昆明男男性行为者安全套使用及影响因素分析

Condom use and its influencing factors among men who have sex with men in Kunming city

目的了解云南省昆明市男男性行为者(MSM)安全套使用情况及其影响因素。方法采用非概率抽样法,以2011年12月—2012年8月在云南彩云天空工作组进行艾滋病自愿咨询检测的250名MSM为研究对象进行问卷调查和定性访谈。结果确诊为艾滋病病毒(HIV)阳性的50例MSM为病例组,HIV阴性的200名MSM为对照组;病例组最近6个月同性肛交安全套从未使用、有时使用和每次均使用率分别为18.0%(9/50)、76.4%(38/50)和6.0%(3/50),对照组分别为9.0%(18/200)、49.0%(98/200)和42.0%(84/200),差异有统计学意义(χ2=23.257,P=0.000);病例组在最近1次同性肛交和商业性行为中安全套使用率分别为44.0%(22/50)和42.86%(3/7),均低于对照组的69.0%(138/200)和100.0%(8/8),差异均有统计学意义(P<0.01或P<0.05);多因素logistic回归分析结果显示,婚姻状况为同居(OR=1.162)、小学及以下文化程度(OR=2.267)、职业为民工(OR=2.432)、到公园公厕寻找性伴(OR=1.041)为MSM不使用安全套的危险因素,在婚(OR=0.642)、平均月收入>4 000元(OR=0.261)、有感染HIV的性伴(OR=0.659)、在互联网上寻找性伴(OR=0.351)、进入MSM圈子>10年(OR=0.235)、知晓艾滋病(OR=0.085)为MSM使用安全套的保护因素。结论病例组安全套使用率低于对照组,应加强处于同居、小学及以下文化程度、民工及到公园和公厕寻找性伴MSM的行为干预,提高其安全套使用率。

Objective To examine the status of condom use and its influencing factors among men who have sex with men（MSM） in Kunming city.Methods With case-control study design,a total of 250 MSM who had voluntary consultation and test for human immunodificiency virus（HIV）/AIDS in Yunnan Rainbow Sky Working Team were recruited from December 2011 to August 2012,and among them 50 HIV positive MSM were recruited and 200 HIV negative MSM were assigned as controls.Data were collected with a questionnaire survey and qualitative interview.Results There were significant differences between cases and controls in the rates of never using condom（18.0% vs 9.0%）,using condom sometimes（76.4% vs 49.0%）,and using condom everytime（6.1% vs 42.0%）in the anal sex with men during the latest 6 months（χ2=23.257,P=0.000）.Among the cases,the condom use rates for the latest anal sex and commercial sex with men were 44.0% and 42.9% and significantly lower than those among the controls（69.0% and 100.0%,P〈0.01 and P〈0.05）.The results of analyses showed that the risk factors for no condom use for the MSM included cohabitation（odds ratio[OR]=1.162）,education of elementary school（OR=2.267）,migrant worker（OR=2.432）,and finding sex partners in park or public toilet（OR=1.041）and the protective factors for condom use were being married（OR=0.642）,with monthly income of more than 4 000 RMB Yuan（OR=0.261）,with a sex partner of HIV infection（OR=0.659）,finding sex partners by internet（OR=0.351）,with MSM experience of more than 10 years（OR=0.235）,and having knowledge on AIDS（OR=0.085）.Conclusion The condom use rate of the case group is lower than that of the control group.We should strengthen the behavior intervention among the MSM in cohabitation,with elementary school education,being migrant worker,and finding sex partners from the park and public toilet to increase the condom use rate among them.