文化程度对男男性行为者高危性行为及HIV、梅毒螺旋体感染率的影响

Effects of education level of men who have sex with men on their high risk sexual behaviors and the infection of HIV and syphilis

目的 研究文化程度对男男性行为人群（MSM）高危性行为及HIV、梅毒螺旋体等病原体感染率的影响.方法 2009年7-11月和2010年3-10月,采用滚雪球和方便抽样方法,在江苏省常州市通过MSM活动场所和网络招募研究对象,最终对659名研究对象进行了问卷调查和血清学检测.根据调查对象的文化程度,分为初中组206名、高中组254名、大学组199名共3组.问卷调查内容主要包括社会人口学信息、性行为特征、安全套使用情况等,并采集血液样本进行HIV、梅毒螺旋体的检测,另对2009年7-11月招募的291名研究对象采集了尿液样本进行淋球菌和生殖道沙眼衣原体核酸检测.采用x2检验等方法对3个文化程度组的性行为特征、HIV等病原体感染情况进行比较.结果 共收回有效调查问卷659份,初中组、高中组、大学组分别占31.3％（206名）、38.5％（254名）和30.2％（199名）.3组最常寻找性伴的场所明显不同,初中组和高中组分别最常去浴池或桑拿房（56.3％,116名）、酒吧或茶吧（34.8％,88名）寻找性伴,而大学组则主要通过互联网寻找性伴（41.1％,81名）（x2=99.35,P＜0.05）.最近6个月与男性发生肛交性行为的比例,初中组（53.4％,109/204）低于高中组（67.7％,172/254）（x2=9.74,P＜0.05）和大学组（72.7％,144/198）（x2 =16.04,P＜0.05）.最近6个月与异性发生性行为的比例,初中组（54.4％,111/204）高于大学组（38.6％,76/197）（x2=10.10,P＜0.05）,但与高中组（46.9％,119/254）差异无统计学意义（x2=2.59,P=0.11）.初中组、高中组、大学组最近1次同性肛交性行为安全套使用率相近,分别为73.4％ （80/109）、78.0％ （131/168）、73.9％ （105/142）;最近1次与异性发生性行为时安全套使用率分别为51.8％ （57/110）、54.6％ （65/119）、61.8％ （47/76）（x2=1.88,P=0.39）.初中组、高中组、大学组HIV感染率分别为9.2％（19/206）、10.6％（27/254）和5.6％ （11/197）（x2=3.68,P=0.16）,淋球菌阳性率分别为3.8％（3/79）、3.4％ （4/117）、0.0％ （0/95）（x2=3.85,P=0.14）,生殖道沙眼衣原体阳性率分别为5.1％ （4/79）、9.4％ （11/117）、4.2％ （4/95）（x2=2.70,P=0.26）.初中组梅毒螺旋体感染率为19.9％ （41/206）,高于高中组的12.2％ （31/254） （x2 =5.11,P＜0.05）和大学组的10.2％ （20/197）（x2=7.45,P＜0.05）.结论 文化程度与高危性行为未呈现明显关联性,文化程度低的MSM感染梅毒螺旋体的风险更大.

Objective To study the effects of educational background of men who have sex with men（MSM） on their high risk sexual behaviors and the HIV/STI infection rates.Methods During July to November of 2009 and March to October of 2010,snowball and convenience sampling methods were adopted to recruit MSM from MSM venues and via the internet in Changzhou city of Jiangsu province,and finally 659 MSM were conducted a questionnaire survey and serological testing.According to the educational background of MSM,they were divided into 3 groups,that is,junior high school group（206 cases）,high school group （254 cases）,and university group（199 cases）.The questionnaire mainly includes information on social demography,sexual behaviors,condom use,etc.Blood samples were collected for HIV and syphilis spirochete detection,and urine samples were also collected in 291 MSM who were recruited during July to November of 2009 for neisseria gonorrhoeae and chlamydia trachomatis nucleic acid detection.x2 test and other statistical analysis methods were used to compare the characteristics of sexual behaviors and HIV/STI infections in 3 groups.Results Of the 659 valid questionnaires returned,junior high school group,high school group,and university group accounted for 31.3% （206 cases）,38.5% （254 cases） and 30.2% （199 cases）.Places where MSM of different education levels most often to seek sexual partners,were significantly different.Junior high school group and high school group mostly went to bathhouse/sauna club（56.3%,116 cases） and bar （34.8%,88 cases） for partners,respectively,while the university group sought partners mainly through the internet （41.1%,81 cases） （x2 =99.35,P 〈 0.05）.53.4% （109/204） of the junior high school group had anal sex with men in the last 6 months,which was higher than that of high school group（67.7%,172/254） （x2 =9.74,P 〈 0.05） and university group （72.7%,144/198） （x2 =16.04,P 〈0.05）.A total of 54.4% （111/204） of the junior high school group had sex with women in the last 6 months,which was higher than that of university group（38.6%,76/197） （x2 =10.10,P 〈 0.05）,but was not statistically significantly different from that of high school group（46.9%,119/254） （x2 =2.59,P =0.11）.The rates of condom use with men at the last anal sex in junior high school group （73.4%,80/109）,high school group（78.0%,131/168）and university group（73.9%,105/142）were similar.The rates of condom use with women in the last intercourse in junior high school group,high school group and university group were 51.8% （57/110）,54.6% （65/119） and 61.8% （47/76）,respectively（x2 =1.88,P =0.39）.In junior high school group,high school group and university group,the infection rates of HIV were 9.2% （19/206）,10.6% （27/254） and 5.6% （11/197） （x2 =3.68,P =0.16）,the positive rates of neisseria gonorrhoeae were 3.8% （3/79）,3.4% （4/117） and 0.0% （0/95） （x2 =3.85,P =0.14）,the positive rates of chlamydia trachomatis were 5.1% （4/79）,9.4% （11/117） and 4.2% （4/95） （x2 =2.70,P =0.26）.The infection rate of syphilis in junior high school group was 19.9% （41/206）,which was higher than high school group（12.2%,31/254） （x2 =5.11,P 〈 0.05） and university group （10.2%,20/197） （x2 =7.45,P 〈 0.05）.Conclusion There was no obvious correlation between education level and high risk sexual behaviors;MSM with lower education level were at higher risk of infection of syphilis.