32名HIV阳性嫖客商业性行为的定性研究

Qualitative study of commercial sex behaviors among 32 HIV positive clients of female sex workers

目的了解艾滋病病毒(human immunodeficiency virus,HIV)阳性嫖客对待商业性行为的态度,知晓HIV感染状况后商业性行为仍不使用安全套的原因,以及探索如何对HIV阳性嫖客的不安全商业性行为进行干预。方法在湖南省长沙市和衡阳市的两个抗病毒治疗(antiretroviral therapy,ART)门诊通过方便抽样招募经商业性行为途径感染HIV的嫖客,进行个人深入访谈。结果共访谈32名HIV阳性嫖客,婚姻状况主要为在婚(23/32),文化程度主要为初中(14/32),平均年龄46.3岁。过去6个月仍有商业性行为者6人。访谈对象在对待商业性行为态度方面,多数人认为他们与正常人一样有性需求,感染HIV并不能意味着他们不能再有商业性行为。知晓感染状况后商业性行为仍不使用安全套的原因包括:安全套影响快感,与性伴熟悉,缺乏交叉感染相关知识,缺乏社会责任感和对非固定性伴的保护意识等。结论 HIV阳性嫖客的不安全商业性行为不容忽视,在感染者首次流行病学调查及随后的随访服务中,要强化感染者的社会责任和义务。

Objective To understand attitudes towards commercial sex behavior among human immunodeficiency virus（ HIV） positive clients of female sex workers,reasons for inconsistent condom use,and to explore the intervention measures for their continued unsafe commercial sex behavior. Methods In-depth interviews were conducted in the outpatients antiretroviral therapy（ ART） clinics in Hunan province,HIV positive clients of males who got infected through commercial sex behaviors were recruited. Results Among the 32 HIV positive clients,most of the interviewees were married（ 23 /32） and completed middle school education（ 14 /32）. The average age was 46. 3 years. In the past 6 months,6 interviewees reported experiences of extramarital sex behavior. Most of the interviewees thought they had the same sex need as normal people and HIV infection did not mean the stop of commercial sex behavior. Major factors for unsafe commercial sex behavior included influence of condoms on sex pleasure,HIV positive sex partners,lack of knowledge on co-infection and lack of the consciousness to protect their irregular sexual partners. Conclusions Unsafe commercial sex behavior of HIV positive clients can not be ignored. Legal obligation of not spreading HIV by a HIV infected individual needs to be emphasized at the initial consoling and follow- up services.