天津市男性浴池男男性行为人群HIV新发感染及影响因素分析

Analysis of newly diagnosed HIV infection and influencing factors among men who have sex with men in gay bathhouses in Tianjin

目的分析天津市浴池MSM的HIV新发感染及其影响因素,为对浴池MSM采取相应的预防干预措施、降低HIV感染提供依据。方法以在男性浴池寻找性伴、最近1年与同性发生过插入性口交或肛交的男性为研究对象,2011年3月至2021年12月建立开放式队列,完成HIV检测和基线调查,并进行随访和检测。调查内容包括人口学、艾滋病相关行为学信息。比较单次检测组和多次检测组的区别,计算阳性率和多次检测组的新发感染率,并应用Cox比例风险回归模型分析多次检测组HIV新发感染率的影响因素。采用EpiData 3.02软件建立数据库,采用SAS 9.4软件进行统计学分析。结果研究期间共检测12195人次,包括研究对象7151人,以≥30岁(70.18%)和外地户籍(61.32%)为主,年龄范围为16~82岁,年龄M(Q1,Q3)为36(28,48)岁,其中检测阳性547人。与单次检测组相比,多次检测组的本地户籍、已婚/同居的比例较高,最近6个月发生肛交、接受同伴教育和最近1年被诊断患过性病的比例均较高,最近6个月发生同性性行为坚持使用安全套的比例较低。研究期间阳性率为7.65%(95%CI:7.00%~8.00%)。HIV阳性率由2011年的12.58%下降到2021年的3.31%。将多次检测组纳入开放式队列1740人,累计随访时间为4688.61人年,期间共新发HIV感染144人。新发感染率为3.07/100人年(95%CI:2.57/100人年~3.57/100人年)。多因素Cox比例风险回归模型分析结果显示,外地户籍者(aHR=1.32,95%CI:1.19~1.45)和最近6个月与同性发生群交者(aHR=1.18,95%CI:1.02~1.36)HIV新发感染的风险更高。结论天津市男性浴池MSM普遍存在群交等不安全性行为,仍需要加强宣传和干预工作,并与MSM社会组织加强合作开展男性浴池MSM同伴教育和HIV主动检测工作,并探索新的方法在MSM中降低HIV新发感染。

Objective To analyze the newly diagnosed HIV infections and influencing factors among MSM(men who have sex with men)in gay bathhouses in Tianjin and to provide evidence for taking preventive interventions to reduce HIV infections in this population.Methods Male individuals who sought sexual partners in gay bathhouses and engaged in insertive oral or anal sex with men within the past year were targeted.An open cohort was formed from March 2011 to December 2021 for HIV testing and baseline investigation,followed by follow-ups and screenings.The survey included demographic data and information related to AIDS behaviors.The differences between single-testing and multiple-testing groups were compared,and the positivity rate and incidence rate of new infections in the multiple-testing group were calculated.The Cox proportional hazards regression model was used to analyze the factors influencing the incidence rate of new HIV infections.EpiData 3.02 was used for database construction and SAS 9.4 for statistical analysis.Results During the research period,12195 tests were conducted,involving 7151 subjects.Among them,primarily those aged≥30 years(70.18%)and non-local residents(61.32%),with ages ranging from 16 to 82,and M(Q1,Q3)of age was 36(28,48),547 tested positive.Compared to the single-testing group,the multiple-testing group had higher proportions of local residents,married/cohabiting individuals,recent anal intercourse,peer education acceptance,and those diagnosed with an STD in the last year,but a lower proportion of consistent condom usage in recent same-sex encounters.The positivity rate during this period was 7.65%(95%CI:7.00%-8.00%),declining from 12.58%in 2011 to 3.31%in 2021.A total of 1740 subjects were included in the open cohort with a cumulative follow-up time of 4688.61 person-years,with 144 new HIV infections identified.The incidence rate of new infections was 3.07/100 person-years(95%CI:2.57/100 person-years-3.57/100 person-years).Multifactorial Cox regression analysis revealed that non-local subjects(aHR=1.32,95%CI:1.19-1.45)and those engaged in group sex with the same gender in the last six months(aHR=1.18,95%CI:1.02-1.36)had higher risks of new HIV infections.Conclusions MSM in gay bathhouses in Tianjin commonly engage in unsafe sexual behaviors like group sex,emphasizing the need for increased awareness,intervention efforts,and collaboration with MSM community organizations for peer education and proactive HIV testing in gay bathhouses.Moreover,exploring new methods to reduce new HIV infections among MSM is necessary.