男男性行为人群艾滋病危险行为同伴干预研究

目的 探讨"发起人主导和同伴驱动相结合的行为干预"方法对促进我国男男性行为(MSM)人群安全套使用和降低性伴数的可行性和有效性.方法 在安徽省有同性恋酒吧的合肥、芜湖、阜阳3个城市,通过招募在MSM活动场所有影响的12名MSM作为"发起人",采用同伴网络招募MSM同伴的方法,在MSM人群中招募了218名符合研究条件的干预对象,建立12个干预活动小组.通过培训"发起人",由他们组织实施4个主题干预活动,干预活动为期1个月.通过比较干预前和干预活动结束后2个月干预对象艾滋病病毒和(或)性接触性感染(HIV/STDs)知识水平、安全套使用率、近2个月的性伴数等指标,来评估干预方法的有效性.结果 干预结束后第3个月随访到170名MSM,随访率77.9%.170名干预对象干预前HIV/STDs知识得分为(14.71±2.59)分,干预后为(16.95±1.81)分,经配对t检验,差异有统计学意义(t=-10.647,P＜0.01);干预后,最近2个月拥有女性性伴报告率由17.6%降低为11.2%,经配对x2检验,差异有统计学意义(P＜0.01);最近3次与男性性伴肛交时安全套使用率从干预前的55.3%提高到干预后的65.2%(x2=9.979,P＜0.01);与男性偶然性伴最近3次肛交时安全套使用率从干预前的43.2%提高到干预后的52.2%(x2=5.797,P＜0.05);与男性固定性伴最近3次肛交时安全套使用率从49.1%提高到60.9%(x2=13.082,P＜0.01);干预前,最近1次与男性性伴、男性偶然性伴、男性固定性伴肛交中未使用安全套的报告率分别为41.2%、35.3%和45.3%,干预后分别降低为25.3%、27.1%和31.2%,分别经配对x2检验,差异有统计学意义(P＜0.01、P＜0.05和P＜0.01).通过群组比较分析的方法,比较干预后随访到的170名干预对象与干预前的218名干预对象的上述指标,除最近2个月有女性性伴报告率、最近3次与男性偶然性伴发生肛交行为中安全套使用率和最近1次与男性偶然性伴发生无保护肛交的报告率3个指标变化差异无统计学意义外,其他指标干预前后变化与上述比较结果基本相似.结论 "发起人主导和同伴驱动相结合行为干预"方法,是可以被我国MSM人群接受并能促进MSM人群肛交性行为中使用安全套.

HIV risk behavior based on intervention among men who have sex with men peer groups in Anhui province

Objective To determine the feasibility and the effectiveness of HIV risk behavior intervention characterized by initiator taking the lead combined with peer's participation，as to preventing HIV epidemic through promoting condom use and reducing the number of sexual partners among men who have sex with men(MSM)groups. Methods Subjects were recruited via peer referral chain. Twelve key MSM were recruited as initiators in bars or other MSM venues in 3 cities of Hefei，Wuhu and Fuyang. Then，each initiator recruited up to 3 MSM to participate and also each of them continued recruiting others. A total of 218 eligible MSM were recruited，and there were four intervention activities conducted. Firstly，twelve initiators were trained according to intervention manual and then intervention activities were implemented by initiators based on their referral chain. Participants were required to complete self-administrated questionnaire at baseline and the third month after intervention finished. The comparison of the results before and after intervention was conducted two months later to see any improvement in HIV/AIDS knowledge，and condom use. Results Of 218 participants，170(77.9%)were followed up in assessment three months later. The results from paired t-Test and Chi Square Test showed that intervention increased HIV/STDs related knowledge(baseline，14.71±2.59；follow-up，16.95±1.81；t=-10.647，P＜0.01)and the rate of having female sexual partner during previous 2 months(baseline，17.6%；follow-up，11.2%；P＜0.01)were of significant differences. Meanwhile，the intervention increased rate of condom use in the last three times of anal intercourse with homosexual partners，casual homosexual partners and primary homosexual partners(baseline，55.3%，43.2%，49.1%；follow-up，65.2%，52.2%，60.9%；x2=9.979，P＜0.01；x2=5.797，P＜0.05；x2=13.082，P＜0.01；respectively)and decreased rate of non-condom use in the last anal intercourse with homosexual partners，casual homosexual partners and primary homosexual partners (baseline，41.2%，35.3%，45.3%；follow-up，25.3%，27.1%，31.2%；P＜0.01，P＜0.05，P＜0.01；respectively)were all of some improvement. Other relevant indicators of 218 participants with 170 followed were compared，excepting the above similar findings，there were no differences in rate of number of female sexual partner during previous 2 months and rate of condom use in the last three anal intercourse with casual homosexual partners and rate of non-condom use in the last anal intercourse with casual homosexual partners. Conclusion HIV risk behavior intervention based on MSM peer groups is feasible and might increase the condom use among MSM.