暗娼与性伴之间安全套协商使用情况分析

目的 了解暗娼与嫖客或固定性伴之间安全套协商和使用情况，为暗娼的艾滋病综合干预措施的制定提供参考依据。方法 采用横断面调查，于2018年4－6月在云南省红河哈尼族彝族自治州蒙自市、建水县，依托娱乐服务场所招募≥16岁暗娼，估算样本量需476人，问卷调查收集其人口学特征、安全套协商及使用情况信息。采用logistic回归模型分析暗娼与不愿使用安全套的嫖客协商后安全套使用的影响因素。结果 共调查暗娼852人，年龄（24.29±8.44）岁。最近1个月性行为，有58.6%（499/852）的暗娼每次都要求嫖客使用安全套但嫖客不愿使用，协商后有88.4%（441/499）的暗娼每次与嫖客都使用安全套。有14.4%（99/687）的暗娼每次都要求固定性伴使用安全套，但固定性伴不愿使用，经协商后，54.5%（54/99）暗娼与固定性伴每次都使用安全套。最近1个月，暗娼说服不愿使用安全套的嫖客时，53.3%（266/499）的采用“强制要求”策略，19.4%（97/499）的采用“风险说服”策略，23.1%（115/499）的采用“强制要求及风险说服”策略，4.2%（21/499）的采用其他策略协商。4.4%（22/499）的暗娼感觉说服嫖客使用安全套困难。多因素logistic回归分析结果显示，和感觉说服嫖客使用安全套困难的暗娼相比，难度适中（OR=4.00，95% CI：1.55～10.32）、容易（OR=30.17，95% CI：3.22～282.44）的暗娼更容易成功协商嫖客每次都使用安全套。和采用其他策略与嫖客协商使用安全套的暗娼相比，采用“强制要求”策略者（OR=4.44，95% CI：1.41～14.01）、采用“强制要求及风险说服”策略者（OR=5.52，95% CI：1.55～19.73）更容易成功协商嫖客每次都使用安全套。结论 通过安全套协商策略，可促使不愿使用安全套的嫖客使用安全套。采用“强制要求”策略更容易成功协商嫖客每次都使用安全套，结合“风险说服”策略更有利于成功协商。     

Determinants of condom use among French heterosexuals with multiple partners.

In September 1988, a sample of French individuals between 18 and 49 years of age, who reported more than one sexual partner in the past six months and who considered themselves heterosexuals (n = 1088), were interviewed at home about risk perception of human immunodeficiency virus (HIV) transmission, sexual behavior, and condom use. Systematic or occasional use of condoms during the previous 12 months was reported by 46.9 percent of respondents. Among condom users, 38.7 percent declared they had never used condoms before the last 12 months, fear of acquired immunodeficiency syndrome (AIDS) rather than contraception being the main motivation of these recent users. Multivariate analysis indicates that voluntary testing for HIV, average or more than average fear of sexually transmitted diseases (STDs), and knowledge of HIV carrier in personal relations are associated with condom use.     

Determinants of condom use and heterosexual multiple sexual partnership in French Antilles and French Guiana

BACKGROUND: After Subsaharan Africa, the Caribbean is the world's region most affected by HIV/AIDS. The French-American departments (Guadeloupe, Martinique, Guiana), FAD, are located in the heart of this region. Although lower than in other states of the Caribbean, AIDS incidence is much more higher than in France (up to 15 times more in Guiana). Transmission is mostly heterosexual. The frequency, particularly among men, of multiple sexual partnerships frequently taking place concurrently, and the persistence of this activity in older age, contribute to the level of the HIV epidemic and its characteristics. The purpose of this article is to identify, in the FAD, the determinants of condom use among persons with multiple sexual partners (either at last intercourse or during a concurrent relationship), taking into account the variety of multiple sexual partnership situations. METHOD: Data are taken from an HIV/AIDS KABP survey, based on a probability sample of men and women aged 18 to 69 years, resident in FAD. In total, 3104 interviews were conducted by telephone in 2004: around 1000 in each department. RESULTS: Among men and women who report two or more partners in the past five years, there is substantial heterogeneity in level of condom use at last intercourse, depending on the duration and type of the relationship: 73% of respondents reported condom use with a casual partner and 14% with a cohabiting partner. Men and women who were engaged in concurrent partnerships in the past five years were at higher risk of infection: 7% reported an STI versus 4% among those who had two or more partners, but not at the same time. Women, older persons, people with a lower level of education and those engaged in concurrent partnerships reported a lower level of condom use, thus increasing their vulnerability to HIV/AIDS. CONCLUSION: Although HIV/AIDS prevention has increased among male and women engaged in multiple sexual partnerships, there is still a lack of consistent condom use in this population. These results highlight the need for more diversified prevention programs, taking into account sociodemographic factors and the diversity of situations involving multiple sexual partnership.     

Women and AIDS: gender relations and condom use with steady partners

An educational project on sexuality, STDs, and AIDS was conducted for four years with some 500 women. As a result, changes were observed in HIV-related knowledge and attitudes, but not in risk behaviors for infection. This fact motivated the development of a qualitative study to learn the reasons why women failed to incorporate HIV preventive behaviors into their daily lives. Six focus groups were conducted with women who had participated in the educational project. The analysis was thematic. Women were familiar with HIV transmission routes and preventive measures. They admitted not using condoms due to fear of being suspected of infidelity and because this might lead to separation of the couple. Women reported that relationships with their partners had been difficult because of lack of dialogue and that men always had the final word. Although women had information about AIDS, they did not use preventive measures in steady relationships because they did not wield decision-making power. Gender inequality and fidelity were two significant issues related to the increase in AIDS among women.     

Recent heterosexual partnerships and patterns of condom use: a weighted analysis

BACKGROUND: In epidemiologic studies of sexual partnerships, characteristics are often collected in part through detailed questions concerning recent partnerships. These data present challenges for analysis. First, although research interest generally lies in all partnerships in a certain time period, participants may be asked to provide detailed information only concerning their most recent, up to a fixed number. As more recent partnerships may differ from others, a simple analysis of these data may lead to bias. Second, the total number of partnerships for a study participant may be informative, so the analyst must choose between inference for the population of partnerships or for a typical partnership from the population of individuals. Third, data may be more fully recorded for study participants than their partners, and not all partners may be eligible to participate. METHODS: We propose weighting to deal with these challenges. Weighting provides a sensitivity analysis for the possible selection bias due to incomplete reporting. We analyze heterosexual condom use in Britain, using data from the National Survey of Sexual Attitudes and Lifestyles 2000. RESULTS: The sensitivity of estimates to possible selection bias is low. We find that the choice of population for inference is important for prevalence estimates, but has relatively little impact on measures of association. By defining within-participant partnership predictors we demonstrate how participants vary their condom use. We establish that, at least for male participants, shorter partnership duration is linked to a higher probability of condom use at last sex but lower probability at first sex. CONCLUSION: We recommend a weighted analysis approach to recent partnership data, which can be simply implemented in standard survey analysis software. In other surveys the sensitivity of estimates to possible selection bias may be substantial and this will need to be assessed in each case.     

Factors associated with maintenance of regular condom use among single heterosexual adults: a longitudinal study

OBJECTIVE: The aims of this study were to describe behavioural and psychosocial characteristics of single heterosexuals towards regular condom use, and to identify factors associated with the maintenance of this behaviour over time. METHOD: A cohort of 179 single heterosexual adults (83 men and 96 women, mean age: 32 years) was followed over a period of 2 years. The data were collected, by phone interviews, at baseline and 1 and 2 years later. The phone numbers were generated using a random digit strategy. RESULTS: The following changes were observed: over time fewer people were sexually active, but those who were, reported more often having had more than one sexual partner. No significant change was observed regarding condom use. The psychosocial variables remained stable during the study period. To have a favourable intention was the main factor associated with maintenance of condom use. Having had a STD, personal normative beliefs and positive attitude were also associated with regular condom use. DISCUSSION: Promotion strategies should highlight the importance of acting as a responsible person, reinforce the advantages of using condoms, and select strategies that favour the implementation of intention of using condoms.     

Gender differences related to heterosexual condom use: the influence of negotiation styles.

The present study had three primary goals. The first was to identify gender differences related to negotiation styles associated with condom use. We hypothesized that women would report engaging in more negotiation behaviors associated with condom use than men. The second goal was to determine whether the relationships between intentions to use condoms and past condom use for women and men were moderated by negotiation behaviors. The third goal was to examine gender differences in responses to an open-ended question inquiring why participants did not use condoms. Male and female college students (N = 219) anonymously completed a series of measures. The results indicated that women and men have unique roles in the negotiation process; women play a more active role in negotiation of condom use, while men play a more reactive role. The relationship between intentions to use condoms and past condom use increased for men when their partners were more active in the process of deciding whether to use condoms. Responses to the open-ended item revealed that women identified perceptions of low risk as the most common reason for not using condoms, while men identified the inconvenience or unavailability of condoms as the most common reason. The implications of these results are discussed as they relate to health efforts to increase condom use.     

Factors influencing sexual initiation,multiple partners and condom use among male slum youth in Pune,India

Abstract

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents’ formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.     

Factors influencing sexual initiation, multiple partners and condom use among male slum youth in Pune, India

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents' formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.     

坚持使用避孕套情况下的夫妻间艾滋病病毒感染因素分析

目的　避孕套干预对夫妻间艾滋病病毒（ＨＩＶ） 传播的作用。方法　为首例ＨＩＶ感染者建立个人档案,固定流行病学医师对感染者和配偶每６ 个月进行一次ＨＩＶ抗体检测和家庭随访,ＨＩＶ抗体检测采用ＥＬＩＳＡ、ＰＡ、ＷＢ法,阳性结果由山东省卫生防疫站确认。结果　首例男性１９９２ 年入境时确认ＨＩＶ感染。卫生防疫人员立即对感染者夫妇进行了预防ＡＩＤＳ教育。几年来配偶间性接触均使用避孕套,但使用前未进行破损检查。其配偶１９９７ 年５ 月曾出现不明原因低热１月余,同年８ 月在第１４ 次检测时阳性,并确认为ＨＩＶ－ １ 型感染。结论　使用避孕套可在较长时间内预防ＨＩＶ经性接触感染,但不正确使用仍可造成ＨＩＶ感染。     

男男性行为者安全套使用影响因素分析

有研究表明，在中国，男男性行为对艾滋病／性病知识了解相对较高，但安全套使用率较低，在此人群中存在明显的知、行分离情况。为探求影响男男性行为人群安全套使用的潜在因素，云南省健康教育所对男男性行为人群进行了专题小组讨论、问卷调查，分析归纳了影响男男性行为人群安全套使用的因素，以期对开展针对此人群的艾滋病／性病干预工作有参考和指导意义。     

Depressive symptoms and condom use with clients among female sex workers in China

This study examines the association between depressive symptoms and condom use with clients among 278 female sex workers (FSW) in Guangxi, China. About 62% of these FSW had a high level of depressive symptoms (CES-D total score >or=16). Multiple logistic regression analyses indicated that FSW with high level of depressive symptoms were less likely to use condoms consistently (aOR = 0.50, 95% CI: 0.28-0.89) or use condoms properly (aOR = 0.44, 95% CI: 0.20-0.99). The findings suggested that HIV prevention programs targeted at FSW should take into consideration the level of depression they experience.     

AIDS public service announcements: effects of fear and repetition on predictors of condom use

An experiment examined the effects of varying levels of fear and message repetition in a radio public service announcement (PSA) on attitudes toward and intentions to use condoms. Predictions were derived from the Theory of Reasoned Action and Fazio's accessibility model. Results suggest that repetition and fear have important effects on intentions to use condoms and attitudes toward using condoms, even after accounting for inputs specified by the Theory of Reasoned Action In addition, frequency affected the relative weights of attitudinal versus normative effects on intentions, suggesting that PSAs may be able to affect attitudes and intentions through spontaneous attitude activation as described by Fazio (1990).     

Perceptions of condom use among African American men who have sex with men

The objectives of this study were to describe what African American men perceive as the risks of different sexual acts when not using condoms, the social and situational barriers to using condoms, the attitudes towards condom use of other men they know, and the strategies needed to promote condom use. In semi‐structured interviews, participants were asked questions regarding their perceptions of the risks of HIV infection from various sexual activities, barriers to condom use, condom attitudes of people in their social and sexual networks, and strategies necessary to promote condom use. Analyses indicated that African American men who sex with men (MSM) most often mentioned sex without a condom as risky sexual behaviour, specifically anal sex. The most frequently perceived barrier to safer sex practice was ‘sex on the spur of the moment’. Respondents also perceived several salient attitudes towards condom use held by the African American MSM they knew. In particular, respondents were divided in their perception of social support for condom use among their friends and acquaintances. Also, they perceived that men in their social and sexual networks held less favourable attitudes towards condom use in committed relationships. Findings are discussed in relation to various interpersonal (e.g., relationship issues) and contextual (e.g., social support and social networks) factors that may influence HIV sexual risk behaviours among African American MSM.     

Partner-specific sexual practices among heterosexual men and women with multiple partners: Results from the French national survey,ACSF

Heterosexual men and women with several partners are at risk of acquiring and transmitting sexually transmitted diseases and HIV. Risk depends on parameters such as the sexual practices themselves which may vary according to the type of partner (regular vs. casual). It is therefore important to describe the sexual practices and identify the correlations between the type of partner and these practices among heterosexuals with multiple partners. A subsample of all subjects having had at least two sexual partners during the previous year (n=1644) was obtained from the ACSF survey (n=20,055), the French national telephone survey on sexual behavior conducted between September 1991 and February 1992. Questions concerned in particular sexual practices of the last encounter as well as type of partner. Petting and vaginal penetration were almost systematic, mutual manual stimulation and orogenital sex were common, while self-masturbation and anal sex were infrequent. On average, a condom was seldom used. However, it was used more often when the partner was occasional. Nonpenetrative and oral practices were also more frequent with occasional partners. Women tended to report lower frequencies of practices and of condom use than men. A subset of heterosexuals with multiple partners engaged in safe sex. Practices tend to be partner-specific, with safer sex practices more likely to occur with occasional partners, although the magnitude of the difference is moderate.     

上海市264名男男性行为者孤独感与多性伴行为研究

目的 了解男男性行为者（MSM）孤独心理并探讨其与艾滋病高危多性伴性行为的关系。方法 2015年3—6月,采用滚雪球抽样的方法对上海市264名MSM进行一般人口学信息,多性伴行为,孤独感评定的问卷调查。结果 MSM人群孤独检出比例为17.4%,多性伴检出比例为52.7%,单因素、多因素logistic回归分析均显示,非本地户籍（OR=2.08,95% CI：1.20~3.63）和高孤独感（OR=2.00,95% CI：1.01~3.94）是发生多性伴行为的危险因素。结论 对MSM人群进行艾滋病高危行为干预时,应当注意他们的孤独心理的问题。     

男男性行为人群的异性性伴HIV易感性研究进展

受自身、家庭、社会等因素影响,超过70.0%的MSM具有结婚意愿,超过90.0%的MSM认为婚姻不可避免,由此产生了一类与MSM密切相关的弱势群体即MSM异性性伴（同妻）。因MSM本身即为HIV感染的高危人群,加之其他易感因素的存在,使得同妻感染HIV的风险增加,成为了HIV感染的重点人群。本文从同妻定义、人群规模,同妻生理健康及HIV易感因素方面进行综述,旨在为同妻人群后续开展性传播疾病防控工作的方向提供依据。