深圳市不同性角色男男性行为者行为特征及梅毒与HIV感染现状分析

Behavioral characteristics and current status of syphilis-HIV infection among men who have sex with men of sexual roles in Shenzhen

目的了解深圳市不同性角色男男性行为者(men who have sex with men,MSM)行为特征及梅毒与HIV感染状况,分析MSM性角色与梅毒和HIV感染的关系。方法运用滚雪球法和同伴推动抽样法招募MSM进行问卷调查和血清学检测,用χ^(2)检验、Wilcoxon秩和检验、Kruskal-Wallis检验进行单因素分析,用有序logistic回归分析不同性角色梅毒HIV双重感染的相关影响因素。结果2019—2021年共调查MSM 839例,其中被动型289人(34.45%),主动型270人(32.18%),双向型280人(33.37%)。3组在年龄、户籍、文化程度、第一次发生性关系对象、首次与同性发生肛交的年龄、近6个月肛交性伴数、近6个月异性性行为、近6个月药物滥用情况上的差异有统计学意义(χ^(2)=34.980、9.570、7.621、7.924、23.229、11.991、37.717、10.678,P<0.05)。839例MSM中,梅毒HIV双重感染率为4.17%,单纯HIV感染率为5.13%,单纯梅毒感染率为9.54%;其中,被动型MSM梅毒HIV双重感染率、单纯HIV感染率和单纯梅毒感染率分别为5.54%、6.92%和10.03%,双向型MSM分别为4.29%、6.43%和9.64%,主动型MSM分别为2.59%、1.85%和8.89%,不同性角色的梅毒HIV双重及单纯感染率差异有统计学意义(χ^(2)=14.520,P=0.0243)。有序logistic回归分析结果显示,近6个月性角色为被动型和双向型、年龄(≥30岁)、高中/中专及以下文化程度、首次与同性发生肛交的年龄越小、近6个月肛交性伴数(≥6位)和近6个月与性伴发生性行为时未坚持使用安全套者,其梅毒HIV双重感染及单纯感染的风险更大。与主动型MSM相比,被动型MSM的梅毒HIV双重感染及单纯感染风险为2.21倍(95%CI:1.39~3.51),双向型MSM的梅毒HIV双重感染及单纯感染风险为1.26倍(95%CI:1.07~2.18)。结论MSM不同性角色具有不同的人口学、性行为特征和梅毒及HIV感染风险,应根据具体的行为特点制定个体化、有针对性的干预策略。

Objective To understand the behavioral characteristics of men who have sex with men(MSM)in different sexual roles and the current status of syphilis-HIV co-infection and mono-infection in Shenzhen,and to analyze the relationship between sexual roles and syphilis-HIV status.Methods The snowball and respondent-driven sampling(RDS)were used to recruit MSM in Shenzhen for questionnaire surveys and serological testing of syphilis and HIV.Chi-square test,Wilcoxon two-sample test,Kruskal-Wallis test,and multivariate logistic regression model were used to analyze the factors associated with the sexual roles and syphilis-HIV co-infection and mono-infection.Results A total of 839 MSM were recruited from 2019 to 2021.Of all,289(34.45%)were receptive group,270(32.18%)were insertive group,and 280(33.37%)were versatile group.Statistically significant differences were found among the three groups in age,household registration,educational background,first sexual partner,age of having anal sex for the first time,number of sexual partners in the last 6 months,having heterosexual sex in the last 6 months,and drug abuse(rush)in the last 6 months(χ^(2)=34.980,9.570,7.621,7.924,23.229,11.991,37.717,10.678,P<0.05).Among 839 MSM,the prevalence of syphilis-HIV co-infection,mono-HIV infection,and mono-syphilis infection were 4.17%,5.13%,and 9.54%,respectively;the infection rates of the receptive group were 5.54%,6.92%,and 10.03%,respectively;the infection rates of the versatile group were 4.29%,6.43%,and 9.64%,respectively;the infection rates of insertive group were 2.59%,1.85%,and 8.89%,respectively;there were statistical differences in infection rates of syphilis-HIV co-infection and mono-infection among different sexual roles(χ^(2)=14.520,P=0.0243).Ordinal logistic regression indicated that playing exclusively receptive and versatile roles in anal sexual intercourse in the last 6 months,the older MSM(≥30),senior high school and below,the younger age at the first anal,having 6 or more anal sexual partners,and not insist on using condoms in anal sexual intercourse were associated risk factors for syphilis-HIV co-infection and mono-infection.Compared with MSM in the insertive group,receptive MSM had 2.21 times the risk of syphilis-HIV co-infection and mono-infection(aOR=2.21,95%CI:1.39-3.51),and versatile MSM had 1.26 times the risk(aOR=1.26,95%CI:1.07-2.18).Conclusion MSM with different sexual roles exhibit distinct demographic and sexual behavior characteristics,as well as varying risks for syphilis and HIV infections.Individualized and different corresponding preventive measures should be taken for MSM towards different sex roles and sexual behaviors.