2012年中国新报告男男性行为HIV感染者随访1年婚姻行为情况分析

Marital status and high-risk sexual behaviors among newly reported HIV infected men who have sex with men in China in 2012, one year follow up study

目的 分析我国男男性行为HIV感染者（MSM感染者）确证后婚姻及危险行为变化情况，为有针对性地开展干预，预防二代传播提供依据。方法 使用截至2012年12月31日的艾滋病网络直报病例报告卡和2013年12月31日艾滋病随访管理定时数据库，对2012年新报告MSM感染者的基本人口学特征、婚姻状况和高危行为及其变化情况进行分析。结果 2012年新报告MSM感染者中，66.1%（10 426/15 768）为未婚，69.6%（10 970/15 768）为高中及以上文化程度。2012年随访到的MSM感染者中，1年后有96.0%（14 451/15 049）仍接受随访，其安全性行为比例从首次随访前的67.7%（9 779/14 451）上升到91.1%（13 277/14 451）；发现感染HIV时已婚有配偶的MSM感染者中，64.1%在1年后仍维持有配偶状态；高中及以上文化程度（OR=1.540，95%CI：1.138～2.085）、职业为工人（OR=1.430，95%CI：1.131～1.808）、干部职员（OR=1.610，95%CI：1.236～2.098）和农民（OR=1.661，95%CI：1.214～2.271）相对于小学及以下文化程度和职业为商业服务的MSM感染者更易采取安全性行为。始终无配偶（OR=0.563，95%CI：0.439～0.722）、有配偶变无配偶（OR=0.624，95%CI：0.448～0.870）和无配偶变有配偶（OR=0.444，95%CI：0.288～0.687）较始终有配偶的MSM感染者更易发生危险性行为。结论 规范化的随访管理有助于MSM感染者采取安全性行为，随访过程中需针对无配偶/固定性伴、低文化程度、职业为商业服务的MSM感染者采取有效的干预措施，预防HIV的二代传播。

Objective To analyze the changes of marital status and high-risk sexual behaviors in newly reported HIV infected men who have sex with men （MSM） and provide evidence for the targeted behavior intervention in this population and the prevention of secondary HIV infection. Methods Data collected from HIV/AIDS case reporting cards and follow-up cards between December 31st, 2012 and December 31st, 2013 were used and newly reported HIV infected MSM were recruited, their demographic characteristics, marital status, and high-risk sexual behaviors were analyzed. Results Of 15 768 newly reported HIV infected MSM in 2012, 10 426 （66.1%） were unmarried and 10 970 （69.6%） had educational level of≥senior high school. Among the 15 049 HIV infected MSM receiving follow up in 2012, 14 451 （96.0%） still received follow up in 2013. The number HIV infected MSM who had protected sexual behaviors increased from 9 779 （67.7%） in 2012 to 13 277 （91.1%） in 2013. Among the HIV infected MSM who had married, 64.1% remained their marital status in 2013. Among the HIV infected MSM, those who had educational level of≥senior high school （OR=1.540, 95%CI：1.138-2.085）, workers （OR=1.430, 95%CI：1.131-1.808）, staff （OR=1.610, 95%CI：1.236-2.098） or farmers （OR=1.661, 95%CI：1.214-2.271） were more likely to have protected sexual behaviors than those who had educational level of primary school or were engaged in commercial services. Those who had never married, （OR=0.563, 95%CI：0.439-0.722）, divorced （OR=0.624, 95%CI：0.448-0.870） or re-married （OR=0.444, 95%CI：0.288-0.687） were more likely to have high-risk sexual behaviors. Conclusion Standardized follow-up seemed helpful for the newly diagnosed HIV infected MSM to have protected sexual behaviors. Highly effective intervention should be focused on MSM who have no spouses or regular sexual partners, with low educational level, or are engaged in commercial services to prevent secondary HIV transmission.