基于三元影响理论的男男性行为者HIV定期检测行为模型构建

A structural equation model of regular HIV testing using the theory of triadic influence among men who have sex with men in China

目的基于三元影响理论构建HIV定期检测行为模型,为提升男男性行为群体定期检测的干预提供参考。方法采用网络调查结合现场便利抽样,选取北京、武汉两地的男男性行为人群,获得其HIV检测相关行为、个人、社交、环境等层面因素数据,利用结构方程模型,构建HIV定期检测行为模型。结果531例中56.1%进行HIV定期检测。结构方程模型拟合(CFI=0.954,TLI=0.945,RMSEA=0.041,SRMR=0.05,χ^(2)/df=1.675)显示,意图是直接影响检测行为作用最强的因素(β=0.208,P<0.01),自我效能、主观规范、知识、获取医疗服务舒适度以及性伴数量等来自个人、社交、环境层面中的因素,均对HIV定期检测有直接或经检测意图具有中介作用(均P<0.05)。结论男男性行为人群HIV定期检测行为比例处于中等水平,仍需进一步提升。干预对策不仅应关注提高男男性行为个体内在因素,更应重视来自社交环境对其检测行为决策的影响,增强社会组织赋权以及医疗机构与不同团体间的合作。

Objective To construct a regular HIV testing model based on the theory of triadic influence,and to provide evidence for improving regular HIV testing among men who have sex with men(MSM).Methods Online and face-to-face surveys were conducted on MSM in Wuhan and Beijing to collect their HIV testing behaviors as well as individual,social and environmental data.Structural equation modeling(SEM)was performed to construct regular HIV testing model.Results Totally 531 MSM were enrolled,and 56.1%of them regularly performed HIV testing.The SEM indicated that intention to testing was the strongest predictor of regular HIV testing(β=0.208,P<0.01),and self-efficacy,perceived norms,knowledge,comfort to access services,as well as numbers of sexual partners had direct effect or indirect effect through intention on regular HIV testing(P<0.05 for all).The model had satisfactory fit indices(CFI=0.954,TLI=0.945,RMSEA=0.041,SRMR=0.05,χ^(2)/df=1.675).Conclusion Regular HIV testing is at moderate level among MSM and needs to be enhanced.Not only personal but also socio-environmental factors should be considered to formulate interventions on regular HIV testing,and empowerment of social organizations as well as cooperation between medical institutions and social communities should be strengthened.