对男男性行为者以防治性病为主预防艾滋病综合干预效果评价

Effectiveness of comprehensive intervention on the prevention of AIDS among men who have sex with men

目的评价以防治性病为主的同伴综合干预对男男性行为人群(men who have sex with men,MSM)在改变高危行为、接受健康服务及控制性病和HIV感染方面的效果。方法通过滚雪球法招募在常州市主要公共活动场所和互联网等的MSM人群。采用现场流行病学现场干预实验方法,在基线调查基础上,在MSM人群中开展以定点性病门诊提供免费或低廉的性病诊疗服务为主要形式的同伴综合干预。一年半后进行干预效果评估。问卷调查内容主要包括对象的一般人口学资料、行为状况和接受干预服务状况,同时采集血液和尿样样本以检测HIV、梅毒、淋球菌和生殖道沙眼衣原体。用SPSS 13.0软件进行χ2检验、t检验和Fisher′s确切检验,均以P<0.05为差异有统计学意义。结果经过一年半的项目实施后,干预后与干预前相比,调查对象接受健康服务以及性病诊疗均有显著性提高(P<0.01)。最近6个月有过肛交行为者由63.90%下降至51.15%(P<0.01),有过性交易者由13.16%下降至7.76%(P<0.05);最近一次男性肛交使用安全套者由80.67%下降至72.47%(P<0.05)。近半年性虐待由6.65%下降至1.81%(P<0.05)。HIV和梅毒(ELISA阳性)感染率干预前后差异无统计学意义,但现症梅毒(TRUST阳性)、淋球菌和生殖道沙眼衣原体感染则显著性下降(P<0.05)。结论依托免费定点性病门诊开展以防治性病为主的同伴综合干预模式,可促进MSM人群降低高危性行为并主动进行性病和HIV的检测咨询与治疗,有效地控制HIV和梅毒感染。

Objective To evaluate the effect of peer comprehensive intervention which was surposed to control STD among MSM on the prevention of HIV infection. Methods Subjects of MSM were recruited using ＂ snowball＂ method in Changzhou. Based on the baseline survey, a comprehensive intervention was conducted in appointed STD clinics to provide free or affordable STD services among MSM, including the detection of HIV, syphilis, gonorrhea and Chlarnydia trachomatis from blood or urine samples. The effectiveness was evaluated a year and half later. SPSS 13.0 software was used for data analysis. Results More MSM were noticed to seek and accept health services and STD treatment after the intervention （P〈0.01） . The proportion of men who had anal sex during the last six months dropped from 63.90% to 51.15%（P（0.01）, and those who had sex trade also dropped from 13.16% to 7. 760% （P〈0.05） . Meanwhile, the proportion of condom use during the latest anal sex decreased from 80.67% to 72.47%（P〈0.05） . During the last half year, sexual abuse cases decreased from 6.65% to 1.81% （P〈0. 05） . The infection rates of HIV and syphilis （ELISA＋）showed no difference before and after intervention, while the rates of active syphilis （TRUST positive）, Neisseria gonorrhoeae and Chlamydia trachomatis genital infection were significantly decreased （P〉0.05）. Conclusions The peer comprehensive intervention based on free STD clinics services to prevent and treat STD, can reduce risky sexual behaviors among MSM, and help them to seek willingly for the detection and treatment of STD as well as HIV, which may effectively control HIV and syphilis infection.