基于结构方程模型的男男性行为人群HIV检测行为影响因素研究

目的 分析MSM人群HIV检测行为的影响因素，为制定促进该人群检测HIV的干预措施提供依据。方法 2018年4-6月，通过滚雪球的方法在江苏省无锡市招募MSM研究对象。采取面对面问卷调查的方式，收集研究对象的人口学信息、性行为特征、接受干预服务情况、心理状态和HIV检测情况等。利用结构方程模型对数据进行拟合并对拟合后的模型进行修正，分析各变量间的关系和影响程度。结果 共招募研究对象MSM 410人，认为自己有必要检测HIV占72.9%（299/410），最近1年HIV检测占69.0%（283/410）。修正后的结构方程模型拟合较好，拟合指数主要结果分别为近似误差均方根（RMSEA）=0.065、规范拟合指数（NFI）=0.946、相对拟合指数（RFI）=0.922、Tucker-Lewis指数（TLI）=0.968、比较拟合指数（CFI）=0.952。模型拟合结果显示，对MSM人群HIV检测行为标准化总效应最高的变量为干预服务，路径系数为0.57；而在干预服务中，HIV检测提醒的因子载荷最大，为0.88。心理状态评分对MSM人群HIV检测行为的标准化总效应呈负向关系，路径系数为-0.33。结论 MSM人群HIV检测意识和检测率有待进一步提高，在采取有效措施促进MSM进行检测的同时，应关注MSM人群心理健康问题。

Study on HIV testing behavior among men who have sex with men based on structural equation model

Objective To analyze HIV testing behaviors and associated factors in men who have sex with men (MSM) and provide evidence for making intervention on promoting HIV testing. Methods Our observational study was conducted between April and June, 2018 in Wuxi, Jiangsu province in MSM. A self-completed questionnaire was used to collect the information about their socio-demographic characteristics, sexual behaviors, acceptance of intervention services, psychological status and HIV testing behaviors. Structural equation model (SEM) was chosen to fit data and the model was modified to analyze the relationships between variables. Results A total of 410 MSM were enrolled in our study, among whom 72.9%(299/410) were aware of the necessity of HIV testing and 69.0%(283/410) reported having HIV tests in the last year. A modified structural equation model presented good fitting results with fitting index of root mean square error of approximation (RMSEA)was 0.065, normed fit index (NFI) was 0.946, relative fit index (RFI) was 0.922, Tucker-Lewis index (TLI) was 0.968 and comparative fit index (CFI) was 0.952. Results of SEM showed that intervention service was the factor with the largest standardized total effect value of 0.57 associated with HIV testing behaviors among MSM. Among intervention services, HIV testing reminding had the biggest factor loading of 0.88. Psychological status scores played a negative role in HIV testing behaviors among MSM with the path coefficient value of -0.33. Conclusions The awareness and testing rate of HIV among MSM population need to be further improved. While effective measures are implemented to promote HIV testing among MSM, more attention should be paid to the mental health problems of MSM.