烟台市男男性行为人群HIV感染者/AIDS病人抗病毒治疗后高危行为变化

Impact of high risk behavioral change on MSMs infected with HIV/AIDS patients under antiretroviral treatment in Yantai City

目的了解男男性行为人群(men who have sex with men,MSM)中人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)病人抗病毒治疗1年后的性伴特征及性行为变化,探索其抗病毒治疗后持续发生高危行为的影响因素。方法定量研究主要通过问卷调查收集调查对象抗病毒治疗前和治疗满1年后的高危行为信息,并进行McNemarx^2检验比较。定性研究为个人深入访谈,深入挖掘访谈对象抗病毒治疗后持续发生高危行为的相关影响因素。结果共调查132例,调查对象与固定性伴发生肛交性行为时安全套使用率较高,治疗前后分别为91.4%和87.1%,差异无统计学意义(x^2=1.500,P=0.682)。与偶然性伴发生性行为时,治疗前后安全套使用率分别为22.2%和28.3%,差异具有统计学意义(x^2=11.257,P=0.010)。发生过无保护肛交性行为者治疗成功率低于未发生无保护肛交性行为者,分别为82.4%和95.7%,差异具有统计学意(x^2=4.601,P=0.032)。结论 MSMs HIV感染者/AIDS病人接受抗病毒治疗满1年后,仍有部分调查对象与偶然性伴发生无保护肛交性行为,可能会增加HIV耐药病毒株传播和性病感染的风险,需进一步加强针对该人群的宣传教育和行为干预。

Objective To evaluate the impact of sexual behaviors among HIV-infected men who have sex with men （MSM） after one year of antiretroviral treatment. Methods A face-to-face questionnaire interview was administrated to collect the information about high-risk behaviors of survey objects before and after one year antiretroviral treatment. Differ- ences in sexual behavior were assessed by using the McNemar Z2 text. Qualitative research with individual interviews was conducted to explore the factors of continuing high-risk behaviors after antiretroviral treatment. Results A total of 132 ca- ses were investigated, with a high rate of condom use in the anal intercourse among respondents and the regular partners, 91.4% and 87. 1% before and after treatment, with no statistical difference （χ2 = 1. 500, P = 0. 682）, anal intercourse with casual partners the condom use rate was 22. 2% and 28.3% respectively before and after treatment, and the difference was statistically significant （ %2 = 11. 257, P = 0. 010）. Treatment success rate of patients with unprotected anal intercourse was lower than no unprotected anal intercourse behavior, 82. 4% and 95.7% respectively, and the difference was statisti- cally significant （ %2 = 4. 601, P = 0. 032 ）. Conclusions Among MSMs HIV-infected patients / AIDS patients after anti- viral treatment a year later, there were still some of the subjects had unprotected anal intercourse with accidental sexual partners, increased the risk of HIV-resistant strains of transmission and sexually transmitted diseases risk, promotion of ed- ucation and behavioral intervention for the target population should be further strengthened.