1．7，95％CI：1-3～2.0]、本市户籍（AOR=1-3，95％CI：1．0—1．7）、调查地区、酒吧，公园招募对象（AOR=1-3，95％CI：1．1～1.7）、买男性性服务（AOR=1.5，95％CI：1.0～2．1）、男男肛交行为中不坚持使用安全套（AOR=1．2，95％CI：1.0—1．5）和自报性病史（AOR=1-3．95％CI：1．0-1.7）是梅毒感染的独立相关变量。结论16个城区MSM的梅毒感染率已达一定水平、男男商业性服务及不安全性行为的流行率较高，亟待加强MSM的梅毒防治工作，包括梅毒和HIV筛查、推广使用安全套等综合干预措施。

Objective To examine the prevalence of and risk factors for syphilis among men who have sex with men （MSM） in 16 cities/districts, 6 provinces in China. Method Based on a previous survey on the entertainment place and population size of MSM, a cross-sectional study was conducted in 2007 using non-probability sampling method among MSM in 16 cities/districts in China. Information about the demography, risk behavior and syphilis infection was collected through questionnaires from MSM. Univariate and multi- variate stepwise logistic regression model was constructed to evaluate independent factors associated with syphilis. Results A total of 4211 participants were recruited. The mean age of these participants was 28 years. Among them, 66.7% were self identified as homosexual, 72.5% were unmarried, and 76.4% had an education beyond senior middle school; in the past 6 months, 8.7% had sexual contact with more than 10 male sex partners, 5.6% had ever paid for male sex service,11.3% had provided commercial sex service to males, and 18.9% had sexual contact with females, while condom was consistently used in only 36.3% of male-to-male anal sexual behavior. Syphilis was diagnosed in 10.6% of these participants. The risk factors independently associated with syphilis included being older than 25 years （adjusted OR = 1.7; 95% CI： 1.3-2.0）, local residency （adjusted OR = 1.3; 95% CI： 1.0-1.7）, being recruited from a bar or a park （adjusted OR = 1.3; 95% CI： 1.1-1.7）, having ever paid for a male sex service （adjusted OR = 1.5; 95% CI： 1.0-2.1 ）, inconsistent condom use during male-to-male anal sexual behavior（ adjusted OR = 1.2; 95% CI： 1.0-1.5 ）, self reported sexually transmitted infection history （adjusted OR = 1.3; 95% CI： 1.0-1.7）. Conclusions There is a high prevalence of syphilis in MSM in the 16 Chinese cities where male-to-male commercial sex service and unsafe sexual be havior are common. Further efforts are urgently needed to scale-up the prevention of and treatment program for syphilis among MSM, which should include syphilis and HIV screening as well as education on the use of condom.