山东省自报告异性途径感染的男性艾滋病患者同性感染途径复核及心理状况分析

Review on infection routes and analysis on their psychological status among male AIDS patients with self-reported heterosexual transmission, Shandong province

目的 通过对自报告异性途径感染的山东省男性艾滋病患者进行复核,了解患者的真实感染途径,分析患者的抑郁、焦虑状况及其影响因素。方法 依托艾滋病综合防治数据信息管理系统筛选自报告异性途径感染的男性艾滋病患者,于2019年9-12月对山东省济南市、青岛市、潍坊市、临沂市四市招募的373例自报告异性感染的男性艾滋病患者进行复核,按照感染途径分为同性组、异性组。对自报告异性感染的373例患者使用艾滋病知识调查问卷、抑郁自评量表(CES-D)、焦虑自评量表(SAS)、领悟社会支持量表(PSSS)开展面对面专项调查,调查抑郁、焦虑情况,通过多因素logistic回归分析法分析相关影响因素。结果 自报告异性途径感染的373名男性患者,复核后39.7%(148/373)为实际通过同性途径感染、60.3%(225/373)为实际通过异性途径感染。复核后同性组和异性组在现住址、婚姻状况、居住情况、居住地、身体状况、发现途径、是否有商业性行为、是否有非婚非商异性性行为、是否有同性性行为、确诊后性行为、确诊后性伴人数、目前是否有性伴、感染前对HIV了解程度、对HIV了解途径方面的差异有统计学意义(P<0.05);复核后同性组抑郁检出率55.8%(82/147),焦虑检出率31.50%(46/146)。单因素分析显示,同性组抑郁检出在现住址、婚姻状况、工作状况、身体状况、首次流调地点、发现途径、社会支持、是否有商业性行为、确诊后性伴人数上的差异有统计学意义(P<0.05);焦虑检出在现住址、艾滋病知识知晓情况、社会支持、行为学改变情况上的差异有统计学意义(P<0.05)。多因素logistic回归分析显示,同性组患者身体状况一般较身体状况较好/特别好者抑郁检出率高;术前/献血途径发现较高危行为后检测发现的抑郁检出率高;低社会支持者较高社会支持者抑郁、焦虑检出率高(P<0.05)。结论 山东省男性艾滋病患者经同性传播占比更高,与网络直报报告比例存在明显偏差,需要加强复核,降低疫情研判误差;同性途径感染的男性艾滋病患者抑郁、焦虑症状严重,身体状况、发现途径、社会支持等因素影响心理健康。

Objective To review the male AIDS patients in Shandong province who reported heterosexual infection, understand the true infection route of the patients, and analyze the depression, anxiety and their influencing factors. Methods Relying on the Comprehensive AIDS Prevention and Control Data Information Management System,male AIDS patients who reported heterosexual infection were screened.From September to December 2019,373 male AIDS patients who reported heterosexual infection were recruited from Jinan city, Qingdao city, Weifang city and Linyi city in Shandong province.All patients were divided into the homosexual infection group and the heterosexual infection group after review according to the infection route.373 patients who reported heterosexual infection were investigated face-to-face by using AIDS knowledge questionnaire, self rating Depression Scale(CES-D),self rating Anxiety Scale(SAS) and perceived social support scale(PSSs).Relevant influencing factors were analyzed by multivariate logistic regression analysis. Results Of the 373 male patients who reported heterosexual infection, 39.7%(148/373) were actually infected by the same sex and 60.3%(225/373) were infected by the opposite sex.After rechecking, there were statistically significant differences between the homosexual infection group group and the heterosexual infection group in terms of current address, marital status, living conditions, residence, physical condition, discovery route, whether there was commercial sexual behavior, whether there was non-marital and non-commercial sexual behavior, whether there was homosexual sexual behavior, sexual behavior after diagnosis, number of sexual partners after diagnosis, whether there were sexual partners at present, understanding of HIV before infection, and understanding pawhways of HIV(P<0.05);After recheck, the detection rate of depression and anxiety in the homosexual infection group was 55.8%(82/147) and 31.50%(46/146) respectively.Univariate analysis showed that there were statistically significant differences between the depressed group and non-depressed group in the current address, marital status, work status, physical condition, the location of the first abortion, the way of discovery, social support, whether there was commercial sexual behavior, and the number of sexual partners after diagnosis in the same sex group(P<0.05).There were significant differences between the anxious group and non-anxious group in the current address, AIDS knowledge, social support and behavioral changes(P<0.05).Multivariate logistic regression analysis showed that the detection rate of depression was higher in patients with average physical condition than in patients with good or especially good physical condition among the hemosexual infection group.The detection rate of depression in patients detected by pre-operation/blood donation route was higher than that detected after high-risk behaviors.The detection rate of depression and anxiety were higher in low social supporters than in high social supporters.The prevalence of depression and anxiety was high(P<0.05). Conclusion Male AIDS patients in Shandong province have a higher proportion of same-sex transmission, which is obviously different from the proportion of online direct reports.It is necessary to strengthen review and reduce the error of epidemic research and judgment;Male AIDS patients infected by the same sex have serious symptoms of depression and anxiety, and their mental health is affected by physical conditions, ways of discovery, social support and other factors.