山东省男男性行为人群卫生服务利用现状及影响因素分析

目的 了解山东省男男性行为人群(MSM)卫生服务利用现状并探讨其影响因素,为后续艾滋病防治干预提供参考依据.方法 于2021年1月—6月在山东省烟台市、威海市、滨州市3个地区进行匿名调查,收集有效问卷1126份,并采用多元logistic回归模型探讨影响MSM接受预防艾滋病服务及艾滋病病毒(HIV)暴露后预防用药的因素...     

Public health challenges of the emerging HIV epidemic among men who have sex with men in China

A large-scale national survey was conducted in 2008 across 61 cities throughout China, covering over 18,000 men who have sex with men (MSM). The prevalence of human immunodeficiency virus (HIV) was 4.9% and incidence ranged from 2.6 to 5.4 per 100 person-years. The prevalence of sexually transmitted diseases ranged from 2.0% to 29.9% among MSM in different parts of China. Syphilis status, recruitment of sexual partners mainly from gay saunas, duration of MSM experience, and unprotected sex with regular male sex partners and multiple male sex partners predicted HIV seroconversion. The prevalence of consistent condom use was low during anal sex, ranging from 29.4% to 37.3%. Within this context, this paper considers the factors surrounding HIV prevention activity, and identifies a number of public health challenges which need to be considered if optimum outcomes are to be achieved. HIV prevention targeting MSM is a delayed response. The high risk associated with gay saunas and the need for steady condom supply at these venues needs urgent consideration. In addition, approximately one-third of MSM in China reported bisexual behavior, which may be attributed to sociocultural reasons and stigma against MSM. Female sex partners of MSM are seldom aware of their exposure to high risk of HIV transmission. Finally, the primitive nature of non-government organizations for HIV prevention and issues around their sustainability pose another serious challenge for the future of HIV prevention campaigns targeting MSM in China.     

A qualitative assessment of health seeking practices among and provision practices for men who have sex with men in Malawi

Background

In the context of a generalized epidemic and criminalization of homosexuality, men who have sex with men (MSM) in Malawi have a disproportionate burden of HIV compared to other adults. Past research has documented low uptake of HIV prevention and health services among MSM, self-reported fear of seeking health services, and concerns of disclosure of sexual orientation and discrimination in health settings. Qualitative research was conducted among MSM and health service providers in Blantyre, Malawi to understand underlying factors related to disclosure and health seeking behaviors and inform the development of a community-based comprehensive HIV prevention intervention.

Methods

Using peer recruitment, eight MSM participants representing a range of ages, orientations, and social and behavioral characteristics were enrolled for in-depth interviews. Five service providers were recruited from the district hospital, local health and STI clinics, and a HIV prevention service organization. We use the Health Belief Model as a framework to interpret the influential factors on 1) health seeking and uptake among MSM, and 2) influences on provision of services by healthcare providers for MSM.

Results

Results highlight disclosure fears among MSM and, among providers, a lack of awareness and self-efficacy to provide care in the face of limited information and political support. Service providers reported concerns of adverse repercussions related to the provision of services to men in same sex sexual relationships. Some MSM demonstrated awareness of HIV risk but believed that within the wider MSM community, there was a general lack of HIV information for MSM, low awareness of appropriate prevention, and low perception of risks related to HIV infection.

Conclusions

Qualitative research highlights the need for appropriate information on both HIV risks and acceptable, effective HIV prevention options for MSM. Information and educational opportunities should be available to the wider MSM community and the health sector. Health sector interventions may serve to increase cultural and clinical competency to address health problems experienced by MSM. To ensure availability and use of services in light of the criminalization and stigmatization of same sex practices, there is need to increase the safety of uptake and provision of these services for MSM.

     

深圳市男男性行为人群相关高危行为干预及其影响因素研究

目的 了解深圳市男男性行为者(MSM)安全套使用及其相关影响因素.方法 2009年8-11月招募深圳市同性恋聚集地的同性接触人群作为访谈对象,采用统一调查表进行问卷调查.对调查的273名MSM进行人口学和行为特征分析;以近6个月发生性行为时不能坚持每次使用安全套的行为为应变量,而各类影响因素为自变量进行logistic回归分析.结果 调查对象来自全国各地,绝大部分为青壮年,平均年龄27.9岁,以未婚居多,文化程度较高,但对艾滋病知识缺乏;安全套使用率低,过去1年每次性行为均使用安全套的比例为20.5%;与同性发生性行为不使用安全套的原因主要是对方为"稳定的性伴和爱人"、"年轻,看起来没病"、"没有滥交".结论 深圳市MSM危险性行为普遍存在,安全套使用情况和影响因素各不相同,艾滋病极有可能在该人群中流行.

Abstract：

Objective To learn the condom-use and it's associated factors among men who have sex with men(MSM)in Shenzhen,so as to provide scientific basis for the development of prevention and control program.Methods Cross-sectional survey was conducted with standardized questionnaire used on individual case.Associated factors with behavior of not persistent condom use were analyzed,using logistic regression method as dependent variable and associated factors with behaviors as independent variables.Results Most of the MSM were young,with average age as 27.9.coming from 26 provinces of China.Only 20.5 percent of the participants were persistently using condoms every time with their sex partners in the past year. The main reasons of not constantly using condom with their male sex partners were having fixed partners,being young,healthy and being faithful.Conclusion High risk sexual behaviors and the low rate of condom-use among MSM might serve as potential risks for HIV epidemics.Data on the rate of condom use and the influencing factors among MSM varied for different sexual partners,suggested that targeted prevention measures should be conducted.     

Stigma matters: HIV and HIV risk perception among men who have sex with men in Serbia; a qualitative study

As a social determinant of health, stigma is a major barrier to health care access, illness management and completing the treatment. It is attributed both to HIV as a health condition and to the populations at risk of being infected with it. In Serbia, HIV is associated with men who have sex with men (MSM), with a noticeable stigma towards them. Drawing upon a qualitative cross-sectional study, conducted in three Serbian cities, we explore the MSM’s perception of HIV in the context of that social stigma. Using a respondent-driven sampling approach, 62 targeted MSM respondents participated in focus groups discussions and in-depth interviews. We found that the participants’ understandings of the HIV infection, risks and prevention are shaped by stigma. Those MSM who resisted stigma relativised the HIV risk, associating it with the general population and HIV-positive MSMs, believing that HIV, perceived as a chronical illness, was unjustly related to MSM. As one of the main preventive measures, serosorting was based on alleged HIV-positive statuses of potential sexual partners. HIV-negative participants described perceiving HIV-positive MSM as the ones responsible for spreading the virus, since they were concealing their positive status. As a response to stigma, MSM tended to challenge the HIV discourse, shifting it away from MSM onto the general (male) population and HIV positive MSM. Our analysis suggests that stigma resistance may make MSM more susceptible to taking risks. HIV prevention programmes should take the social context of MSM into account and target MSM-related stigma.     

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM)

ABSTRACT

In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.     

Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants’ knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants’ opinions about PrEP’s contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil’s civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.     

The role of patient–provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men

We examined factors that may be associated with whether Black men who have sex with men a) disclose their sexual orientation to healthcare providers, and b) discuss their sexual health with healthcare providers to inform interventions to improve HIV prevention efforts and reduce HIV incidence rates among Black men who have sex with men. During 2011–2012, we conducted semi-structured individual in-depth interviews with Black men who have sex with men in New York City. Interviews were audio recorded. We examined transcribed responses for main themes using a qualitative exploratory approach followed by computer-assisted thematic analyses. Twenty-nine men participated. The median age was 25.3 years; 41% (n = 12) earned an annual income of < US$10,000; 72% (n = 21) had a college degree; 86% (n = 25) reported being single; 69% (n = 20) self-identified as gay or homosexual. We identified three main themes affecting whether the men discussed their sexual orientation and sexual health with healthcare providers: 1) comfort discussing sexual health needs; 2) health literacy; and 3) trust. Identifying strategies for improved comfort, health literacy and trust between Black men who have sex with men and healthcare providers may be an important strategy for increasing sexual health patient–provider communications, increasing opportunities for HIV prevention including testing and reducing HIV-related health disparities.     

中国2006--2010年男男性行为者艾滋病疫情分析

目的 分析2006-2010年中国男男性行为者(MSM)的艾滋病疫情特征.方法 分析2006-2010年中国艾滋病病例报告系统中男男性传播病例的三间分布(时间、人群、地区)及哨点监测系统中MSM的HIV抗体检出率及安全套使用率.结果 艾滋病病例报告系统显示,2006-2010年男男性传播病例构成比从1.5％增长到10.8％,是增长最快的传播途径.与其他传播途径相比,男男性传播HIV/AIDS病例具有以下明显的特征:15～29岁为主(54.6％)、文化程度较高(具有高中及以上学历者占69.8％)、未婚为主(64.8％)、干部/教师/医生离退休人员(14.3％)及学生(7.9％)等职业占相当高的比例、流动性强(流动人口占36.2％)、城市为主(城市人口占72.6％)、专题调查(26.7％)及无偿献血(6.4％)检出比例较高.地区分布差异大,主要分布在北京、四川、广东、重庆、江苏、辽宁、上海和浙江等经济发达地区的大中城市.哨点监测系统显示,2006-2010年中国MSM的HIV抗体阳性检出率(中位数)为3.4％,最近一次安全套使用率(中位数)为73.2％.结论2006-2010年中国男男性传播艾滋病报告病例构成比增长快速,哨点监测发现MSM感染率较高,安全套使用率较低,表明MSM艾滋病流行严重且呈明显上升趋势,其中以15～29岁青年学生及无偿献血人员感染为主.     

山东省部分男男性接触者艾滋病防治相关知识、态度和行为调查

目的了解山东省男男性接触者艾滋病防治相关知识、态度和行为状况,为制定艾滋病防治政策提供科学依据。方法采用滚雪球法或方便样本法,在全省8个城市使用统一设计的调查问卷对男男性接触者进行面对面调查,并采集静脉血标本。结果共调查1617名男男性接触者,平均年龄为26岁,已婚占71.9%,大学以上文化程度占58.6%,青年学生占25.3%。艾滋病防治相关知识全部回答正确率较低,为28.2%;发生高危性行为的比例较高,安全套使用率低于50%;检出HIV抗体阳性18例,感染率1.3%。结论山东省男男性接触者人群中存在着艾滋病流行,并有向一般人群蔓延的潜在危险。因此,应进一步加强该类人群艾滋病防治相关知识的宣传教育和安全套推广使用工作,以提高他们的艾滋病防治知识知晓率和自我防护意识。     

Unhealthy environments,unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity – negative perceptions and treatment that MSM encounter due to their sexual orientations – can increase HIV vulnerability among young MSM. Participants (n?=?44) were young MSM diagnosed with HIV infection during January 2006–June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n?=?28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population.     

我国男男性行为人群HIV自我检测及相关因素研究进展

HIV检测是艾滋病防控工作的第一步, 我国MSM的HIV感染率高, 检测率低。HIV自我检测(HIV自检)为MSM提供了一个新的选择, 对扩大HIV检测在该人群中的覆盖面具有重要作用。本文综述了我国MSM的HIV自检及相关因素, 为HIV自检在该人群中的推广提供依据。     

Syndemics of depression,alcohol use,and victimisation,and their association with HIV-related sexual risk among men who have sex with men and transgender women in India

We examined the presence and co-occurrence of psychosocial health conditions (depression, frequent alcohol use, and victimisation) among men who have sex with men (MSM) and transgender (TG) women in India, and their cumulative association with sexual risk. A survey questionnaire was administered among a convenience sample of 600 participants (MSM?=?300; TG women?=?300) recruited through six non-governmental organisations in four states. Prevalences of the number of psychosocial health conditions among MSM were: none?=?31.3%, one?=?43%, two?=?20%, and three?=?5.7%; and among TG women: none?=?9%; one?=?35.33%, two?=?38.33%, and three?=?17.33%. In bivariate and multivariate models, these conditions were positively and additively related to sexual risk, providing evidence for a syndemic of psychosocial health conditions among MSM and TG women and their synergistic effect on sexual risk. In addition to the number of syndemic conditions, resilient coping and social support were significant predictors of sexual risk among MSM and TG women, respectively. HIV preventive interventions in India should screen for and address co-occurring psychosocial health conditions – experiences of violence, mental health issues, and alcohol use – among MSM and TG women.     

HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: Implications for HIV prevention,care, and surveillance

Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a ‘health in all policies’ approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.     

深圳市458例男男性接触者社会心理压力及性功能障碍现状调查

目的 了解深圳市男男性接触者(MSM)社会心理压力及性功能障碍现状,探讨男男性接触者性健康和需求.方法 2006年4月成立彩虹工作组,到深圳市内MSM活动的桑拿、酒吧、公园等场所开展外展服务.知情同意原则下,采取方便抽样方法,问卷调查MSM的人口学基本特征、性取向、社会心理压力和性功能障碍等内容.结果 共调查458例MSM,其中同性恋者211例(46.1%),双性恋者195例(42.6%).66.8%MSM感觉在深圳没有或很少受到歧视,10.3%MSM的大部分或全部家人知道其性取向,且支持率极低;最好的朋友支持其男男性行为的MSM比例为19.0%;若想找人倾谈有关性取向的问题时,43.7%MSM认为不容易找到倾诉对象;64.8%MSM因为不想让其他人知道性取向而交女朋友或结婚.25.8%MSM对自己的性取向感到不安,15.9%MSM因为自己的性取向而觉得羞耻,29.7%MSM觉得因为自己性取向而受到社会排斥,46.9%MSM因为性取向而承受来自家家人及亲友的压力,57.6%MSM能接受自己的性取向,47.2%MSM担心其他人知道自己的性取向,49.8%MSM担心因同性性行为而感染HIV.最近1年内与男性伴性交时,30.6%MSM感到疼痛,38.6%MSM觉得性高潮来得太快,34.7%MSM性交前怕表现不好而焦虑.22.5%MSM勃起或维持勃起有困难,23.4%MSM即使不痛也觉得无趣,16.2%MSM无法有性高潮,17.7%MSM觉得对性没有兴趣.最近1年内与女性性伴性交的122例MSM中有12.3%-23.0%存在不同表现的性功能障碍.结论 深圳市部分男男性接触者普遍面临社会心理压力,部分伴随性功能障碍.     

男男性接触者STI、AIDS危险行为调查

目的了解大连市男男性接触者（MSM）人群的基本情况,为预防艾滋病、性病传播提供依据.方法采用匿名横断面调查设计,在酒吧等场所对MSM进行现场问卷调查,收集相关信息.结果 247份有效问卷结果表明,最近6个月内94.7%的MSM与男性有过性交行为,43.7%的MSM与女性有性接触,7.8%的MSM在近6个月内同性买淫,17.4%的MSM在6个月内同性卖淫,81.4%的MSM采用相应预防方法,72.9%的MSM考虑过应进行艾滋病感染检测.结论大连市MSM人群中艾滋病高危行为普遍存在,极有可能造成流行.     

男男性行为人群VCT服务利用状况的定性研究

目的从卫生服务供求两个方面了解当前男男性行为人群VCT服务的现状和影响因素。方法采用面对面访谈和小组讨论的方式，与廊坊市以及其下辖的3个区县主管艾滋病防治工作的领导、VCT工作人员、男男性行为者进行个人深入访谈。结果研究发现男男性行为人群VCT服务的利用率较低，主要原因是宣传不到位、服务水平不足、人群健康意识薄弱和社会歧视。结论亟需从服务提供者和使用者两个方面改善供需状况，以有效改善MSM人群VCT服务利用水平。     

400例MSM行为特征及HIV、HAV、HCV、HEV、梅毒感染状况的横断面调查

目的 了解云南省玉溪市MSM人群的行为特征及HIV、HAV、HCV、HEV、梅毒感染状况,为开展有针对性的健康教育和行为干预提供依据。方法 2018年4 - 7月在玉溪市采用横断面调查,滚雪球抽样方法,共纳入400例MSM,开展行为学问卷调查,采集血液样本进行HIV、HAV、HCV、HEV和梅毒抗体检测。 结果 400例MSM中98.25%对艾滋病基本知识知晓。318例最近6个月与男性发生过肛交性行为,88.68%都坚持每次使用安全套,最近1次肛交时96.86%使用了安全套。84例最近6个月与异性发生性行为,94.05%都坚持每次使用安全套,最近1次与异性发生性行为时98.81%使用了安全套。HIV、HAV、HCV、HEV、梅毒感染率分别为3.00%（95%CI:1.33～4.67）、1.25%（95%CI:0.16～2.34）、0.25%（95%CI:0.00～0.74）、1.00%（95%CI:0.03～1.98）、4.75%（95%CI:2.67～6.83）。结论 MSM人群不仅是HIV、HCV、梅毒的高危人群,HAV、HEV也高发,需针对该人群推广接种HAV、HEV疫苗。     

携手共享七彩天空--昆明男男性行为者性病艾滋病综合防治

[目的]提高男男性行为者的性病艾滋病预防意识,促进安全性行为的实施,控制艾滋病在此类人群中传播。[方法]建立适应项目工作的环境,开展多种形式的服务。[结果]建立了稳定的志愿者队伍,提高了男男性行为者的性病艾滋病预防知识,促进了安全套的使用率。[结论]在昆明男男性行为者人群中开展性病艾滋病防治工作取得预期的效果,其成功的经验为下一步的工作奠定了基础。     

Considerable interest in pre-exposure prophylaxis uptake among men who have sex with men recruited from a popular geosocial-networking smartphone application in London

Men who have sex with men (MSM) who use smartphone applications (apps) to meet sexual partners represent a high-risk subset of MSM. As such, the use of pre-exposure prophylaxis (PrEP) may be highly suitable. The purpose of the study was to evaluate awareness of and willingness to use PrEP among 179 HIV-uninfected MSM recruited in London who use these apps. Regression models were fit to assess the associations between perceived barriers and willingness to use PrEP in the future. Most (84.9%) had heard of PrEP and more than half (57.1%) were willing to use PrEP in the future if it were to become available. Low perceived risk for acquiring HIV (prevalence ratio (PR): 0.11; 95% confidence interval (CI): 0.04, 0.33) and concerns about PrEP-related side effects (PR: 0.01; 95% CI: 0.00, 0.04) were associated with being unwilling to use PrEP. Efforts to make PrEP widely available should be continued. Uptake interventions should focus on correcting self-perceptions of HIV risk and educate MSM about the potential side effects of PrEP use so that MSM can make more informed decisions about prevention options.