男男性行为者采取艾滋病预防行为动机的影响因素研究

Influencing factors of the motivation on protective behaviors in HIV prevention among men who have sex with men

目的本研究旨在应用保护动机理论探索MSM采取艾滋病预防行为(安全套、暴露前预防和暴露后预防)动机的影响因素。方法在云南省昆明、玉溪、红河、大理、德宏五地的未感染HIV的MSM中使用自填式问卷进行横断面调查。利用结构方程模型研究采取预防措施的动机和保护动机理论因素得分的联系。结果共回收有效问卷372份,其中333人(89.5%)表示在最近一次性行为中使用了预防措施,在过去6个月内不同肛交次数的MSM使用预防措施的情况不同,差异有统计学意义(P<0.05),使用安全套的理论因素得分水平与其他两种预防措施相比较,差异有统计学意义(P<0.001)。自我效能影响了MSM采用安全套、暴露前预防和暴露后预防的动机(路径系数分别为0.801、0.777和0.672,P<0.001),MSM的自我效能越高,越有可能形成保护动机,采取预防行为;易感性可以促进MSM使用暴露前预防的动机(路径系数0.147,P=0.028);反应效能(路径系数0.163,P=0.026)和反应代价(路径系数0.297,P<0.001)对MSM采取暴露后预防的动机有影响,反应效能越大,反应代价越小越有利于MSM产生使用暴露后预防的动机。结论在安全套、暴露前预防和暴露后预防的推广宣传中,可以通过提高人群的自我效能等保护动机理论因素水平,促进MSM产生保护动机,使得预防干预措施取得更理想的效果。

Objective To explore the factors influencing the motivation of adopting HIV prevention measures(condom,pre-exposure prophylaxis,and post-exposure prophylaxis)among men who have sex with men in Yunnan Province based on the theory of protective motivation.Methods A cross-sectional survey was conducted using a selfadministered questionnaire among HIV uninfected MSM in Kunming,Yuxi,Honghe,Dali,and Dehong Prefecture,Yunnan Province.Structural equation modeling was used to examine the association between motivation in taking protective measures and scores on theoretical factors of protection motivation.Results 372 valid questionnaires were returned,of which 333(89.5%)respondents reported using prevention measures during their most recent sexual behavior.The use of prevention differed with different frequencies of anal intercourse in the past six months.The differences were statistically significant(P<0.05).The level of theory factor scores for different measures of condom use was compared with the other two prevention measures,the differences were statistically significant(P<0.001).In addition,self-efficacy influenced the motivation of MSM to adopt condoms,pre-exposure prophylaxis,or post-exposure prophylaxis(path coefficient 0.801,0.777,and 0.672,P<0.001).It seemed that the higher the self-efficacy of the MSM was,the more likely they would develop a protective motivation to adopt condoms and pre-exposure prophylaxis.Vulnerability could promote the motivation of MSM to use pre-exposure prophylaxis(path coefficient 0.147,P=0.028).Response efficacy(path coefficient 0.163,P=0.026)and response cost(path coefficient 0.297,P<0.001)affected the motivation of MSM to adopt post-exposure prophylaxis.The higher the response efficacy and the smaller the response cost,the more favorable the motivation of MSM to use post-exposure prophylaxis.Conclusions During the promotion of condoms,pre-exposure prophylaxis and post-exposure prophylaxis,the level of theoretical factors of motivation for protection can promote motivation for protection among MSM and leading to better results of prevention interventions for MSM.