南京市男男性行为者中异性性行为特征及影响因素分析

Characteristics and influencing factors of heterosexual intercourse among MSM in Nanjing City

目的了解南京市男男性行为者(MSM)中有异性性行为者(MSMW)和无异性性行为者(MSMO)的行为特征及影响因素,为制定更有针对性的干预措施提供依据。方法在知情同意的前提下,采用分类滚雪球法招募MSM,开展问卷调查,收集人口学、行为学等信息并进行HIV、梅毒抗体血清学检测。结果共调查MSM 1895人,MSMW组405人(21.4%),MSMO组1490人(78.6%)。MSMW组HIV/梅毒感染率分别为10.12%和8.15%;MSMO组HIV/梅毒感染率分别11.88%和7.52%,2组感染率差异均无统计学意义(P>0.05)。最近6个月内同性多性伴现象普遍存在,2组差异无统计学意义(P>0.05)。MSMW组发生无保护性肛交的比例和商业性行为的比例高于MSMO组,而商业性行为中坚持每次使用安全套的比例低于MSMO组(P<0.05)。多因素Logistic回归分析结果显示,大专及以上文化程度(OR=0.68,95%CI:0.48～0.96)和知晓艾滋病防治知识(OR=0.58,95%CI:0.37～0.91)是MSM发生异性性行为的阻碍因素,在婚/同居(OR=5.24,95%CI:3.24～8.03)、性取向为双性恋/异性恋/不确定、性角色为双向组或插入组、最近6个月有商业性行为(OR=3.77,95%CI:1.89～7.49)、酒吧型交友场所(OR=2.50,95%CI:1.61～3.87)是MSM发生异性性行为的促进因素(P<0.05)。结论南京市MSMW的比例较高,存在高危行为,应从社会及家庭的角度加以防治,以控制HIV从高危人群向一般人群扩散。

Objective To examine the characteristics and influencing factors among MSM with men and women （MSMW） or with men only （MSMO） in Nanjing City. Methods Under the principle of informed consent, MSM were re-cruited by snowball sampling for a face to face questionnaire survey and serological test for HIV/syphilis. The same question-naire was used to acquire the information of demography and sexual behaviors. Results A total of 1895 MSM were recruited, including 405 （21.4%） MSMW and 1490 （78.6%） MSMO. The infection rates of HIV/syphilis were 10. 12% and 8. 15% in MSMW, 11.88% and 7. 52% in MSMO, respectively. The infection rates of HIV/syphilis were not significantly different between MSMW and MSMO （a l l P 〉0. 05） . It was a universal phenomenon that both MSMW and MSMO had two or even more male sexual partners in the past 6 months （ P 〉 0. 05 ） . MSMW were more likely to have unprotected anal inter-course and higher rate of commercial sexual but lower utilization rate of condom than MSMO （ P 〉 0. 05 ） . There were statis-tically significant differences between the two groups for many risk factors examined in multivariable models. College or above education level （ OR = 0. 68 , 95% C l 0. 48 - 0. 96 ） and awareness of HIV knowledge （ OR = 0. 58 , 95% C l： 0. 37 - 0. 91） were obstacle factors for MSM to have heterosexual intercourse. MSM who were married or cohabiting （ OR = 5 .2 4 , 95% Cl： 3. 24 -8. 03）,being bisexuality or heterosexuality or uncertain in sex orientation, being predominantly inserted partners or both inserted and receptive partners in homosexual behavior, had commercial sexual within the past 6 months（OR=3.77, 95% Cl ： 1.89 - 7. 49） , seeking partner from bars （O R = 2 .5 0 , 95% Cl ： 1 .6 1 - 3 .8 7 ） were more likely to have heterosexual intercourse （ P 〈 0. 05 ） . Conclusion The prevalence of heterosexual intercourse was high among MSM in Nanjing. Prevention strategies through social and family supports should be taken to target distinct subgroups that compose the population of MSM and stop HIV transmitting from high risk group to general population.