Men who have sex with men who do not access sexual health clinics nor disclose sexual orientation are unlikely to receive the HPV vaccine in the UK

BackgroundMen who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer.PurposeTo examine HPV vaccine acceptability amongst MSM in the UK.MethodsUsing advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability.ResultsOut of 1508 MSM (median age = 22, range: 14–63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29–2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39–3.14] and HIV-positive status [OR = 1.96, CI 1.09–3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05–1.63], HPV infection severity [OR = 1.89, CI 1.16–3.01), HPV vaccination benefits [OR = 1.61, CI 1.14–3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14–2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95–6.73] were also associated with acceptability.ConclusionsAlthough nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation.     

Men having sex with men and the HPV vaccine in France: A low vaccine coverage that may be due to its infrequent proposal by physicians

IntroductionIn France, the human papilloma (HPV) vaccine is recommended to all female adolescents, and since 2016 to men having sex with men (MSM) under the age of 27. Here, we aimed to explore HPV vaccine coverage in adult MSM living in France.MethodsWe elaborated an anonymous online questionnaire targeting MSM and disseminated it between October 7, 2018 and January 15, 2019 by various means, including a Facebook® discussion forum for pre-exposure prophylaxis (PrEP) users.ResultsOverall, 2094 participants completed the questionnaire (mean age 35.4 ± 11 years); 25.8% were in the age class targeted by the HPV vaccine recommendation; 16.1% were in a PrEP program. On a 1–10 scale, they evaluated being “in favor of vaccination” at a median of 10, and general vaccine usefulness and harmfulness at medians of 10 and 2, respectively; 62.4% considered that the HPV vaccine was rather not or not at all dangerous. Those using PrEP had better perceptions of vaccination in general and of the HPV vaccine in particular. For the 1728 participants with a family physician, he/she had proposed the HPV vaccine in 9.9% of cases (9.1% of those in the targeted age class [<27 years]). Overall, 1994 knew their HPV vaccine status; 8.0% had received at least 1 dose of the vaccine, including 17.9% of those in the targeted age class (and 52.2% among the 40 participants in this age group who received PrEP). When the 1935 participants who declared to be unvaccinated against HPV were asked whether they would accept to be vaccinated, 34.4% answered “rather yes” and 45.5% “definitely yes”.ConclusionHPV vaccine coverage is low among French MSM. Our results suggest that this trend has more to do with the infrequent proposals made by clinicians than with negative vaccine perceptions.     

Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research

ObjectiveTo compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505.DesignRetrospective, observational study.MethodsThe University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations.ResultsOnline recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33 months), Craigslist - 12(33 months), WBMC - 11(6 months), and GRINDR - 16(0.56 months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior.ConclusionUse of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.     

Assessing knowledge of human papillomavirus among men who have sex with men (MSM) using targeted dating applications

BackgroundThe incidence of HPV-related oropharyngeal and anal cancer has been increasing significantly over the past 30 years, especially among males. This study sought to better understand the level of knowledge of HPV-related disease in the LGBTQ+ community, and serve as a method to increase awareness for HPV vaccination as a safe and effective method for cancer prevention.MethodsSCRUFF and Jack’d are geosocial networking and dating mobile applications for men who have sex with men (MSM). All users of the applications who were located in the US at the time of the study were invited to participate in a survey on HPV knowledge, the HPV vaccine, and vaccination status. The Pearson test was used to identify possible associations.ResultsHalf of the HPV vaccine-eligible respondents reported having received at least one dose of the HPV vaccine, while only 37.9% of the individuals aged 9–26 reported being vaccinated against HPV. Among the unvaccinated, 63.3% reported being interested in future vaccination, or learning more about it. No significant differences were noted regarding vaccination status nor HPV knowledge between respondents from rural vs urban locations. Respondents from the South were the least knowledgeable about cancer and genital warts caused by HPV (79.4%, p < 0.01), and had the lowest rate of vaccination compared to other regions (18.5%, p < 0.01). More than half of respondents reported being either somewhat comfortable (15.8%) or very comfortable (42.2%) with receiving the HPV vaccine from a dentist.ConclusionsThe findings of this study identify demographic groups and geographical areas where preventive campaigns for HPV would be most needed. The findings highlight dental providers as an underutilized source of HPV education and vaccine recommendation. The study reveals opportunities to close gaps in care and knowledge, and points to future directions for research and development of effective interventions.     

Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne,Australia

The Victorian Government introduced a time-limited quadrivalent human papillomavirus (HPV) vaccination catch-up program targeting gay and bisexual men who have sex with men (MSM) aged up to 26 years in 2017. As of 2017, men aged ≥20 years were not eligible for the school-based HPV vaccination program. This study examined the prevalence of anal HPV among 496 MSM aged 20–26 years before they received the first dose of the HPV vaccine at the Melbourne Sexual Health Centre, Australia. More than half (56.5%) had any high-risk HPV genotypes detected in the anus. Almost half (43.1%) had at least one quadrivalent HPV vaccine-preventable genotype (6, 11, 16 or 18) and one-fifth (21.0%) had HPV 16 detected in the anus. These findings suggest that a targeted catch-up HPV vaccination program for MSM is still beneficial to protect against high-risk HPV genotypes associated with anal cancer, as well as low-risk HPV genotypes.     

深圳市458例男男性接触者社会心理压力及性功能障碍现状调查

目的 了解深圳市男男性接触者(MSM)社会心理压力及性功能障碍现状,探讨男男性接触者性健康和需求.方法 2006年4月成立彩虹工作组,到深圳市内MSM活动的桑拿、酒吧、公园等场所开展外展服务.知情同意原则下,采取方便抽样方法,问卷调查MSM的人口学基本特征、性取向、社会心理压力和性功能障碍等内容.结果 共调查458例MSM,其中同性恋者211例(46.1%),双性恋者195例(42.6%).66.8%MSM感觉在深圳没有或很少受到歧视,10.3%MSM的大部分或全部家人知道其性取向,且支持率极低;最好的朋友支持其男男性行为的MSM比例为19.0%;若想找人倾谈有关性取向的问题时,43.7%MSM认为不容易找到倾诉对象;64.8%MSM因为不想让其他人知道性取向而交女朋友或结婚.25.8%MSM对自己的性取向感到不安,15.9%MSM因为自己的性取向而觉得羞耻,29.7%MSM觉得因为自己性取向而受到社会排斥,46.9%MSM因为性取向而承受来自家家人及亲友的压力,57.6%MSM能接受自己的性取向,47.2%MSM担心其他人知道自己的性取向,49.8%MSM担心因同性性行为而感染HIV.最近1年内与男性伴性交时,30.6%MSM感到疼痛,38.6%MSM觉得性高潮来得太快,34.7%MSM性交前怕表现不好而焦虑.22.5%MSM勃起或维持勃起有困难,23.4%MSM即使不痛也觉得无趣,16.2%MSM无法有性高潮,17.7%MSM觉得对性没有兴趣.最近1年内与女性性伴性交的122例MSM中有12.3%-23.0%存在不同表现的性功能障碍.结论 深圳市部分男男性接触者普遍面临社会心理压力,部分伴随性功能障碍.     

Oral and oropharyngeal high-risk HPV prevalence,HIV status,and risk behaviours in a cohort of South African men who have sex with men

Data lag is evident when observing studies focussing on human papillomavirus (HPV) prevalence in the head and neck of men who have sex with men (MSM) in Southern Africa. Sexual behaviours other than anal intercourse, and associated factors are similarly underreported. HPV vaccination has not yet commenced for this population group. One hundred and ninety-nine MSM were enrolled in this study. Participants completed a questionnaire followed by a clinical oral examination, and a rinse-and-gargle specimen in Thinprep^® vials containing Preservcyt^® solution was collected. Detection and genotyping for high-risk HPV were done by an automated system (Abbott^® m2000sp). Six percent of MSM in this cohort had high-risk HPV present in the mouth/oropharynx. This cohort averages 29 years of age, more than half were unemployed (53.3%), and 66.8% were human immunodeficiency virus (HIV) seropositive. The most common sexual practice was anal sex (69.4%) followed by oral sex (28.6%), and by rimming (9.6%). A significant association between oral insertive sex and oral/oropharyngeal HPV status was demonstrated (p = 0.0038; phi coefficient = 0.20). An incidental but significant association between rimming and HIV status was found (p = 0.0046; phi coefficient = 0.19), and HIV seropositive participants had higher oral/oropharyngeal HPV presence. The HPV prevalence of 6% reported in this study is in alignment with global reports. The prevalence of oral/oropharyngeal HPV in this MSM cohort was influenced by sexual practices. MSM participants who practiced rimming appear to be at higher risk of HIV acquisition. Given the transmission routes of HPV in this vulnerable population, vaccination must be urgently studied as an intervention for prevention.     

Willingness to participate in HIV vaccine clinical trials among Chinese men who have sex with men

HIV vaccine trials require volunteers. Little is known about willingness to participate (WTP) in HIV vaccine trials among Chinese MSM. A survey of 550 MSM was conducted from March to June 2008, in Beijing, China. Data were collected on demographics, behaviors, perceptions about HIV/AIDS and HIV vaccines, and concerns about participation in HIV vaccine clinical trials. Of study participants, 35.8% were definitely willing to participate, 35.1% were probably willing, 16.4% were probably not willing, and 12.7% were definitely not willing. Analyses suggest that perceived family support, perceived protection against HIV infection and fear that participation would result in social distancing were associated with WTP. MSM in China may be good candidates for HIV vaccine trials. Further studies are needed to evaluate actual enrollment.     

Vaccine acceptability,uptake and completion amongst men who have sex with men: A systematic review,meta-analysis and theoretical framework

BackgroundDue to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.MethodsIn January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling.ResultsSeventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM).ConclusionDespite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.     

男男同性恋HIV感染者自我管理效果评价研究

目的  评估自我管理模式在感染艾滋病病毒(human immunodeficiency virus,HIV)的男男同性恋人群中的实践效果,为制定该人群HIV/艾滋病(acquired immune deficiency syndrome,AIDS)综合管理策略提供依据。 方法  依托男男同性恋非政府组织(non-governmental organizations,NGOs)采用同伴推动抽样方法(respondent-driven sampling,RDS)招募研究对象,并随机分为干预组和对照组。干预组实行自我管理模式,建立自我管理小组,在慢性病自我管理(chronic disease self-management,CDSM)的理论基础上以小组为单位开展健康教育课程和同伴教育;对照组实行常规随访管理模式,即以疾控中心为主体开展的医学随访等相关活动;1年后开展效果评估。 结果  自我管理小组在健康感受、角色功能、生活质量、健康转换、心理健康5个指标的得分上有不同程度的提高。自我管理小组有焦虑症状的比例从38.6%下降到22.6%,经常使用安全套的比例从43.3%提高到47.3%,坚持服药的比例从68.2%提升到78.8%。 结论  自我管理模式可有效突破目前男男同性恋人群艾滋病管理的瓶颈,可以改善该人群的生存质量。     

中国男男性行为群体物质滥用的Meta分析

目的 了解我国男男性行为群体（men who have sex with men,MSM）中物质滥用的现状并且分析其时间和地区分布特点,为制定有针对性的干预措施提供理论依据。方法 通过检索中国期刊全文数据库（CNKI）、万方数据资源系统（Wanfang）、维普数据库（VIP）、PubMed数据库中于2010年1月1日至2020年12月31日公开发表的、针对中国MSM物质滥用相关的研究文献,提取文献数据,纳入STATA软件计算合并率并进行发表偏倚的评估。结果 共纳入24篇文献研究,涉及研究总量共22 829例MSM。结果表明,在2010年至2020年间,我国MSM中物质滥用的合并率达30.6%（95%CI:0.238~0.373,P<0.001）。结论 我国MSM物质滥用情况较为严重,需加大对重点人群的干预力度。     

男男性行为人群与男性性伴和女性性伴的性行为特征及影响因素

目的  了解安徽省男男性行为人群（men who have sex with men,MSM）与其男性性伴和女性性伴的性行为特征及影响因素。 方法  以合肥、芜湖和六安3个城市为研究现场,采用滚雪球法和网络招募法招募MSM人群,对符合纳入标准的MSM进行匿名问卷调查。采用多因素Logistic回归分析模型分析MSM人群最近6个月发生异性性行为的危险因素。 结果  共招募1 200名MSM,最近6个月78.3% MSM与男性性伴有过肛交性行为,20.9%与女性性伴有过异性性行为,16.5%最近6个月与男性性伴、女性性伴均有过性行为。最近6个月异性性行为中的安全套坚持使用率（29.9%）明显低于同性性行为的安全套坚持使用率（53.0%）,在最近一次异性性行为中的安全套使用率（52.2%）也明显低于同性性行为中的安全套使用率（79.6%）（均有P < 0.05）。多因素分析结果显示,已婚（包括在婚/同居/离异/丧偶）、在调查城市居住时间>2年、有同性商业性行为的MSM更容易发生异性性行为。 结论  MSM人群存在较高比例的双性性行为,且安全套坚持使用率较低,应该加强对他们的性健康教育、风险感知教育和行为干预。     

Evidence of decreased HPV vaccine acceptance in Polish communities within Scotland

Human papillomavirus (HPV) vaccines are currently utilised globally in national immunisation programmes. Many new European migrants have settled in the United Kingdom (UK) since the 2004 European Union expansion with approximately 91,000 Polish people resident in Scotland. Following anecdotal reports from several NHS Boards within Scotland of lower HPV vaccine uptake in Polish communities compared with other ethnic minorities, an extract containing both forename and surname, was taken from the Scottish Immunisation Recall System (SIRS) for all girls in S2 and S3 in school years 2014/15 to 2016/17. We then used the OnoMap algorithm software to derive ethnicity. OnoMap identified between 289 and 321 age-eligible girls as Polish with significant disparity noted for completed HPV vaccine uptake between UK (87.2–89.8%) and Polish ethnicities (69.7–77.2%) (P?<?0.01). Preliminary discussions with Polish families suggest that vaccine programme differences, trust in medical/healthcare practitioners, and cultural influences may be important drivers of acceptance.     

Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV

IntroductionYoung men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies.MethodsAn agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection.ResultsCompared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage.ConclusionsPublic health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.     

大连市男男性行为人群艾滋病危险行为调查

目的 了解辽宁省大连市男男性行为人群(MSM)行为学特征及艾滋病病毒(HIV)、丙型肝炎(HCV)和梅毒感染率,探索HIV感染的影响因素。方法采用定向抽样方法招募MSM,进行面对面的问卷调查,并采血样进行HIV、梅毒和HCV检测。结果 共招募932名MSM,HIV抗体阳性率3.43%(32/932),梅毒血清学阳性率12.12%(113/932),HCV抗体阳性率1.07%(10/932);最近6个月,88.73%(827/932)的调查对象曾经与男性发生过肛交;其中每次使用安全套的占52.18%;多因素Logistic回归模型提示,受教育程度低、外地户籍、最近6个月为男性提供商业性服务的男性、梅毒抗体阳性的MSM其HIV感染的风险高;最近1年接受过HIV抗体检测是HIV感染的保护因素。结论 大连市MSM HIV感染率高,高危行为普遍存在。     

Expected epidemiological impact of the introduction of a partially effective HIV vaccine among men who have sex with men in Australia

A trial of the ALVAC-AIDSVAX HIV vaccine was recently found to be partially effective in preventing HIV transmission among study participants in Thailand. The success of this trial means that vaccination may become a viable intervention for the prevention of HIV infection in the medium-term future. Assuming that the vaccine has similar relative protective effectiveness per exposure event for reducing transmission among men who have sex with men (MSM) in high-income settings we investigated the potential population-level impact of rolling out such a vaccine among MSM in New South Wales, Australia. Using a detailed individual-based transmission model that simulates a population of sexually active MSM it was found that one-off intervention of 60% or 30% coverage of a vaccine with characteristics like the ALVAX-AIDSVAX vaccine would likely reduce the cumulative incidence of HIV by 9.6% and 5.1%, respectively, over a 10-year period. Due to the waning of vaccine efficacy, a booster vaccination could be required to maintain this reduction in incidence over the long term. If the previously vaccinated population is given a booster vaccine, with the same protection conferred as with the initial vaccination, every 5 years or every 2 years then the cumulative incidence over 10 years for 60% coverage could be reduced by 14.4% and 22.8%, respectively. Such a weak vaccine, with boosting, may be a potential intervention strategy for the prevention of HIV infection in MSM in high-income countries if further trials show boosting to be safe, acceptable, and cost-effective. However, the moderately low population-level impact suggests that a public health strategy involving such a vaccine should be supplemented with other biomedical and educational strategies.     

男男性行为人群包皮环切术预防HIV意愿调查

目的 了解男男性行为人群进行包皮环切手术以预防艾滋病感染的意愿情况及其影响因素。方法 于2009年2月-3月,在北京市招募男男性行为者进行问卷调查,了解其对艾滋病及包皮环切术预防艾滋病感染的认知情况。结果 在参加调查的200名男男性行为者中,13人已经接受了包皮环切,3人不清楚是否做过包皮环切;在参加者184人未做过包皮环切的中,36.4%表示愿意参加今后的包皮环切预防男男性行为感染艾滋病的科学研究。多因素Logistic回归分析显示,其影响因素包括包皮过长(OR=2.82,95%CI=1.45～5.49)和认为包皮环切能增加自己/同伴性伴的同性性乐趣或性快感(OR=4.50,95%CI=1.77～11.49)。结论 应在该人群中加大包皮环切及艾滋病知识的普及力度,消除人们对包皮环切手术及相关预防艾滋病感染研究的担心和歧视。     

男男性行为者异性性行为特征及影响因素分析

目的 了解北京市男男性行为者的异性性行为特征及其影响因素.方法 于2006年11月～2007年2月,在北京市招募男男性行为者进行问卷调查,了解其社会人口学和高危性行为特征.结果 47.1%(255/541)的人曾与女性发生过性行为,在多因素Cox比例风险模型中,文化程度低(HR=1.98,95%CI=1.54～2.56);性行为方式以异性为主(HR=2.92,95%CI=2.06～4.15);与男男性行为者首次异性性行为的发生差异有统计学意义.13.9%(75/541)的人近3个月与女性发生过性行为,多因素Logistic回归分析结果显示,年龄＞26岁(OR=2.0,95%CI=1.12～3.56)、性行为方式以异性为主(OR=24.2,95%CI=11.1～52.6)和近1个月喝醉过(OR=2.6,95%CI=1.3～5.0)与男男性行为者近3个月发生异性性行为的关系差异有统计学意义.结论 应采取相应措施控制人类免疫缺陷病毒(HIV)从男男性行为者向其女性性伴扩散.     

男男性接触者一般状况及艾滋病知信行调查

目的 了解男男性接触（MSM）人群一般情况、艾滋病知识及性行为特征，为制定相应干预措施提供依据。方法 由专业人员对目标人群进行一对一的访谈，MSM匿名自填调查问卷。结果 共调查MSM150人，以青壮年、中高等教育程度、商业服务人员和学生为主；艾滋病传播预防知识知晓率达84．30％；近一半的调查者通过网络找过性伴，超过半数到外地找过性伴；80％的人近期有多性伴和肛交行为，每次都用安全套的比例≤50％；自身对感染HIV的风险认识不足。结论 MSM人群年龄低，流动性大，高危行为广泛存在，对艾滋病知识虽有一定了解，但存在侥幸心理，对自身感染的风险认识不足。提示我们对MSM人群的干预工作任重而道远。