中国大陆男同性性接触者的艾滋病高危行为及影响因素研究（一）

目的 本文描述了中国大陆男同性性接触者（MSM）与HIV/AIDS/STD相关的高危行为、认识和某些影响因素。方法 通过自我填写问卷和当面访谈填写问卷两种形式,对426位男性进行了调查。结果 本组主要生活在大中城市、接受过较好教育、较为年轻的MSM,平均约18岁开始与同性性交,4/5以上有口-生殖器性交,半数以上有肛门性交行为,累计性伴有位数9人。2/5以上的近一年内有偶遇性性伴,约半数人在调查时有固定性伴,但仅少数人与性伴保持闭合性性关系。约1/3已婚,近半数佤女性性交过。1/4曾患性传播疾病,近一年患病率为6.81%.wcy 1/10进行过HIV抗体检测.1人阳性,约1/3使用过安全套,通常在少数情况下使用,只有2人坚持使用,不用安全套的原因主要是认为安全套能降低快感自己无感染HIV的可能和性伴健康,虽然他们已普遍具有关于HIV传播的一般知识.结论 中国大陆部分MSM在性方面相当活跃,存在HIV在MSM中高水平流行虽然他们已普遍具有关于ＨＩＶ传播的一般知识．结论 中国胸有成竹陆部分ＭＳＭ在性方面相当活跃,存在ＨＩＶ在ＭＳＭ中高水平流行的可能性．ＨＩＶ在中国ＭＳＭ中的流行速度高于９０年代初中期在西方国家ＭＳＭ中的流行速度,而且流行还会直接蔓延到妇女人群,由于社会文化等因素的阻力,对中国ＭＳＭ的ＡＩＤＳ干预面临重大困难。     

中国大陆男同性性接触者的艾滋病高危行为及影响因素研究(二)

（续上期） 表3 与男性发生性关系时的安全套使用惰况 应答人数（n） 口交 肛交 项 目 插入 被插入 插入 被插入 用过从不用 用过从不用 用过从不用 用过从不用 46 173 32 182 93 140 72 152年龄 17～8 38 6 42 13 36 12 36 25—29 97 19 102 64 69 45 83 35-9 38 7 38 16 35（I）15 33受教育年限 0一 11 60 7 63 22 53 14 55 12～44 113（1）25 119 71 87（！）58 97（l）地域 大城市 34 107 23 112 73 80 58 89 小城镇纠J 12 66 9 70 20 60（‘）14 63（‘）有过同性情人 曾…     

对北京部分男男性接触者HIV／AIDS的KABP调查

目的 对北京部分男男性接触者（men have sex with men,MSM)进行HIV/AIDSR的KABP调查,为今后在MSM中开展干预工作奠定基础。方法 培训MSM中的志愿者,由他们到MSM活动场所酒吧、公园、浴池等地,对MSM进行自愿匿名的问卷调查,发放宣传品及安全套并提供自愿匿名的抗-HIV检测。结果 MSM中固定性伴比例较低（36.9%）,多性伴现象较普遍,一半以上的MSM（53.8%）与女性有过性接触;安全套使用率低;每次都用的进行口交者为6.2%,接受口交者为6.5%,进行肛交者为30.9%,接受肛交者为40.4%。有40.5%的人认为自己不可能感染HIV。有23.8%的人自诉曾出现过性病病症。MSM对艾滋病传播途径认识正确率较高（78.6%以上）,但对性病/艾滋病相关知识的认识较差,正确率为36.9%-65.5%。MSM主动进行抗-HIV检测的较少,本次仅为11人（13.84%）。其中1人为抗-HIV阳性。结论 MSM的不安全的性行为使他们成为感染STD、HIV的高危人群,并将这一危险扩散到一般人群。     

同性固定性伴侣对男男性接触者AIDS高危行为的影响

目的 了解中国大陆有固定同性性伴侣男男性接触者(Men who have sex with men，MSM)的艾滋病(AIDS)高危行为及相关情况。方法 采用不记名邮寄问卷形式调查。结果 收回有效问卷1109份。有固定同性性伴侣者689人，平均年龄34．0岁，首次性交平均年龄18．7岁，累计男性性伴侣平均34．8人，92．4％有口交行为，82．9％有肛交行为。近1年内，53．7％有过陌生男性性伴侣，53．1％与女性性交过。69人检测过抗艾滋病病毒(HIV)抗体，3人阳性。约87．2％的人曾使用安全套。结论 本组有固定同性性伴侣的MSM在性方面相当活跃，存在HIV高水平流行的可能性，而且流行会在MSM与异性爱人群之间互动。由于社会文化等因素阻力，对中国MSM的AIDS干预尚需要做出更大努力。     

吉林省高危人群艾滋病性病感染情况调查研究

目的了解全省高危人群艾滋病性病感染情况及其艾滋病知识知晓情况,以便对全省高危人群采取针对性的干预措施以预防和控制艾滋病的流行.方法在1999年8～12月对全省五种高危人群的HIV及性病感染情况进行了调查,同时采用匿名问卷对其进行了艾滋病知识情况的调查.结果在完成的4 153份匿名调查问卷当中,能够正确回答预防艾滋病方法的有1 950人,占全部调查对象的46.95%;在完成问卷调查的4 153名调查对象中,对4 113名研究对象进行了检测,共检出HIV感染者1人,HIV感染率为0.02%,该感染者为职业献血员;此五种高危人群除外性病门诊病人,共感染性病454例,感染率为14.57%.结论我省高危人群STD感染率较高,而艾滋病知识知晓率较低,今后应利用大众传媒加强对高危人群艾滋病相关知识的宣传,加强对有偿供血员的管理仍是今后预防艾滋病的工作重点.     

男同性性接触者与艾滋病流行

1 国际科学界对同性爱的研究 由于发现严厉打击不能减少和消除男同性爱(同性爱,俗称同性恋)人群,从19世纪至今,国际科学界对人类的同性爱现象进行了大量动物学、医学、心理学、社会学、人类学、伦理学、法学等多学科研究。研究发现,同性爱者的出现,首先与先天因素(包括染色体、大脑结构等)有关,其次与个人出生后18～36个月的环境因素有关;治疗不能使同性爱者变成异性恋者;同性爱者与社会上绝大多数人(称异性恋者)的不同,只限于他们偏好选择的性伴侣是同性;对人类文明史作出重要贡献的人群中,有许多人是同性爱者。在经过100多年的科学研究后,世界卫生组织1992年确认,同性爱是属于少数人的自然现象,并不再将其列为心理障碍(即变态)。     

乌鲁木齐市男男性行为者艾滋病高危性行为及影响因素分析

目的了解新疆乌鲁木齐市男男性行为者(MSM)高危性行为、安全套使用情况及分析其影响因素。方法在乌鲁木齐市釆用非概率抽样的同伴推动法,以网络为平台,采用自编及改编问卷以调查抽取的调查对象一般情况、性取向、性行为等。结果获得有效问卷338份及相应的有效数据;在已检测艾滋病病毒(HIV)的MSM中,感染率为13.0%。年龄、职业属性、婚姻状况等对HIV感染影响并不显著(均P0.05)。调查对象的文化程度(P0.01)、6个月内同性关系使用安全套情况(P0.001)、同性性伴累计数(P0.001)、是否进行定期检测(P0.018)与HIV感染显著相关。Logistic回归分析结果显示,文化程度、初次性行为年龄及是否买性,均与安全套的使用相关(P0.05)。结论降低各个阶层MSM性行为脆弱性,开展卫生政策干预及健康咨询,促进MSM安全套使用,从而降低艾滋病感染率。     

对北京部分男男性接触者HIV/AIDS的KABP调查

目的对北京部分男男性接触者(men have sex with men,MSM)进行HIV/AIDS的KABP调查,为今后在MSM中开展干预工作奠定基础.方法培训MSM中的志愿者,由他们到MSM活动场所酒吧、公园、浴池等地,对MSM进行自愿匿名的问卷调查,发放宣传品及安全套并提供自愿匿名的抗-HIV检测.结果MSM中固定性伴比例较低(36.9%),多性伴现象较普遍,一半以上的MSM(53.8%)与女性有过性接触;安全套使用率低;每次都用的进行口交者为6.2%,接受口交者为6.5%,进行肛交者为30.9%,接受肛交者为40.4%.有40.5%的人认为自己不可能感染HIV.有23.8%的人自诉曾出现过性病病症.MSM对艾滋病传播途径认识正确率较高(78.6%以上),但对性病/艾滋病相关知识的认识较差,正确率为36.9%～65.5%.MSM主动进行抗-HIV检测的较少,本次仅为11人(13.84%).其中1人为抗-HIV阳性.结论MSM的不安全的性行为使他们成为感染STD、HIV的高危人群,并将这一危险扩散到一般人群.     

对男同性性接触者的艾滋病干预(二):思考与体会

目的 阐述作者对男同性性接触者AIDS干预工作的思考和实际工作经验.方法 通过对男同性性接触者,特别是同性爱志愿者的3年交流并实施AIDS干预的经历,进行理性思考并对实践经验加以总结.结果 通过多学科的理论指导、与同性爱志愿者在平等关系基础上的交流,认识从事男同性性接触者的AIDS干预面对的来自异性爱人群、同性爱人群等不同方面的阻力,通过对志愿者的深入理解,建立互助关系,促进工作开展.结论 面对男同性性接触者的AIDS干预工作,不应仅局限于生物-心理-社会医学模式的范畴,而应融入更多学科的理性思考,积极实践,加强与不同层面的男同性性接触者的交流.唯有如此,才有可能较成功地开展工作.     

对男同性性接触者的艾滋病干预:(一)理论与实践

本文阐述了指导对男同性性接触者(MSM)艾滋病干预的基本理论、实践结果与经验。强调采用有关同性爱的多学科当代科学知识的指导进行干预的重要意义,作者提出了针对MSM艾滋病干预的方法和效果,特别是强调了学术界与同性爱志愿者合作对工作的重大促进作用。作者还提出了学术界开展这一工作应有的基本观点,指出了学术界人士与MSM建立理解、平等、尊重、互助关系的必须性,选择同性爱志愿者的必要条件。此外,介绍了目前开展工作所面临的困难。     

具有同性性接触的男性调查

目的 了解有同性性接触男性的与可能传播艾滋病、性病有关的性行为。方法 采用自拟的问卷对35例有同性性接触男性进行调查。结果 所有被访者中口交发生率94.3％,肛交68.6％,吻肛28.6％;他们中71.4％有异性性接触。结论 口交和肛交在他们的性接触中占重要位置,应加强防病意识教育。     

Alcohol Use and Risk of HIV infection among Men Who Have Sex with Men

In the United States, men who have sex with men (MSM) currently represent more than 50% of those living with HIV and over 70% of HIV+ men (CDC 2007, ). Male-to-male sexual contact has been identified as the predominant route of transmission among this sub-group, which underscores the need for research that targets risk factors associated with risky sex-related HIV acquisition. Along these lines, research has shown that one potentially important predictor variable for risky sex among MSM is alcohol use. The major aim of this paper is to review and integrate empirical evidence on the association of alcohol use and risky sex among MSM. A summary of the quantitative research is provided first, followed by a critique of the reviewed literature, a discussion of the consistency of the existing empirical evidence with predictions of current theories, and finally, recommendations for future research designed to evaluate alcohol-related sexual risk in MSM.     

Dynamics of Sexual Risk Behavior in HIV-Infected Men Who Have Sex with Men

Much is known about the factors associated with risky sexual behavior among HIV-negative men who have sex with men (MSM) and among MSM whose HIV antibody status is unknown. However, little is known about the dynamics of continuing risky behavior among HIV-positive MSM. This research employed both questionnaire and extensive individual interview techniques to assess the levels of risky behavior, as well as the factors associated with risky behavior, in a sample of 42 seropositive MSM. Findings suggest that risky behavior occurs with some frequency, and that it is occasioned by informational, motivational, and behavioral skills-relevant deficits in the population at focus. Moreover, levels of risky behavior appear to differ with seropositive and seronegative primary partners. Implications for designing interventions for seropositive MSM are discussed.     

东北某地男同性恋者艾滋病病毒/艾滋病的知识态度行为调查

目的　了解男同性恋者艾滋病相关知识、态度及危险行为状况 ,为行为干预提供线索。 方法　 采用横断面调查设计 ,对进出某酒吧的男同性恋者进行问卷调查。 结果　 文化程度普遍较高 ,但对艾滋病知识缺乏 ,知识的来源主要通过报纸、杂志和电视。安全套使用率低 ,每次性行为均使用安全套的比例为 1 4 4% ,不使用安全套的原因主要是自己或性伴侣不喜欢用或性行为时身边无安全套。随着艾滋病知识的增加 ,每次都用安全套的比例呈现上升趋势 ,从未使用安全套的比例则呈现明显下降的趋势。 1 1 7%做过艾滋病病毒 (HIV)检测 ,无人获得过HIV检测阳性结果。不做HIV检测的原因主要是自认为感染的可能性不大 ,认为自己是阴性或不想考虑阳性的事。首次性行为年龄中位数为 1 8岁 ;性伴侣数较多 ,平均为 1 0 3个。 40 5 %的调查对象在半年内有过女性性伴侣 ,96 6 %在半年内有过男性性伴侣 ,84 5 %半年内有无保护肛交史。 结论　 该市男同性恋者艾滋病相关知识缺乏 ,危险性行为普遍存在 ,安全套使用率低 ,艾滋病极有可能在此人群中流行 ,应尽快采取措施加强预防     

Racial Mixing and HIV Risk Among Men Who Have Sex with Men

We conducted a cross-sectional survey of MSM using a time-location-sampling design in San Francisco during 2007–2008. The investigation focused on the selection of sexual partners, partner preferences, perceptions of HIV risk, and social mixing with respect to race/ethnicity. The sample of 1,142 MSM was 56% White, 22% Latino, 14% Asian, and 9% Black and reported on 3,532 sexual partnerships. Black MSM had a significant, three-fold higher level of same race sexual partnering than would be expected by chance alone (i.e., in the absence of selective forces with respect to race among partners). Black MSM were reported as the least preferred as sexual partners, believed at higher risk for HIV, counted less often among friends, were considered hardest to meet, and perceived as less welcome at the common venues that cater to gay men in San Francisco by other MSM. Our findings support the hypothesis that the sexual networks of Black MSM, constrained by the preferences and attitudes of non-Blacks and the social environment, are pushed to be more highly interconnected than other groups with the potential consequence of more rapid spread of HIV and a higher sustained prevalence of infection. The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed.     

HIV Prevention Altruism and Sexual Risk Behavior in HIV-Positive Men Who Have Sex with Men

An understanding of men's motivations to avoid risk behavior is needed to create efficacious HIV prevention programs for HIV-positive men who have sex with men (MSM). This study investigates the relationship between sexual risk behavior and HIV prevention altruism, which is defined as the values, motivations, and practices of caretaking towards one's sexual partners to prevent the transmission of HIV. In a sample of 637 HIV-positive MSM, HIV prevention altruism significantly protects against serodiscordant unprotected anal intercourse (SDUAI) in crude analysis, but not after adjustment for drug use and compulsive sexual behavior. HIV prevention altruism is also related to not engaging in anal intercourse, but is not related to serodisclosure to secondary partners. Lack of altruism appears related to sexual risk behavior in HIV-positive MSM, although other psychological and contextual factors play significant roles. The promotion of HIV prevention altruism may provide a formidable new direction for HIV prevention programs.     

Perceptions of Lifetime Risk and Actual Risk for Acquiring HIV Among Young Men Who Have Sex with Men

Among young men who have sex with men (MSM) surveyed in six US cities, we evaluated the magnitude and correlates of perceived lifetime risk for acquiring HIV, and missed opportunities to increase risk perception by providers of health-care and HIV-testing services. Overall, approximately one quarter of young MSM perceived themselves at moderate/high risk for acquiring HIV. Adjusting for demographic, prior testing, and behavioral characteristics, moderate/high perceived risk had the strongest association with unrecognized HIV infection. However, half of the 267 young MSM with unrecognized infection perceived themselves at low lifetime risk for acquiring HIV, and many young MSM with low-risk perception reported considerable risk behaviors. Providers of health-care and HIV-testing services missed opportunities to assess risks and recommend testing for young MSM. To increase HIV testing, prevention providers should intensify efforts to assess, and to increase when needed, perceptions of lifetime risks for acquiring HIV among young MSM.     

Loss to Follow-Up from HIV Pre-Exposure Prophylaxis Care in Men Who Have Sex with Men in West Africa

Loss to follow-up (LTFU) from HIV pre-exposure prophylaxis (PrEP) care compromises the goal of HIV elimination. We investigated the proportion of LTFU and associated risk factors among men who have sex with men (MSM) enrolled in a PrEP demonstration project in Burkina Faso, Côte d’Ivoire, Mali, and Togo. CohMSM-PrEP, a prospective cohort study, was conducted between November 2017 and June 2021 in community-based clinics. MSM aged 18 years or older at substantial risk of HIV infection received a comprehensive prevention package, including PrEP and peer education. LTFU was defined as not returning to the clinic for six months. Associated risk factors were investigated using a time-varying Cox’s model. Of 647 participants followed up for a median time of 15 months, 372 were LTFU (57.5%). LTFU was associated with younger age (adjusted hazard ratio [95% Confidence Interval]; 1.50 [1.17–1.94]), unemployment (1.33 [1.03–1.71]), depression (1.63 [1.12–2.38]), and perceiving no HIV risk with stable male partners (1.61 [1.23–2.10]). Contacting peer educators outside of scheduled visits was protective (0.74 [0.56–0.97]). Our findings show that LTFU from PrEP care in West African MSM is a major challenge to achieving HIV elimination, but that the involvement of peer educators in PrEP delivery helps to limit LTFU by providing users with adequate support.