Male partner involvement in prevention of mother to child transmission of HIV in Sub-Saharan Africa: Successes, challenges and way forward

Sub-Saharan Africa has the highest number of mother to child transmissions of HIV. PMTCT programme plays a big role in reducing the MTCT nevertheless its effectiveness in Sub-Saharan Africa depends on involvement of male partners considering the fact that men are decision makers in African families. They make important decisions that have big impact on women’s health. Male partner involvement has been seen to increase uptake of PMTCT services and their involvement underscores their importance in reducing HIV infection in children. Recently many sub-Saharan countries adopted male partner involvement in PMTCT programme with an aim of increasing the uptake of PMTCT services. The programme has made some progress in improving the effectiveness of PMTCT services. On the other hand the strategy is facing a lot of challenges, the biggest being low male partner involvement. This article therefore seeks to review the successes and challenges faced by male involvement in Sub-Saharan Africa. It also proposes the way forward in order to improve its effectiveness. We used peer reviewed articles of research studies conducted in Sub-Saharan Africa and other related reliable sources of data to write the paper.

Male Involvement in the Maternal Health Care: Expectations of Pregnant Women in Bolgatanga Municipality in the Upper East Region of Ghana

Background: Male involvement during pregnancy and childbirth is very important as it has been shown to increase the number of times a pregnant woman undertakes antenatal care visits before delivery. The purpose of this study was to determine whether there is a relationship between the background characteristics of participants and their male partners’ involvement in maternal health care in the Bolgatanga Municipality of Upper East Region. Methods: The study design employed was a facility-based cross-sectional study design in 9 health facilities in the Bolgatanga municipality. The study populations for this study consisted of pregnant women using antenatal services in the health facilities before the commencement of this current study and are residents of the Bolgatanga municipality. A multistage sampling strategy was used in the sampling of participants for this study with an estimated sample size of 422. Results: Findings show that the majority of 403 (95.5%) of the participants expect their male partner accompanies them during the antenatal care clinic. The chi-square test revealed that marital status had a significant influence on male partners’ support in house chore and support in antenatal care service (P-value of 0.001 and 0.002, Conclusion: This study’s findings showed that pregnant women always want their male partners to accompany them to antenatal care and during labour and delivery. The pregnant women expected their male partners to be educated on the effects of pregnancy, how to take care of a pregnant woman, how to tolerate their partners, Sex during pregnancy, and how to prepare for emergencies (blood donation, transportation and finance).

退休行为对老年人自评健康的影响——基于中国城镇男性的评价研究

实施渐进式延迟退休政策已迫在眉睫,识别现有退休制度下的退休行为对居民健康水平的影响具有现实意义。本文基于2011-2018年中国健康与养老追踪调查(CHARLS)数据,采用模糊断点回归技术识别退休行为对老年男性自评健康的影响及机制路径。研究发现,虽然男性退休对自身自评健康影响不显著,但配偶退休会显著降低男性伴侣的自评健康水平,在进行一系列稳健性分析后结论仍然成立。此外,已退休和受教育程度较低的男性群体更容易受到配偶退休的负面冲击。机制研究发现,配偶隔代照料时间的提高和男性生活满意度的下降是配偶退休对伴侣自评健康产生消极影响的主要路径。本文研究结论有助于全方位认识退休政策的健康效应,为国家制定延迟退休政策提供启示。

昆明市某医院人流患者男性伴侣焦虑现况及影响因素分析

目的了解人流患者男性伴侣焦虑现状,分析其影响因素.方法抽取昆明某医院妇产科2015年4~5月的人流手术患者的男性伴侣进行问卷调查,采用焦虑自评量表（self-rating anxiety scales,SAS）测量男性伴侣的焦虑状况及情绪反映.应用SPSS17.0进行正态分布描述t检验或方差分析卡方检验,偏态分布采用秩和检验,焦虑情况相关因素分析采用二分类Logistic回归统计分析.结果被调查的205名男性伴侣中具有焦虑症状的53例,占25.9%,其中轻度焦虑44人（21.5%）,中度焦虑8人（3.9%）,重度焦虑1人（0.5%）.男性伴侣焦虑相关的主要危险因素为怀孕次数（OR=3.35）,而受教育程度（OR=0.60）、人流次数（OR=0.20）、年龄（OR=0.32）为保护因素.结论人工流产发生时,男性伴侣存在明显的焦虑情绪,以轻、中度为主.对女性情绪有影响,应对男女双方进行健康宣教,向社会倡导正确的性观念,普及相关知识,减少焦虑的发生.

未婚女性重复意外妊娠原因分析

目的调查意外妊娠未婚女性的生殖健康知识、避孕行为和态度,分析发生重复意外妊娠的主要相关原因,以降低未婚女性重复意外妊娠的发生率。方法选择发生2次及以上意外妊娠而行人工流产的未婚女性,共1183例(研究组);将3236例初次意外妊娠的未婚女性作为对照组。采用自制调查问卷了解未婚女性及其男性伴侣的生殖健康知识、避孕行为和避孕态度,对2组的调查结果进行比较。结果 2组安全避孕方式、女性的安全避孕态度比较差异无统计学意义(P>0.05);与对照组比较:研究组生殖健康知识水平更高(P<0.01),未采用任何避孕措施比例更低(P<0.01),采用不安全避孕措施更高(P<0.01),男性伴侣安全避孕态度更消极(P<0.01)。结论未采用安全避孕措施是导致未婚女性发生重复意外妊娠的主要原因;单纯提高生殖健康知识水平并不能有效降低未婚女性发生重复意外妊娠的发生率,男性伴侣的避孕态度是影响未婚女性发生重复意外妊娠重要原因。

婚姻挤压下农村大龄未婚男性的多伴侣行为研究

利用"中国农村大龄男性生殖健康和家庭生活调查"的数据,对农村大龄未婚男性多伴侣性行为及其影响因素进行了实证研究。研究发现,农村大龄未婚男性总体中的多性伴侣发生率不高,然而有过性经历的农村大龄未婚男性多伴侣性行为发生率较高,他们的性伴侣类型多样。Logistic回归分析显示,性态度和观看黄色录像行为是影响农村大龄男性多伴侣性行为的显著因素。然而,教育和年龄的影响均不显著。这说明,受到婚姻挤压的农村大龄未婚男性的多伴侣行为更可能只是为了满足性需要。

宫颈HPV阳性患者男性性伴侣外生殖器HPV感染情况及基因型分析

目的了解宫颈人乳头瘤病毒(HPV)阳性患者男性性伴侣外生殖器HPV感染及其基因分型分布情况。方法收集2017年1月到2018年7月因女性性伴侣宫颈HPV阳性就诊于妇科的579例男性资料,用HPV拭子对其尿道口、龟头及冠状沟取材,检测HPV高危和低危共27种亚型的感染情况。结果共229例男性感染HPV,总体感染率为39.55%。21～30岁为59.18%,31～40岁为36.61%,41～50岁为35.47%,≥51岁为44.25%,组间比较差异有统计学意义(P<0.05)。不同亚型检出频率由高到低前5位分别为:53、16、43、52、51。在229例感染者中,单重感染占58.5%,其次为双重感染达26.2%,最高达六重感染。结论宫颈HPV阳性者男性性伴侣的外生殖器HPV感染率较高,其中亚型53、16、43、52、51为常见,以单重感染为主。发现女性宫颈HPV感染时,建议对其男性性伴侣进行外生殖器HPV检测及治疗。

HIV感染的男男性行为者对同性固定性伴阳性告知的质性研究

目的:探究HIV感染的男男性行为者(MSM)对同性固定性伴进行阳性结果告知的体验,为制定性伴告知干预策略提供依据。方法:采用质性研究中现象学的研究方法,对12例HIV感染的MSM进行半结构式访谈,并对资料进行分析。结果:通过分析提炼出3个主题,对疾病的接受程度高、心理负担重、与固定性伴的关系好。结论:在MSM人群开放的文化氛围下,HIV感染的MSM对同性固定性伴进行阳性告知相对容易。加大HIV相关知识宣传,增强MSM人群对于自身高危状态的认识,提倡良好的伴侣关系均可促进该人群对同性固定性伴进行阳性告知。

乳腺癌对患者配偶性功能的影响

目的:了解女性乳腺癌患者配偶的性行为及性功能变化与临床变量和社会人口学变量之间的潜在关系。方法:采用横断面研究,2020年5月至2020年10月收集病例,共纳入196例23~59岁的女性乳腺癌患者的男性配偶。通过在线问卷或电话访问方式,填写男性性功能问卷(BSFI),并收集社会人口学变量和临床变量。结果:受访者年龄(46.13±7.75)岁,至调查时患者患癌时间(1.58±0.48)年。受访者性功能障碍发生率在患者患癌前(9.68%)后(49.76%)存在显著差异(P<0.001);主要类型是性欲低下(38.3%)。患者接受乳腺根治性切除术(OR=5.533,P=0.017,95%CI=1.366~22.412)和接受放疗者(OR=3.439,P<0.044,95%CI=1.058~11.171)其配偶出现性欲低下问题概率更高。受访者性欲低下的发生率的受自身年龄(OR=1.134,P=0.001,95%CI=1.053~1.222)影响显著。结论:女性患乳腺癌及治疗情况可能影响配偶性功能状态。医务工作者有必要对影响患者及其配偶性功能的因素加以关注,以采取相应的干预措施。

成年男性伴侣暴力态度量表的编制

目的:编制适用于我国成年异性恋男性的伴侣暴力态度量表(MIPVAS)。方法:选取不同年龄阶段的10名男性进行开放式访谈,编制初始问卷;选取559名男性用于条目分析和探索性因子分析,从中选取处于恋爱或婚姻中的男性373名用于效标关联效度检验;另外选取347名男性用于验证性因子分析和内部一致性信度分析,其中51名男性在间隔4周后完成重测。所有被试均为成年异性恋男性。使用冲突策略量表简版(CTS2S)为效标工具。结果:MIPVAS共23个条目,包括性暴力态度、身体暴力态度、精神暴力态度和控制行为态度4个因子,因子负荷0.51~0.91,4个因子可解释总变异的72.55%;验证性因子分析表明4因子模型拟合良好(RMSEA=0.07,CFI=0.92,TLI=0.91);效标效度检验显示,MIP-VAS总分及各因子分与CTS2S总分和各因子分均呈正相关(ICC=0.29~0.55,均P<0.001)。4个因子的内部一致性系数为0.79~0.94,重测信度(ICC)为0.64~0.87。结论:本研究编制的成年男性伴侣暴力态度量表具有较好的效度和信度,可以用于测量成年异性恋男性对伴侣实施不同类型暴力的态度。

Acceptability of Routine HIV Testing by Pregnant Women in Lusaka District Ante Natal Urban Clinics in Lusaka, Zambia

Background: Each year around 1.5 million women living with Human immuno deficiency Virus (HIV) become pregnant, and without antiretroviral drugs there is a chance that their child will become infected. Following the introduction of Routine Human immuno deficiency Virus testing policy in Zambia, the Human immuno deficiency Virus test is offered to all pregnant women unless they decline. However, more pregnant women are declining to be tested. Objective: The main objective of this study was to investigate factors that influence acceptability of routine HIV testing by pregnant women in Lusaka district urban clinics. Materials and Methods: A cross sectional study using a quantitative approach was conducted in Lusaka District clinics. The sample size was 366 ante natal pregnant women who were selected by simple random sampling, selected from three (3) selected research setting. The study population included pregnant women aged 15 to 49 years, coming for ante natal visit for the first time, before being tested for HIV, were eligible and agreed to participate in the study. A pretested semi structured interview schedule was used to collect data. Data were entered and analysed with Statistical Package for Social Sciences (SPSS) version 20 program. Chi-square was used to test for significant associations and Binary Logistic regression modelling was carried out to predict the outcome. A 5% level of significance (p value) 0.05 confidence interval was set. Results: Study findings revealed that majority 85.6% (317) of respondents indicated willingness to undergo routine HIV testing in pregnancy though 77.3% perceived it a compulsory test. Binary logistic regression revealed that maternal age, educational level and information education and communication (IEC) contributed significantly to the model. The odds revealed that acceptability of routine HIV testing by older pregnant women (37 - 49 years) were 8 times (OR = 7.67, p = 0.003) higher than the younger ones. The odds of acceptability by respondents with tertiary education were 141 times (OR-141.23, p-0.0001), likely to accept HIV testing than those with primary or no education. And the odds also revealed that acceptability by women who cited adequate IEC (OR-2.6, p-0.024) were 3 times higher than those who cited inadequate IEC. Conclusion: The study showed that majority of the pregnant women was willing to undergo Routine HIV testing however a percentage regarded the test as a mandatory test without any choice of denial. Therefore there is need to address some factors that are likely to affect the routine HIV testing and impede the success of implementation of the PMTCT programme in the country which goes beyond testing for HIV alone. Recommendations: Ministry of Health needs to provide health education messages in different tribes. MOH should also intensify male involvement in HIV Testing and Counselling. LDHO should consider training more community health care givers as Voluntary Counselling and Testing providers. The District should organize regular refresher courses and presentations on Routine HIV testing to health workers and Ministry of Health should consider conducting a country wide study.

Exposure to sublethal concentration of flupyradifurone alters sexual behavior and cuticular hydrocarbon profile in Heriades truncorum,an oligolectic solitary bee

The aboveground oligolectic bee,Heriades truncorum,is a particularly good model for studying the impact of pesticides on sexual communication,since some aspects of its mating behavior have previously been described.We have tested(1)the interference of the pesticide flupyradifurone on male precopulatory behavior and male mating partner preferences,(2)the way that the pesticide interferes in male quality assessment by the female,and(3)the effects of the pesticide on the chemical compounds in the female cuticle.We exposed bees of both sexes to a sublethal concentration of flupyradifurone.Various behaviors were registered in a mating arena with two females(one unexposed and one exposed)and one male(either unexposed or exposed).Unexposed males were quicker to attempt to mate.Treatment also impacted precopulatory behavior and male quality assessment by females.Males approached unexposed females more quickly than insecticideexposed ones.Females exposed to insecticide produced lower amounts of some cuticular hydrocarbons(sex pheromone candidates)and appeared less choosy than unexposed females.Our findings suggest that insecticide exposure affects sexual communication,playing a role both in male preference and in male quality assessment by the female.

浙江省男大学生的异性临时性伴来源及相关因素分析

目的了解浙江省男大学生(男生)的异性临时性伴来源情况与相关因素,为高校大学生的艾滋病防治对策提供依据。方法2018年10-11月采用分层整群抽样方法,在浙江省13所高校31674名大学生中开展问卷调查,从2665名自述有性行为的男生中,选取自述异性临时性伴且回答性伴来源的男生为研究对象。收集研究对象社会人口学特征、艾滋病防治知识、性行为特征和干预情况等资料。采用logistic回归模型对男生的异性临时性伴来源进行分析。结果在自述有性行为的男生中,自述有异性临时性伴的男生占15.9%(423/2665)。男生异性临时性伴数为1、2~和≥5个的分别占39.4%(147/373)、37.5%(140/373)和23.1%(86/373);每次坚持使用安全套的比例为40.1%(167/416)。男生异性临时性伴来源为社会人员的占33.8%(143/423),年龄(20.27±1.40)岁。多因素logistic回归分析结果显示,相比于异性临时性伴数为1个、异性临时性伴为熟人和最近1年无异性固定性伴者,男生的异性临时性伴来源的相关因素包括临时性伴数≥5个(aOR=3.00,95%CI:1.53~5.89)、通过娱乐场所找临时性伴(aOR=3.04,95%CI:1.64~5.64)和最近1年与异性固定性伴发生性行为(aOR=0.41,95%CI:0.25~0.68)。结论浙江省高校男生的异性临时性伴来源多样,男生的异性临时性伴来源与临时性伴数较多、通过娱乐场所寻找临时性伴和无异性固定性伴存在一定相关性。建议加强高校大学生的自我防护意识与能力,倡导安全性行为,降低大学生中的HIV传播风险。

男男性行为人群与男性性伴和女性性伴的性行为特征及影响因素

目的了解安徽省男男性行为人群(men who have sex with men,MSM)与其男性性伴和女性性伴的性行为特征及影响因素。方法以合肥、芜湖和六安3个城市为研究现场,采用滚雪球法和网络招募法招募MSM人群,对符合纳入标准的MSM进行匿名问卷调查。采用多因素Logistic回归分析模型分析MSM人群最近6个月发生异性性行为的危险因素。结果共招募1 200名MSM,最近6个月78.3%MSM与男性性伴有过肛交性行为,20.9%与女性性伴有过异性性行为,16.5%最近6个月与男性性伴、女性性伴均有过性行为。最近6个月异性性行为中的安全套坚持使用率(29.9%)明显低于同性性行为的安全套坚持使用率(53.0%),在最近一次异性性行为中的安全套使用率(52.2%)也明显低于同性性行为中的安全套使用率(79.6%)(均有P<0.05)。多因素分析结果显示,已婚(包括在婚/同居/离异/丧偶)、在调查城市居住时间>2年、有同性商业性行为的MSM更容易发生异性性行为。结论 MSM人群存在较高比例的双性性行为,且安全套坚持使用率较低,应该加强对他们的性健康教育、风险感知教育和行为干预。

2011—2016年深圳市男男性行为人群梅毒和HIV感染情况及影响因素

目的分析深圳市男男性行为人群（MSM）梅毒和HIV感染情况及影响因素。方法于2011—2016年，在深圳市采用同伴推动抽样法和滚雪球抽样法招募研究对象到深圳市某彩虹门诊接受自愿咨询检测。纳入18岁及以上、自述最近6个月同性肛交性伴数≥1个者，共3109名。采用一对一问卷调查方法收集其社会人口学特征、HIV检测史、近2年内献血史、药物滥用史、性取向、性角色、既往从事商业性服务工作、既往接受商业性服务史、最近6个月有无女性性伴等。采集静脉血5ml，检测梅毒和HIV感染情况。比较研究对象最近6个月与女性和男性发生性行为时使用安全套情况；采用多因素非条件逐步logistic回归模型，分析影响研究对象梅毒感染和HIV感染的相关因素。结果3109名MSM的年龄为（31．49±8．64）岁，其中感染梅毒者为565例（18．17％），感染HIV者为330例（10．61％），梅毒合并HIV感染者为165例（5．31％）；791名（25．44％）MSM报告最近6个月肛交时保持固定单一性伴。保持固定单一性伴的MSM的梅毒感染率较低，OR（95％c，）值为0．64（0．51-0．81）；保持固定单一性伴的MSM的HIV感染率较低，OR（95％CI）值为0．66（0．49-0．90）。结论深圳市MSM中保持固定单一性伴者比例较低，保持固定单一性伴能降低MSM感染梅毒和HIV的风险。

北京市MSM HIV和梅毒感染与性行为影响因素调查

目的了解北京市男男性行为者(Men who have sex with men,MSM)与固定和临时男性性伴无保护性肛交的情况及其影响因素。方法于2008年3月～6月,在北京市招募MSM进行问卷访谈,了解其社会人口学、高危行为特征,以及心理状况,并采集血样进行HIV抗体、梅毒抗体、HBsAg和HCV抗体检测。结果共调查550名MSM,近1个月分别有86人(15.6%)和62人(11.3%)与固定和临时男性性伴发生无保护性肛交。多因素logistic回归分析结果显示,大学本科及以上文化程度(OR=1.70,95%CI:1.06～2.72)和近3个月与男性性伴同居(OR=2.41,95%CI:1.45～4.02)是MSM与固定男性性伴无保护性肛交的影响因素,近3个月男性性伴数≥10人(OR=4.11;95%CI:2.04～8.30)和近1个月感到悲伤(OR=1.82;95%CI:1.04～3.18)是MSM与临时男性性伴无保护性肛交的影响因素。结论北京市MSM无保护性肛交现象较为普遍,HIV和梅毒感染率高,应采取宣传教育、安全套推广等措施以控制HIV等性传播疾病的流行。

多性伴行为在未婚流产少女男伴中的现况及影响因素

1994年国际人口与发展大会（ICPD）明确提出“应促进男性参与生殖健康和分担责任”。以往多项研究也证明了男性伴侣（男伴）对女青年生殖健康的影响。男伴的高危性行为不仅会导致女性非意愿妊娠、人工流产，还会增加其感染性病、艾滋病的风险。本研究拟探索未婚流产少女男伴多性伴行为的发生情况及其影响因素。

未婚流产少女男伴首次性行为的年龄及其影响因素

目的:了解北京和济南两地未婚流产少女男伴首次性行为的年龄及其影响因素。方法:采用自编结构式问卷对北京和济南两地共467名未婚流产少女的男性伴侣进行调查。结果:未婚流产少女的男性伴侣首次发生性行为的平均年龄为(20.25±2.72)岁,首次性行为的前两位原因依次为"好奇,想知道性交感受"(43.0%),"生理需要"(32.3%)。单因素分析结果表明,首次性行为年龄(≤18岁组和>18岁组)与性态度、首次接触描写性行为的书刊/录像/网站的年龄、被迫性行为、紧急避孕、吸烟、饮酒、暴力冲突等13个因素有关(P<0.05)。多元因素分析结果提示,接触描写性行为书刊/录像/网站的年龄过早和过去1年与家人发生冲突的次数多是过早发生性行为的危险因素。结论:未婚流产少女男伴首次性行为的年龄较早,过早发生性行为的男伴健康危险行为和不安全性行为的发生率较高。

我国四城市MSM人群HIV感染者性伴类型和性行为特征

目的了解我国城市男男性行为人群（men who have sex with men,MSM）HIV感染者性伴类型和性行为特征,为预防控制HIV传播提供依据。方法本研究以2008年4月~2009年9月在北京、哈尔滨、郑州和成都4个城市的MSM人群中检出的HIV阳性者为对象,以匿名的方式进行一对一问卷调查,并采集研究对象静脉血进行梅毒抗体检测。结果本次调查203名对象,平均年龄为（30.9±9.3）岁,约1/3的MSM曾与女性结婚,自认为是同性和双性性取向者所占的比例分别为68.5%和28.1%。梅毒现感染检出率为27.1%。近6个月有46.6%的研究对象通过互联网寻找性伴,28.0%在洗浴场所结识性伴。分别有63.2%、34.2%和29.5%的研究对象在过去6个月中拥有男性偶然性伴、男朋友和男性固定性伴,9.3%和4.7%的研究对象拥有妻子和女朋友,近6个月中拥有1、2和3种性伴者所占的比例分别为60.1%、32.6%和6.2%。近6个月研究对象曾与男性发生肛交和商业肛交性行为的比例分别为89.7%和9.0%,27.2%的调查对象与女性发生阴道性交,10.4%的研究对象有过群交性行为。调查对象与各种性伴发生性行为（不包括口交）坚持使用安全套的比例在25.5%~43.8%之间。结论 MSM人群HIV感染者在各种不同场所寻找性伴和拥有不同类型的性伴,且安全套的使用率较低,将加速HIV在MSM人群中流行,并向女性人群传播。

2250例男男性接触者性伴与性传播感染率相关性研究

目的探讨我国男男性接触者（MSM）性伴状况与性传播感染（STI）感染率相关关系。方法采用匿名自填问卷方式对9城市MSM进行调查，用SPSS 11．0软件处理。结果STI组男性伴数量多于非STI组（P〈0．05），自身性伴为较少性伴者的STI感染率低于有较多性伴者（P〈0．05）。通过公厕、公园或浴池结识性伴者的STI感染率，高于通过同学朋友邻居结识性伴者（P〈0．05）。自认为与性伴关系彼此专一者的STI感染率明显低于与性伴关系非彼此专一者（P〈0．01）。在婚者STI感染率高于非在婚者（P〈0．05），与妻子分居者STI感染率高于与妻子仍有性行为者（P〈0．05）。结论减少MSM的男性伴数量，可以降低STI感染率。通过公厕、公园或浴池等场所结识性伴是MSM人群STI／HIV传播的重要途径。MSM中STI／HIV感染存在异性性传播的风险。