使用暴露前预防的MSM性行为变化及原因的定性研究

A qualitative study of changes in sexual behavior and related reasons among MSM using pre-exposure prophylaxis medication

目的 了解MSM使用暴露前预防(PrEP)后性行为变化及原因。方法 由北京和南京两地的3家社会组织线上招募服用过PrEP药物的MSM,进行深入访谈,收集PrEP使用情况、PrEP使用后性行为变化及其原因的相关信息,对访谈内容按主题进行归类整理。结果 本次共访谈了23名PrEP使用者,年龄范围21~46岁。在药物使用方面,18人通过互联网医药平台购买过PrEP药物,16人用过国产药物,9人一直采用每日服药方案,4人一直使用按需服药方案,个人经济能力、性行为特征、药物效果及不良反应、药物获取的隐私性、便捷性和可靠性等因素影响PrEP药物的获取与使用。在性行为变化方面,11人使用PrEP后安全套使用减少,3人使用PrEP后性行为频率提高,1人性行为方式发生转变,1人性角色发生转变。性行为变化的主要因素包括:对PrEP的信任程度较高,易产生侥幸心理;年龄偏大者认为安全套影响性体验,使用PrEP的同时会减少安全套的使用;部分使用者通过提高性行为频率以节约药物成本;部分受访者对性病的了解较少,缺乏防范意识。结论 PrEP的使用会导致安全套使用减少等性行为变化,未来在推广PrEP的同时,应加强宣传PrEP的正确使用,提高个体风险意识和性健康认知,同时推广多种HIV预防策略的综合应用。

Objective To understand the characteristics of pre-exposure prophylaxis(PrEP)uptake and the changes in sexual behavior after initiation of PrEP in men who have sex with men(MSM).Methods MSM who had taken PrEP were recruited through the Internet by social organizations in Beijing and Nanjing for in-depth interviews to collect information on the status of PrEP uptake and changes in sexual behavior before and after PrEP initiation.The interview contents were classified and sorted by topics.Results In total,23 PrEP users aged between 21 to 46 years old were interviewed.18 out of 23 users reported purchasing PrEP drugs through online medical platforms.16 users reported using domestically-produced drugs.9 users adopted the daily dosing regimen and 4 used the on-demand dosing regimen.Factors associated with the procurement and usage of PrEP included personal financial capacity,sexual behavior characteristics,drug side effects,user privacy protection,the convenience of drug purchasing,and reliability of drug acquisition.From the perspective of changes in sexual behavior,1l users reduced condom usage after using PrEP.3 users increased the frequency of sexual behavior.I user experienced a change in sexual behavior patterns,and I user experienced a change in sexual roles.Users who had changes in sexual behavior reported the underlying reasons for the changes included 1)misunderstanding the PrEP effect which led to a risk-taking mentality;2)uncomfortable experiences of using condoms,especially among older MSM which made them reduce their usage of condoms while using PrEP;and 3)to save drugrelated costs by increasing the frequency of sexual behavior,especially among those who chose on-demand regimen.Some interviewees also reported having limited knowledge of sexually transmitted diseases and therefore lacked a sense of prevention.Conclusions The use of PrEP may lead to changes in sexual behaviors,such as reduced condom use.It is necessary to strengthen the importance of condom use besides promoting PrEP.Tailored strategiess are needed to improve individual risk awareness and sexual health knowledge,and promote the comprehensive application of multiple HIV prevention approaches.