天津市MSM利用手机APP查询HIV快速检测结果与其危险行为关系的定性研究

A qualitative study on the relationship between use of smartphone APP to query HIV rapid test results and risky behaviors among MSM in Tianjin Municipality

目的 了解天津市MSM通过智能手机APP查询HIV快速检测结果的原因,并分析查询结果与危险行为之间的关系。方法 通过天津市MSM社会组织招募,选择在该组织接受过HIV抗体快速检测并在微信公众号查询过结果的MSM作为研究对象。采用面对面深入访谈方法,了解其最近一年HIV检测史、查询史、男男性行为特征以及精神活性物质使用史等。所有访谈录音转录后使用Nvivo 12.0进行分析。结果 共访谈16名MSM,年龄19~42岁,在3个月内查询快速检测结果的频次为2~12次,16名MSM均表示使用手机APP查询HIV快速检测结果的目的是为了向性伴表明自己的健康状况。16名访谈对象中15名有固定性伴,13名有临时性伴。有固定性伴的MSM大部分人(13/15)查询后在与固定性伴性行为中会发生无套性行为、使用精神活性物质,他们认为查询明确了固定性伴的阴性状况,出于对固定性伴的信任,以及对安全套影响性体验的担心和对快感的追求,选择不使用安全套并使用精神活性物质;而在有临时性伴的MSM中,大部分人(11/13)查询后在与临时性伴性行为中仍坚持使用安全套、不使用精神活性物质,他们并不信任临时性伴的健康状况,担心阴性结果不能排除窗口期,仍需要使用安全套,且使用安全套还能减少感染其他性病的风险。结论 MSM查询HIV检测结果后在与固定性伴性行为中会发生无套性行为和精神活性物质的使用。因此,未来在推广APP检测和结果告知时,应特别关注对有固定性伴的MSM的综合干预。

Objective To understand the reasons why men who have sex with men(MSM) in Tianjin Municipality query HIV rapid test results via a smartphone APP, and to analyze the relationship between query results and risky behaviors. Methods Participants were recruited through Tianjin social organization. MSM who had received rapid HIV antibody testing at the organization and had queried the results on the WeChat official account were enrolled in the study.One-on-one, face-to-face, in-depth interviews were conducted to collect information such as their HIV testing history,history of test result queries on the WeChat official account, MSM behavioral characteristics, and history of psychoactive substance use in the past year. All interview recordings were transcribed and analyzed using Nvivo 12.0. Results A total of 16 MSM aged 19-42 years were interviewed, and the frequency of querying for rapid test results ranged from 2 to 12times in the past 3 months. All 16 MSM reported that the purpose of querying rapid HIV test results using a smartphone APP was to indicate their health status to their sexual partners. 15 of the 16 interviewees had regular sexual partners, while 13 had casual sexual partners. The majority of the MSM with regular partners(13/15) had condomless sex and used psychotropic substances during sex with their regular partners after querying. They believed the query confirmed the negative status of their regular partners and trusted their partners, and cited concerns that condoms would reduce sexual enjoyment and pleasure, leading to a decision not to use condoms and in favour of psychotropic substances. Conversely, the majority of MSM with casual partners(11/13) continued to advocate for condom use and refrained from psychotropic substances during sexual encounters with casual partners postquery. Their decisions stemmed from mistrust in their casual partners' health status and the understanding that a negative result might not eliminate the possibility of a window period. Therefore, they maintained that condom use was essential, also noting it would lessen the risk of other sexually transmitted infections. Conclusions Condomless sex and psychotropic substance use occur during sex with regular partners after MSM query HIV test results. Therefore, when promoting APP testing and result notification in the future, special attention should be given to comprehensive intervention programs for MSM with regular sexual partners.