男男性行为者自我歧视与性行为和心理因素的关系

Relations between self-drscrimination of MSM and sexual behavior and psychological factorsRelations between serf-discrimination of MSM and sexual behavior and psychological factors

目的 了解男男性行为者（MSM）自我歧视感受经历及与相关行为和心理因素的关系.方法 在绵阳城区,采用同伴推动抽样法（RDS）对MSM人群自我歧视感受、性伴及性行为、抑郁症状等进行自填式匿名调查,调查中首先从不同MSM亚群确定12名符合调查条件的种子,种子参加调查后每人发放3张招募卡,由其发给3名符合条件且愿意参加调查的同伴参加调查,以此类推,直到完成调查样本量.采用x2检验、等级相关、列联系数等进行统计学分析.结果 共调查201名,在最近6个月觉得同性性取向伤害了家庭或让家庭蒙羞的占59.2%（119/201）、掩饰自己的同性性取向免被歧视的占79.6%（160/201）、因有过同性性行为感到羞耻的占39.3%（79/201）.觉得同性性取向伤害了家庭或让家庭蒙羞与同期是否和MSM朋友去过迪斯科或夜总会（r=0.196,x^2=7.95,P＜0.05）、听音乐或看电影（r=0.201,x^2=8.423,P＜0.05）、是否接受过人类免疫缺陷病毒（HIV）健康咨询（r=0.231,x^2=11.329,P＜0.05）、一夜情数（rs=0.183,μ=2.588,P＜0.05）、抑郁症状检出（rs=0.241,μ=15.717,P＜0.05）和压力感受（rs=-0.310,μ=23.112,P＜0.05）相关,其中经历较多（3～4次）歧视者相应行为报告率依次为66.7%（11/33）、52.9%（18/34）、41.2%（14/34）、17.6%（6/34）、44.1%（15/34）、44.7%（10/24）.因有过同性性行为感到羞耻与同期是否和MSM朋友常去听音乐或看电影（r=0.195,x^2=7.933,P＜0.05）、一夜情数（rs=0.145,μ=2.051,P＜0.05）、男男肛交数（r=0.165,x^2=10.823,P＜0.05）、女性性伴数（r=0.265,x2=11.422,P＜0.05）和近6个月与女性性行为有无保护性（r=0.513,x^2=7.442,P＜0.05）、抑郁症状检出（rs=0.152,μ=13.034,P＜0.05）和压力感受（rs=-0.259,μ=21.190,P＜0.05）相关性有统计学意义,其中经历较多歧视者相应行为报告率依次为22.7%（5/22）、9.1%（2/22）、13.6%（3/22）、9.1%（2/22）、66.7%（2/3）、57.1%（4/7）、33.3%（19/57）.掩饰同性取向免被歧视与是否常去网吧（r=0.272,x^2=15.932,P＜0.05）、接受过HIV检测服务（r=0.232,x^2=11.446,P＜0.05）和压力感受（rs=-0.373,μ=28.868,P＜0.01）相关性有统计学意义,其中经历较多歧视者相应行为报告率分别为65.1%（28/43）、20.2%（17/84）、33.3%（19/57）,相应歧视感受经历多,到相关社会活动场所,接受过HIV咨询、HIV检测、MSM朋友宣传和性伴数较多,抑郁症状检出、压力感受较高.结论 MSM面临普遍的自我歧视,对个体行为、社群心理健康及艾滋病流行带来影响.

Objective To understand the self-discrimination experience of MSM and its relationship with sexual behavior and psychological factors.Methods By respondent-driven sampling（RDS） method, a call-for action and anonymous self-administration questionnaire investigation was carried out in Mianyang city on experience of self-discriminations, sexual partners and behaviors and depression symptom, etc.The first 12qualified people were designated as the ＂root＂ in the whole investigation from different MSM subgroups.Every ＂root＂ would get 3 recruit cards after their own investigation,then cards could be promoted to another 3 qualified people who were willing to accept questionnaires.And this process would go on till the sample size was accomplished.χ2 test,rank correlation and contingency coefficient would be applied for the statistical analysis.Results In total, 201 persons were investigated.Within the past 6 months, 59.2%（119/201） persons felt they did harm to their family or made the family down as gays ,79.6% （160/201）had to disguise their real sexual orientation in avoidance of being discriminated, 39.3% （ 79/201 ） were humiliated for having gay sex.It showed correlation between humiliation or harm to family and frequency to disco balls/night clubs（ r = 0.196, χ2 = 7.95, P 〈 0.05 ）, concerts or theaters （ r = 0.201, χ2 = 8.423, P 〈0.05 ） with MSM friends, HIV health consultancy （ r = 0.231, χ2 = 11.329, P 〈 0.05 ）, experiences of one night stands （ rs = 0.183 ,μ = 2.588, P 〈 0.05 ）, detection of depression （ rs = 0.241 ,μ = 15.717, P 〈 0.05 ）and stress-related perception（rs =-0.310,μ= 23.112,P〈0.05） ,the corresponding behavior report rates of who experienced 3 -4 times were 66.7% （ 11/33 ） ,52.9% （ 18/34 ） ,41.2% （ 14/34 ）, 17.6% （ 6/34 ）,44.1% （15/34） ,44.7% （10/24）.Statistical significance was found between the relations of humiliation for gay sex and frequency into concerts or theaters （ r = 0.195, χ2 = 7.933, P 〈 0.05 ） with MSM friends,experiences of one night stands （rs =0.145,μ=2.051,P〈0.05）,man-man anal sex （r=0.165,χ2 =10.823, P 〈 0.05 ）, numbers of female sexual partners （ r = 0.265, χ2 = 11.422, P 〈 0.05 ）, protectiveness of female sexual behavior in the past 6 months （ r =0.513 ,χ2 =7.442 ,P 〈0.05 ） ,detection of depression（ rs =0.152 ,μ = 13.034, P 〈 0.05 ） and stress-related perception （ rs = - 0.259,μ = 21.190, P 〈 0.05 ）, the corresponding behavior report rates of who experienced 3 - 4 times were 22.7% （5/22） ,9.1% （2/22）,13.6% （ 3/22 ）, 91.6% （ 2/22 ）, 66.7% （ 2/3 ）, 57.1% （ 4/7 ）, 33.3% （ 19/57 ） .It has statistical significance between the relations of disguising their real sexual orientation in avoidance of being of HIV test （ r= 0.232, χ2 = 11.446, P 〈 0.05 ）, and stress-related perception （ rs = - 0.373 ,μ = 28.868,P 〈 0.05 ）.It was found that increasing of discrimination was connected to entrance into gay-welcome places,acceptance of HIV consultancy and tests, posting gay information among MSM friends and hold of many sexual partners.Meanwhile, the pressure was rising when depression was checked out.Conclusion Selfdiscrimination was prevalent among MSM ,which had brought critical influence on the individual behavior,MSM psychological health and prevalence of AIDS.