HIV阳性男男性行为者抑郁现状及相关因素研究

目的 了解HIV阳性男男性行为者（men who have sex with men, MSM）抑郁现状及相关因素,为提高其心理健康水平提供依据。方法 采用方便抽样的方法,于2016年7-8月在南京市某医院对参加抗病毒治疗的 HIV阳性MSM进行问卷调查。采用logistic回归分析抑郁的相关因素。结果 抑郁症状发生率为38.6%（134/347）。多因素logistic回归分析显示,高社会支持（OR=0.955,95%CI:0.914~0.998）和高自尊（OR=0.788,95%CI:0.731~0.849）的HIV阳性MSM发生抑郁的可能性较小。 确诊时间＜12 月（OR=1.943,95%CI:1.080~3.493）和高感知歧视者（OR=1.049,95%CI:1.021~1.078）更有可能出现抑郁症状。结论 HIV阳性MSM抑郁症状的发生率较高,尤其是新发感染者。需要制定心理干预、咨询、治疗相结合的综合服务模式,以减少歧视,提高社会支持水平,缓解他们的负性情绪,从而改善其生存质量。     

Sexual risk reduction among HIV-positive drug-using men who have sex with men

According to the US Centers for Disease Control, the majority of new HIV infections are the direct result of unprotected sexual relations between serodiscordant individuals. Thus, the development of behavioral interventions to increase the safer sex practices of HIV-positive individuals has the potential to reduce the number of new infections. Currently, less than 1% of the total US population is infected with HIV. Targeting behavioral interventions to this smaller group of HIV-positive individuals has the potential for making cost-effective reductions in the number of new infections. Despite reports that some HIV-positive individuals continue to engage in high-risk behaviors, interventions designed to prevent secondary transmission of HIV are rare. In this era of highly active antiretroviral therapy (HAART), interventions for HIV-positive individuals are more critical than ever to address the unique challenges and issues they face regarding disclosure and partner notification, use of HAART and sexual risk behavior, and HIV-related stigma. Although a growing number of reports document the efficacy of sexual risk reduction interventions for HIV-positive individuals, to date none of these studies have focused on drug-using populations. This article focuses on sexual risk reduction interventions for HIV-positive men who have sex with men (MSM), the largest group of HIV-positive individuals in the United States. It reviews factors associated with high-risk behaviors and discusses some findings from research with HIV-positive methamphetamine users, including (1) data from a small qualitative study and its implications for the development of new interventions, and (2) baseline data from an ongoing large-scale study of the efficacy of a theory-based sexual risk reduction intervention for HIV-positive methamphetamine-using MSM. The article concludes with a discussion of future research issues, including, for example: Can sexual risks be reduced in the context of active drug use? Are different patterns of drug use, or specific drugs, associated with increased risk behavior? How do gender, race, and culture relate to the efficacy of specific interventions?     

Methamphetamine-using HIV-positive men who have sex with men: Correlates of polydrug use

Methamphetamine use has become a major problem among communities of men having sex with men (MSM), where it has been associated with high-risk behaviors. Methamphetamine is often combined with other drugs that may increase its risks and adverse health consequences. To examine differences in background characteristics, HIV-risk behaviors, and psychosocial variables among polydrug-using HIV-positive MSM, the researchers classified a sample of 261 HIV-positive, methamphetamine-using MSM into three user groups: (1) methamphetamine only; (2) methamphetamine, marijuana, and poppers (light polydrug users); and (3) methamphetamine and other drugs (e.g., cocaine, heroin, hallucinogens, and ketamine; heavy polydrug users). Only 5% reported using only methamphetamine during the past 2 months; 31% were classified as light polydrug users, and 64% were classified as heavy polydrug users. Heavy polydrug users were significantly younger than light polydrug users (35.6 vs. 38.4, P<.01) and reported using methamphetamine for significantly fewer years (10.3 vs. 14.2 years, P<.001), but did not differ in the amount and frequency of methamphetamine or alcohol consumed. Heavy polydrug users reported significantly more sex partners of HIV-negative and unknown serostatus and had more unprotected sex with these partners. Heavy polydrug users had significantly higher scores on impulsivity and negative self-perceptions, as compared with those of light polydrug users. In this sample of HIV-positive MSM, most of those who used methamphetamine had a pattern of polydrug use. Heavy polydrug users reported significantly more high-risk sexual behaviors and tended toward higher levels of impulsivity than light polydrug users. The implications of these findings are two-fold: (1) Longitudinal research is needed to establish causal relationships among methamphetamine use, impulsivity, negative self-perceptions, and sexual risk behavior in this target population; (2) behavioral interventions should evaluate whether methamphetamine use and sexual risk behavior can be reduced by modifying impulsivity and negative self-perceptions.     

男男性接触HIV感染者早期抗病毒治疗可接受性状况调查

目的 调查男男性接触(MSM) HIV感染者早期接受艾滋病抗病毒治疗意愿及其影响因素.方法 2012年6-8月,采用方便抽样方法,从杭州市和宁波市艾滋病综合防治数据库中选取能够配合调查的MSM感染者作为调查对象.共有280例未开始抗病毒治疗的MSM HIV感染者接受了调查.采用自行设计的问卷,调查了其人口学特征、艾滋病知识知晓情况、性行为信息、安全套使用情况、目前身体状况、对于早期抗病毒治疗的认知情况及接受意愿等相关信息.剔除其中60例CD4+T细胞水平不符合纳入标准的感染者后,共有220例纳入分析.采用x2检验比较不同特征调查对象早期抗病毒治疗可接受性的差异,应用非条件logistic回归分析研究早期抗病毒治疗可接受性的影响因素.结果 HIV感染者早期抗病毒治疗的接受率为62.7％ (138/220).认为早期抗病毒治疗可以延缓发病、可以预防性伴感染、不担心周围人怀疑自己有病和性伴不知晓感染状况者具有较高的可接受意愿,可接受率分别为68.8％(130/189)、68.7％ (103/150)、78.4％(69/88)、72.5％(74/102),与之相对应者的可接受率分别为24.1％(7/29)、50.0％(30/60)、52.7％(68/129)、45.8％(58/107),差异均有统计学意义(x2值分别为21.46、6.43、14.84、7.55,P值均＜0.05).logistic回归分析结果显示,认为早期抗病毒治疗可以延缓发病(OR=11.50,95％CI:3.29～40.22)和认为可以预防性伴感染(OR =3.72,95％ CI:1.53～9.03)的感染者更倾向于接受早期抗病毒治疗,而担心周围人怀疑自己有病(OR =0.19,95％CI:0.08 ～ 0.48)和性伴知晓其感染状况(OR =0.31,95％ CI:0.13～0.70)的感染者更倾向于不接受早期抗病毒治疗.结论 MSM HIV感染者早期抗病毒治疗可接受性较高,对于早期抗病毒治疗的认识、隐私泄露的顾虑是促进其接受治疗的主要影响因素.     

深圳市HIV阳性男男性行为者的社会网络和社会支持现况研究

目的 分析HIV阳性男男性行为者(men who have sex with men, MSM)的社会网络特征和社会支持现况及其影响因素,为改善该人群的社会支持提供依据。 方法 收集2017—2018年在深圳市宝安区疾病预防控制中心转介治疗的HIV阳性的MSM的相关资料,采用描述性流行病学方法进行分析。 结果 110例HIV阳性MSM中,报告105个核心社会网络,提名249个网络成员,网络大小(3.37±1.43),网络密度(0.86±0.21)。社会支持总分为(26.42±7.74)分,主观支持得分(15.24±4.88)分,客观支持得分(4.98±2.62)分,支持利用度得分(6.20±1.98)分。方差或t检验分析显示,不同社会网络大小,网络成员的性别、社会关系种类、文化程度构成、性取向构成以及是否和网络成员有性行为的HIV阳性MSM社会支持得分差异有统计学意义。多重线性回归分析显示,网络成员的文化程度构成、性取向构成、关系亲密度和网络成员有性行为是社会支持得分的影响因素。 结论 应尽可能提高HIV阳性MSM的社会支持。     

已知和未知自身感染状况的男男性行为人群HIV阳性者性行为特征分析

近年来男男性行为者(MSM)人群中HIV感染呈上升趋势,与其多性伴、高频次的无保护性行为密切相关;本研究选择北京地区,分别对HIV阳性告知前的MSM和已知自身感染HIV阳性MSM两组群体开展了横断面调查,比较其性行为特征的差异,为开展有效的行为干预和心理支持提供依据.     

Oral sex and HIV among men who have sex with men

Sexual transmission of the human immunodeficiency virus (HIV) continues to pose a public health problem worldwide. Men who have sex with men are still at differential risk of infection. Although there is evidence to claim that HIV can be transmitted by oral sex, the perception of this risk is ambiguous and relates paradoxically to behavior change. New models of risk perception must be developed in various areas of knowledge to obtain a fuller understanding of this phenomenon.     

南通市男男性接触人群HIV感染者阳性告知前后因素分析

目的了解江苏省南通市男男性接触人群（MSM）艾滋病病毒（HIV）感染者阳性告知前后艾滋病防治知识知晓率和行为学特征改变。方法选取2005年1月-2013年9月南通市艾滋病自愿咨询检测（VCT）门诊MSM人群HIV感染者94人,在阳性告知前后进行问卷调查。结果告知后艾滋病知晓率97.85%明显高于告知前84.04%（χ²=8.847,P<0.01）,其中初中及以下文化程度组告知后知晓率95.00%明显高于告知前75.00%（χ²=4.021,P<0.05）。同性性行为肛交方式有改变（χ²=14.270,P<0.01）;安全套使用率提高（χ²=154.183,P<0.05）,告知后每次使用比例72.73%明显高于告知前5.74%;但告知前后性伴数没有差异。在同性商业性行为中,告知后性伴数减少（χ²=9.090,P<0.05）,安全套使用率提高（χ²=7.391,P<0.05）,告知后每次使用比例71.43%高于告知前11.76%,但肛交类型没有改变。在与异性发生性行为中,安全套使用率提高（χ²=7.400,P<0.05）,告知后每次使用比例86.40%高于告知前42.50%。结论南通地区MSM人群HIV感染者知晓率整体较高,阳性告知后减少了高危行为。     

Factors associated with sex in the context of methamphetamine use in different sexual venues among HIV-positive men who have sex with men

Background  

Harm reduction has focused primarily on reduction of high-risk substance using behaviors rather than reductions in high-risk sexual behaviors. Furthermore, most studies focus on individual behavior change, with less attention paid to the social and environmental context. This paper promotes understanding of the interplay between the individual and the social context by examining the psychosocial and behavioral characteristics of 321 methamphetamine-using HIV-positive men who have sex with men (MSM) in San Diego, CA based on the locations or venues of their sexual activities when "high" on methamphetamine.     

男男性传播HIV感染者对早期抗病毒治疗的可接受性及影响因素研究

【目的】探索男男性行为人群(MSM)中艾滋病病毒(HIV)感染者对早期抗病毒治疗的可接受性及其影响因素,为推动上海市MSM人群治疗作为预防(Tas P)策略实施提供依据。【方法】选择2015年1月—2017年6月上海市静安区新发现的、未开始治疗的且愿意配合开展流行病学调查的男男性传播HIV感染者共193例,采用自行设计的问卷,在知情同意的情况下,以面对面的方式进行问卷调查,内容包括人口学特征、艾滋病知识知晓情况、行为学特征、目前身体状况、抗病毒治疗知识、对早期抗病毒治疗的认知情况及接受意愿等。【结果】男男性传播HIV感染者对艾滋病早期抗病毒治疗政策的知晓率为14.5%,HIV感染者早期抗病毒治疗的接受率为82.4%。是否知晓早期抗病毒治疗的相关知识均与是否愿意接受早期抗病毒治疗显著相关(P值均0.05)。多因素logistic回归分析结果显示,认为艾滋病目前可以治愈(OR=4.60,95%CI:1.45~14.61)、认为早期抗病毒治疗可以延缓发病(OR=4.58,95%CI:1.11~18.94)和认为可以预防性伴/配偶被感染(OR=3.56,95%CI:1.29~9.78)的HIV感染者更倾向于接受早期抗病毒治疗。【结论】上海市男男性传播HIV感染者对早期抗病毒治疗可接受性较高,但对早期抗病毒治疗政策的了解较少,应进一步加强MSM人群早期抗病毒治疗的动员和宣传,提高感染者对早期抗病毒治疗的全面认知,更好地促进Tas P策略的实施,进而预防HIV在MSM人群的传播。     

Differences in substance use and sexual partnering between men who have sex with men,men who have sex with men and women and transgender women

Men who have sex with men (MSM), men who have sex with men and women (MSM/W) and transgender women (TGW) remain the populations most severely and disproportionately impacted upon by HIV in Los Angeles County. Baseline data from community-based HIV-prevention programmes serving these populations were analysed to explore differences in demographic characteristics, substance use and sexual partnering between the three groups. Despite high HIV prevalence overall (MSM 34.7% versus MSM/W 16.1% versus TGW 21.9%, p < .001), there were striking differences in risk behaviours. Higher rates of homelessness were reported by MSM/W compared to MSM and TGW. Lower rates of education and less substance use were reported by TGW (62.2%), compared to MSM (79.7%) and MSM/W (92.6%). A much higher number of male sexual exchange partners were reported by TGW (MSM 1.04 [SD = 4.8] versus MSM/W 1.54 [SD = 10.3] versus TGW 12.37 [SD = 23.9], p < .001). Findings support the need for HIV-prevention interventions that specifically address the unique risk patterns among each population in order to curb HIV acquisition and transmission.     

Differences in substance use and sexual partnering between men who have sex with men, men who have sex with men and women and transgender women

Men who have sex with men (MSM), men who have sex with men and women (MSM/W) and transgender women (TGW) remain the populations most severely and disproportionately impacted upon by HIV in Los Angeles County. Baseline data from community-based HIV-prevention programmes serving these populations were analysed to explore differences in demographic characteristics, substance use and sexual partnering between the three groups. Despite high HIV prevalence overall (MSM 34.7% versus MSM/W 16.1% versus TGW 21.9%, p < .001), there were striking differences in risk behaviours. Higher rates of homelessness were reported by MSM/W compared to MSM and TGW. Lower rates of education and less substance use were reported by TGW (62.2%), compared to MSM (79.7%) and MSM/W (92.6%). A much higher number of male sexual exchange partners were reported by TGW (MSM 1.04 [SD = 4.8] versus MSM/W 1.54 [SD = 10.3] versus TGW 12.37 [SD = 23.9], p < .001). Findings support the need for HIV-prevention interventions that specifically address the unique risk patterns among each population in order to curb HIV acquisition and transmission.     

Differences in the social networks of African American men who have sex with men only and those who have sex with men and women

Objectives. We compared social network characteristics of African American men who have sex with men only (MSMO) with social network characteristics of African American men who have sex with men and women (MSMW).Methods. Study participants were 234 African American men who have sex with men who completed a baseline social network assessment for a pilot behavioral HIV prevention intervention in Baltimore, Maryland, from 2006 through 2009. We surveyed the men to elicit the characteristics of their social networks, and we used logistic regression models to assess differences in network characteristics.Results. MSMO were significantly more likely than were MSMW to be HIV-positive (52% vs 31%). We found no differences between MSMO and MSMW in the size of kin networks or emotional and material support networks. MSMW had denser sexual networks, reported more concurrent and exchange partners, used condoms with more sexual partners, and reported interaction with a larger number of sexual partners at least once a week.Conclusions. Although there were many similarities in the social and sexual network characteristics of MSMO and MSMW, differences did exist. HIV prevention interventions should address the unique needs of African American MSMW.Recent epidemiological data suggest that the highest rates of HIV infection in the United States are found among African American men who have sex with men (MSM).¹ According to the National HIV Behavioral Surveillance survey in 2004–2005, among 5 cities studied, Baltimore, Maryland, had the highest HIV rates among African American MSM, with a prevalence of 51% and an estimated incidence rate of 8% per year.² African American MSM are also more likely than are MSM of other racial/ethnic groups to report bisexual identity.^3–9Some studies have focused on men who have sex with men and women (MSMW) as a potential bridge group to heterosexual transmission.^10,11 Several investigators have found that MSMW have lower HIV rates than do men who have sex with men only (MSMO).^11–13 Some studies have found that MSMW report more sexual partners than do MSMO,^11,14 although another has found that not to be true.¹⁵Social network factors have been linked to transmission of HIV and other sexually transmitted infections.^16–18 Indeed, there is evidence that network structural characteristics, such as network density (the extent to which social network members know one another) and partner concurrency, may lead to high rates of sexually transmitted infectious diseases.^19–21 Network dynamics have also been used to explain the greater burden of HIV and AIDS among African Americans compared with other racial groups in the United States.²² Network characteristics such as network size, composition, and density have been found to be associated with HIV risk behaviors, such as sharing injection equipment,^23–27 having multiple partners, engaging in unprotected sex, and exchanging sex for money or drugs.^28–31Social network analysis is a useful method to assess amounts, types, and sources of emotional and instrumental social support³² without assuming that social support is derived from specific role relationships, such as spouse, coworker, main sexual partner, or friend. In different populations, specific role relationships may not exist, or the same role may provide different types of social support. Few studies have examined the social networks of MSM,^33,34 and there is even less information on the social networks of African American MSM. Miller et al.³⁵ conducted in-depth interviews with 21 African American MSM and inquired about the composition of their social networks. They found that African American MSM listed twice as many non-MSM male friends as MSM friends. Few listed MSM friends with whom they did not have sex. A study of HIV-positive men and women reported that African American MSM received more social support from friends and health care providers than they did from family members.³⁶ It has been suggested that some African American MSM perceive that their community consists of their social network members rather than a physical location.³⁷We examined differences in social network composition between African American MSMO and African American MSMW. Examining social network composition is critical not only for assessing the dynamics of transmission of HIV but also for assessing the social and economic support available to people with HIV. Support issues are especially important among impoverished urban populations. Understanding social network composition is also critical for developing and sustaining appropriate HIV prevention and care programs. In these analyses we were specifically interested in examining the sources and functions of social support within participants'' social networks, the sexual risk behaviors participants engaged in with network members, and the overlap between social support networks and sexual networks. We anticipated that MSMO would report more dense social networks than MSMW but less social support.     

Correlates of sex trading among drug-using men who have sex with men

OBJECTIVES: We examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men (MSM). METHODS: Audio computer-assisted self-interviewing questionnaires were completed by 387 MSM. The association of predictors with sex trading was assessed with chi(2) tests and multiple logistic regression. RESULTS: Sex-trading prevalence was 62.5% (95% confidence interval=57.7%, 67.4%). Sex trading was associated with crack use, injection drug use, childhood maltreatment, non-gay self-identification, and homelessness (adjusted odds ratios=3.72, 2.28, 2.62, 2.21, and 1.88, respectively). CONCLUSIONS: Multiple risk factors are associated with sex trading among MSM. Interventions may need to address crack and injection drug use, homelessness, and childhood maltreatment and target non-gay-identified MSM who engage in sex trading.