应用同伴推动抽样法开展杭州市MSM的HIV感染现况及影响因素调查分析

Investigation of HIV Infection and Impact Factors among MSM in Hangzhou

目的了解杭州市男男性行为人群（MSM）的艾滋病病毒（HIV）感染现况及其影响因素。方法采用同伴推动抽样法抽取杭州市MSM,用标准化问卷收集MSM的社会人口学、性行为特征和性伴网络、抑郁症状、生活习惯和社会文化特征、检测史等信息,并采集血液样本进行HIV和梅毒的血清学检测。采用RDSAT软件对数据进行权重处理,并用SPSS软件进行单因素和多因素分析,NETDRAW软件作网络招募图。结果共招募511名MSM,调整后的HIV和现症梅毒感染率分别为8.5%[95%可信区间（CI）：5.3%～12.2%]和8.8%（95%CI：3.6%～14.2%）。多因素分析显示：杭州MSM的HIV感染与较低的文化程度[比值比（OR）：4.288,95%CI：1.439～12.783]、最近6个月口交人数较多（OR：3.716,95%CI：1.292～10.685）、吸烟史（OR：2.222,95%CI：1.049～4.706）、自我评估可能感染HIV（OR：4.018,95%CI：1.311～12.313）和很可能感染（OR：7.966,95%CI：1.724～36.814）,以及现症梅毒阳性（OR：8.056,95%CI：3.118～20.820）等有关。结论杭州市MSM的HIV感染水平较高,需加强对低文化程度、口交人数较多、吸烟、自我评估可能感染HIV,以及现症梅毒阳性者的HIV干预力度,心理支持应作为HIV干预的重要组成部分。

Objective To assess the HIV prevalence and impact factors among men who have sex with men（MSM）in Hangzhou.Methods Respondent driven sampling（RDS）method was used to recruit a sample of 511 MSM in Hangzhou.With informed consent,the MSM completed a questionnaire for the information collection on socio-demographic characteristics,sexual behavior,depression symptoms and HIV/syphilis status after being tested.RDSAT was used to weight the collected data and SPSS used for the bivariate and multivariate analysis,and NetDraw for visual depictions of the network of HIV positives.Results Weighted HIV and syphilis prevalence among MSM were 8.5% and 8.8%,respectively.Factors independently associated with HIV-positive included low educational level（OR：4.288,95%CI：1.439～12.783）,a higher number of oral sex partners in the past 6months（OR：3.716,95%CI：1.292～10.685）,smoking（OR：2.222,95%CI：1.049～4.706）,having high risk and very high risk of HIV infection by self-assessment（OR：4.018,95%CI：1.311～12.313;OR：7.966,95%CI：1.724～36.814）and syphilis positive（OR：8.056,95%CI：3.118～20.820）.Conclusion RDS performed first in Zhejiang province was found a useful analytical tool for monitoring HIV prevalence among MSM.HIV prevention and control should focus on the MSM group who are less educated,smoking,at high risk HIV-infection by self-assessment,syphilis positive,and have more oral sex partners.Psychological support should be important for the behavior intervention of the MSM group in the future.