不同招募途径的男男性行为人群梅毒感染状况及影响因素分析

Syphilis infection and its high risk factors among men who have sex with men by different recruitment channels

目的了解不同招募途径的男男性行为人群（MSM）的梅毒感染状况及影响因素。方法2011年7—12月，对中国卫生部一盖茨基金会艾滋病防治合作项目地区的14个城市（北京、上海、天津、重庆、哈尔滨、沈阳、青岛、西安、南京、武汉、杭州、长沙、昆明、广州）及海南省的MSM进行招募。当地社区组织通过不同途径对MSM进行干预及动员检测，通过匿名问卷收集调查对象的一般人口学资料及性行为相关信息等，收集静脉血进行梅毒螺旋体检测。共招募MSM34100名，其中32701名接受梅毒检测。对不同招募途径的人口学特征、性行为特征及梅毒螺旋体检测情况采用×。检验，对梅毒感染影响因素分析采用单、多因素logistic回归分析。结果32701名MSM的年龄为（30．96_＋9．57）岁，包括浴池组2284名（7．0％）、酒吧组4774名（14．6％）、网络组6266名（19．2％）、公园／公厕组1997名（6．1％）和其他组17380名（53．1％）。浴池组梅毒感染率（12．4％，282／2284）明显高于其余4组『酒吧组：4．5％（216／4774）；网络组：6．7％（422／6266）；公园／公厕组：8．3％（166／1997）；其他组：6．4％（1103／17380）]（x2=164．58，P〈0．001）。多因素logistic回归结果显示，年龄较大、近3个月男性性伴数在2人以上者【8．O％（1408／17714）；0R（95％C1）：1．44（1．04～1．98）]、最近3个月未与女性发生性行为者[6．8％（1446／21276）；0R（95％C1）：1．25（1．07～1．46）]、最近1次性行为未使用安全套[8．0％（769／9668）；OR（95％ CI）：1．13（1．03～1．25）]梅毒感染风险较高；婚姻状态为已婚[7．2％（456／6305）；OR（95％CI）：0．84（0．73～0．98）]；文化程度在大专以上者[5．3％（829／15684）；OR（95％CI）：0．60（0．53—0．67）1梅毒感染风险较小，现住址为本市和本省[本市：6．5％（1843／28185），OR（95％CX）：0．73（0．61～0．87）；本省：6．6％（170／2593），0R（95％C1）：0．67（0．53—0．85）]与外省调查对象[9．5％（158／1653）]相比梅毒感染率低。结论浴池组梅毒感染率较高，其年龄偏大、文化程度较低且易发生高危性行为，应重点加强浴池场所干预。

Objective To understand the syphilis infection and its high risk factors among men who have sex with men（MSM） recruited from different channels. Methods Supported by the China-Gates Foundation HIV program from July to December 2011, we cooperated with community based organizations to conduct syphilis testing intervention among MSM from 14 cities（Beijing, Shanghai, Tianjin, Chongqing, Harbin, Shenyang, Qingdao, Xi＇an, Nanjing, Wuhan, Hangzhou,Changsha, Kunming, and Guangzhou） and one province（Hainan province）.Participants were recruited from different channels by the staff of local CBOs, Demographic（e.g. age, marital status, and education） and behavioral（e.g, condom use and sexual partners） data were collected using anonymous questionnaires. Blood samples were also collected to test for syphilis. A total of 34 100 MSM participated in the survey. Participants were excluded from data analysis（1 399, 4.1%） if they did not receive syphilis tests or they completed less than 80.00% of the key questions in the survey. Chi-square tests were used to understand the socio-demographic and behavioral differences between each group. Results of syphilis tests were also compared. Logistic regression models were used to test the statistical significance of these differences.Results A total of 32 701 MSM were enrolled and received syphilis testing. The average age of participates was 30.96±9.57. And among them, 2 284 cases （7.0%） were recruited from gay bathhouses, 4 774 （14.6%）from gay bars, 6 266 （19.2%）from the interuet,1 997 （6.1%） from the parks/toilets and 17 380（53.1%） from other channels.MSM recruited from the bathhouses had the highest syphilis infection rate than other 4 groups： gaybars （4.5%, 216/4 774）,internet （6.7%, 422/6 266）, parks/toilets （8.3%, 166/1 997）,other channels （6.4%, 1 103/17 380） （X2=164.58, P〈0.001 ）.The muhivariate logistic regression analysis showed that being〉20 years of age（P〈0.001）,having more than 2 homosexual partners in recent 3 months（8.0%（1 408/17 714）,0R（95%C1）：1.44（1.04-1.98））, having no sex with females in past 3 months（6.8%（1 446/21 276）,0R（95%CI）： 1.25（1.07-1.46））, and not using condom at last anal sex（8.0% （769/9 668）,0R（95%CI）：1.13（1.03-1.25）） were associated with a higher probability of being infected with syphilis. Whereas MSM married（7.2%（456/6 305）,0R（95%CI）：0.84（0.73-0.98））, having a college or a higher education （5.3% （829/15 684）,OR（95% CI）：0.60（0.53-0.67））,being local residents （6.5% （1 843/28 185）,OR （95%CI）：0.73（0.61-0.87）） and living in the local province of project cities（6.6%（170/2 593）,0R（95%CI）：0.67 （0.53-0.85）） were protective factors.Conclusion MSM who were recruited from gay bathhouses have a higher rate of syphilis infection than those in channels relatively. They are older, with low education levels and high-risk sexual behaviors. Tailored interventions are required in the future, especially for MSM from gay bathhouses.