产业工人中男男性行为HIV感染者确证前后的高危性行为变化及相关因素研究

Study on changes in high-risk sexual behaviors and associated factors in HIV-infected men who have sex with men in industrial workers before and after diagnosis of HIV infection

目的了解产业工人中男男性行为HIV感染者(MSM感染者)在确证前后的高危性行为变化及相关因素,为制定针对HIV感染者的行为干预措施提供依据。方法2021年8-9月在深圳市开展横断面调查,通过方便抽样选取产业工人中MSM感染者为研究对象,估计样本量为530人。问卷调查结合日常随访收集研究对象社会人口学、高危性行为、性伴告知、病毒载量检测和性病患病史等信息。采用χ^(2)检验比较确证前后的高危性行为的差异,采用多因素logistic回归分析研究对象确证后12个月内高危性行为的相关因素。结果产业工人中MSM感染者560例,确证后12个月内发生无保护肛交(UAI)的比例为32.1%(180/560)。确证前12个月内与同性临时、商业和固定性伴发生UAI的比例分别为73.4%(381/519)、75.1%(187/249)和69.5%(207/298),确证后12个月内分别降低到36.2%(146/403)、40.2%(86/214)和34.2%(67/196),差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,研究对象确证后12个月内发生UAI的保护性因素包括大专及以上文化程度(aOR=0.41,95%CI:0.23~0.71)、确证后肛交性角色为被插入方(aOR=0.40,95%CI:0.19~0.85)或插入方和被插入方均有(aOR=0.40,95%CI:0.20~0.83)以及确证后未发生无保护口交(aOR=0.02,95%CI:0.01~0.05);研究对象确证后12个月内发生UAI的危险性因素是不认为病毒载量检测值持续阴性需要坚持使用安全套(aOR=3.02,95%CI:1.37~6.69)。结论相比于确证前,尽管产业工人中MSM感染者在确证后与同性性伴发生UAI的比例有所降低,仍有约1/3的比例发生高危性行为,应针对该人群开展强化干预以减少高危性行为。

Objective To explore changes in high-risk sexual behaviors and associated factors in HIV-infected men who have sex with men(MSM)in industrial workers,and provide evidence for designing behavioral interventions for this population.Methods In this observational study,HIV-infected MSM were recruited in industrial workers using convenient sampling during August to September 2021.The sample size was estimated to be 530.A questionnaire was used and combined with routine follow-up to collect socio-demographic characteristics,high-risk sexual behaviors,partner notification,viral load testing and history of sexually transmitted diseases before and after diagnosis of HIV infection.Theχ^(2) test was used to analyze the changes in high-risk sexual behaviors before and after diagnosis and logistic regression was conducted to identify factors associated with high-risk sexual behaviors.Results A total of 560 HIV-infected MSM in industrial workers were recruited in this study.Of whom,32.1%(180/560)had unprotected anal intercourse(UAI)within 12 months after diagnosis.The proportions of those having UAI with casual,commercial and regular same-sex partners significantly decreased from 73.4%(381/519),75.1%(187/249)and 69.5%(207/298)within 12 months before diagnosis to 36.2%(146/403),40.2%(86/214)and 34.2%(67/196)within 12 months after diagnosis,respectively.Educational level of college or above(aOR=0.41,95%CI:0.23-0.71),passive anal sex(aOR=0.40,95%CI:0.19-0.85),both active and passive anal sex after diagnosis(aOR=0.40,95%CI:0.20-0.83)and no unprotected oral sex(aOR=0.02,95%CI:0.01-0.05)were negatively associated with UAI within 12 months after diagnosis.Whereas,not considering necessary to use condom consistently after having repeated undetectable viral load(aOR=3.02,95%CI:1.37-6.69)was positively associated with UAI within 12 months after diagnosis.Conclusions Compared with that before diagnosis of HIV infection,although the prevalence of UAI seemed to decrease in HIV-infected MSM in industrial workers after diagnosis,nearly one third of them had high-risk sexual behaviors.Therefore,relevant interventions should be strengthened to reduce high-risk sexual behaviors.