中国三城市 H IV 感染者中男男性行为人群男性固定性伴告知状况及其影响因素

The status of HIV disclosure to primary sexual partners and sexual behaviors among HIV-infected men who have sex with men of 3 cities in China

目的：调查广州、重庆、成都市HIV感染者中男男性行为人群（ MSM）男性固定性伴告知情况，并分析其影响因素。方法于2012年12月至2013年5月，采用“滚雪球”方法在广州、重庆、成都市开展调查。纳入≥18岁、HIV感染者、发生过男男性行为、接受调查时分别居住于3个城市者，调查其男性固定性伴告知状况，采用多因素非条件logistic回归模型分析其影响因素。本次调查共发放问卷600份，获得有效问卷541份，有效率为90.2％。结果541例HIV感染者年龄为（30.2±7.7）岁，拥有男性固定性伴者占78.2％（423／541），其中，有配偶者占10.9％（46／423），拥有1名男性固定性伴者占58.9％（249／423），拥有2名以上男性固定性伴者占41.1％（174／423）。将自身 HIV 感染状况告知全部男性固定性伴、配偶和部分男性固定性伴的比例分别为41.8％（177／423）、4.5％（19／423）和20.3％（86／423），未告知任何男性固定性伴者占37.8％（160／423）。近6个月，拥有HIV阳性性伴的调查对象占35.2％（149／423），其男性固定性伴告知率为70.5％（105／149），高于拥有HIV阴性性伴者[26.3％（72／274）]（χ^2=77.46，P＜0.01）。拥有HIV感染状况未知性伴的调查对象占52.7％（223／423），其男性固定性伴告知率为22.4％（50／223），低于拥有已知HIV感染状况者[63.5％（127／200）]（χ^2=73.11，P＜0.01）。拥有HIV阳性性伴者将自身HIV感染状况告知男性固定性伴的可能性是拥有HIV阴性性伴者的6.36（3.75～10.80）倍，拥有未知HIV感染状况性伴者将自身HIV感染情况告知男性固定性伴的可能性是拥有HIV已知感染状况性伴者的0.44（0.25～0.76）倍，与男性固定性伴有肛交行为的调查对象，其男性固定性伴告知的可能性是无肛交行为者的0.46（0.22～0.95）倍。结论广州、重庆、成都市HIV感染者中MSM的男性固定性伴告知状况处于较低水平；男性固定性伴告知状况与该部分人群拥有的性伴特征有关，有HIV阳性性伴者的男性固定性伴告知率较高。

Objective To investigate the status of HIV disclosure to primary partners and to explore the correlates of HIV disclosure among HIV-infected men who have sex with men （ MSM） in Guangzhou, Chongqing and Chengdu.Methods This survey was conducted in Chengdu ,Chongqing and Guangzhou by using “snowballing” sample from December ,2012 to May,2013.Participants who were eighteen years old or elder,HIV-infected,had sex with men and lived in three cities when the survey was conducted were eligible for subjects of this survey.Primary partners and disclosure status of participants were investigated.Multiple Unconditioned Logistic Regression analysis was used to analyze the influence factors associated with HIV disclosure.Of 600 participants , 541 were excluded because of logical problem or incomplete items in questionnaire and the effective response rate was 90.2%.Results Of the 541 HIV-positive MSM participants,the mean age was （30.2 ±7.7） years old,78.2%（423/541） of the participants had male＂nbsp;primary partners.Of the 423 participants who had male primary partner ,10.9%（46/423） had wife, 58.9%（ 249/423 ） had one primary partner , and 41.1%（ 174/423 ） had two or more.The proportion of HIV disclosure to all male primary sexual partners and wife was 41.8%（ 177/423 ） and 4.5%（ 19/423 ） respectively,20.3%（86/423） of them disclosure to some of male primary partners and 37.8%（160/423） not disclosure to any male primary partners.Participants who had HIV-positive male partners in the past 6 months （ accounting for 35.2%（ 149/423 ） ） were more likely to disclose HIV infection to their primary sexual partners （ 70.5%（ 105/149 ） ） than those who had non-HIV-positive sexual partners （ 26.3%（72/274）） （χ^2=77.46,P〈0.01）.Participants who had male unknown HIV-status sexual partners in the past 6 months（accounting for 52.7%（223/423）） were less likely to disclosure HIV infection to primary sexual partners （22.4%（50/223） ）than those who had already known HIV-status sexual partners （63.5%（127/200）） （χ^2=73.11,P〈0.01）.The possibility of HIV disclosure to primary sexual partner among participants who had HIV-positive sexual partner increase to 6.36 （ 3.75-10.80 ） times of those who had HIV-negative partners , and the possibility among participants who had sexual partners of unknown HIV status decreased to 0.44 （ 0.25-0.76 ） times of those who had sexual partners of already known HIV status.Compared with having non-anal sex behaviors with male primary partner , the possibility of HIV disclosure to primary sexual partner decreased to 0.46 （0.22-0.95） times among participants who had anal sex behavior with male primary partners.Conclusion There were low proportion of HIV disclosure to primary sexual partners among HIV-infected MSM in Guangzhou ,Chongqing and Chengdu.HIV disclosure to primary sexual partners may beassociated with characteristics of their sexual partners , and participants who had HIV-positive male partners were more likely to disclose HIV infection to their primary sexual partners.