ATP2B1 基因单核苷酸多态性及基因-吸烟交互作用与原发性高血压的关联研究

目的 评估新近确诊感染HIV的MSM人群在确诊前后的性行为变化。方法 在成都和天津,对新近确诊感染HIV的MSM人群进行回顾性调查,收集调查对象确诊前和确诊后6个月的性行为信息。对确诊前后6个月内的性行为进行比较 （McNemar χ2检验）,对确诊后6个月内的高危行为的影响因素进行logistic回归分析。结果 共调查129名新近确诊的HIV感染者或患者,平均年龄为31.8岁,主要通过互联网寻找性伴。调查对象中发生无保护肛交性行为 （UAI）的比例从确诊前的70.5%下降到确诊后的16.3%,性伴数>1人的比例从确诊前的66.7%下降到确诊后的33.3%,有固定性伴的比例从确诊前的72.9%下降到确诊后的55.0%,有偶然性伴的比例从确诊前的62.8%下降到确诊后的31.0%。确诊前6个月内发生UAI、 确诊后性伴数>1人、 确诊后有固定性伴是确诊后发生UAI的危险因素。常去互联网以外的其他场所寻找性伴、 确诊后发生UAI、 确诊后有固定性伴、 确诊后未告知固定性伴是确诊后性伴数>1人的危险因素。结论 MSM人群HIV感染者在确诊后6个月内无保护肛交性行为下降显著,多性伴的情况也明显减少,但仍有部分感染者继续发生无保护性行为。     

男男性行为人群新确证HIV感染者首次性行为特征与艾滋病相关危险因素的关系

目的研究昆山市男男性行为人群(MSM)新确证HIV感染者首次性行为特征与社会人口学特征、艾滋病相关高危行为的关系,为感染者的管理和行为干预提供指导。方法选择昆山市2016年8月至2018年9月MSM新确证HIV感染者,以面对面问卷调查的方法收集资料,采用单因素、多因素分析方法对首次性行为特征影响因素进行分析。结果 204例研究对象的平均年龄为(32.92±9.54)岁,43.14%被调查者发生首次性行为时性伴性别为男性,91.67%被调查者近6个月内曾发生男男同性性行为。首次性行为性伴性别与年龄、文化程度等社会人口学特征有关(P0.01)。首次性行为性伴为男性者更可能与男性发生一夜情、性角色更倾向于被插入为主(P0.05);首次性行为性伴为女性者更可能发生婚外异性性行为、近6个月与女性发生性关系,拥有更多的女性性伴,近6个月安全套使用率更低(P0.05或P0.01)。结论昆山市MSM新确证HIV感染者首次性行为特征与社会人口学特征、艾滋病高危行为相关。     

个人社会网络分析方法在男男性行为者高危性行为研究中的应用

目的了解广州市男男性行为者(men who have sex with men,MSM)的同伴社会网络特征,应用个人社会网络分析方法探讨MSM同伴社会网络特征与高危性行为的关系。方法 2014年2月—2014年5月通过广州MSM社区组织门诊点对MSM进行招募,并采用面对面的问卷访谈方式调查其同伴社会网络成员特征和近三个月高危性行为情况,利用多因素logistic回归分析方法分析MSM同伴社会网络特征与高危性行为之间的关系。结果共招募397名男男性行为者(核心成员,ego),最近三个月与不同性伴发生无保护性肛交(unprotected anal intercourse,UAI)的频率分别为:固定性伴58.7%、临时性伴47.1%、任何性伴55.2%。397名MSM核心成员总共提名670名网络其他成员(alter),社会网络大小为1.7±0.7,社会网络密度为0.2±0.2。在校正了核心成员的基本情况等因素后,MSM同伴社会网络特征与近三个月和固定性伴发生UAI的关系有统计学意义的变量为:社会网络大小(OR=1.53,95%CI:1.15~2.04)、物质支持(OR=1.09,95%CI:1.02~1.17)、网络其他成员近3个月与固定性伴有UAI(OR=1.008,95%CI:1.003~1.014)、网络其他成员鼓励核心成员使用安全套可能性大(OR=0.992,95%CI:0.986~0.998)、网络其他成员自身使用安全套可能性大(OR=0.993,95%CI:0.988~0.997);在校正了核心成员的基本情况等因素后,MSM同伴社会网络特征与近三个月和任何性伴发生UAI的关系有统计学意义的变量为:网络其他成员近3个月与固定性伴有UAI(OR=1.008,95%CI:1.003~1.014)、网络其他成员鼓励核心成员使用安全套可能性大(OR=0.994,95%CI:0.989~1.000)、网络其他成员自身使用安全套可能性大(OR=0.995,95%CI:0.991~1.000)。结论同伴社会网络与MSM高危性行为的发生有关,社会网络成员的高危性行为模式和态度是MSM频繁发生高危性行为的重要影响因素。     

苏州市MSM人群艾滋病高危行为特征、感染状况及影响因素分析

目的了解苏州市男男性行为者(MSM)艾滋病高危行为特征、感染情况及其影响因素。方法采用横断面调查,采取分类滚雪球抽样的方法于2008年5月起,对苏州市范围内的MSM人群就艾滋病(AIDS)知识态度、高危行为特征的面对面问卷调查结果 ,以及血样的艾滋病病毒(HIV)及其他性传播疾病(STD)感染的实验室检测数据进行统计分析。结果所调查280名MSM中,82.7%最近六个月发生过同性性行为,其中79.4%有多个同性性伴;48.7%曾与异性发生过性行为,其中21.2%有多个异性性伴;最近六个月与同性发生肛交性行为时坚持使用安全套的比例为52.0%,与异性发生性行为时该比例为21.2%。300名被调查者均采集血样进行了血清学检测,确证HIV阳性人数22人,阳性率为7.3%;确证梅毒抗体阳性人数为66人,阳性率为22.0%。在多因素logistic回归模型中,常通过互联网寻找性伴(OR=1.93,95%CI=1.01～3.67)、最近六个月曾与固定性伴发生性行为(OR=0.45,95%CI=0.25～0.79)与最近六个月同性性行为时安全套坚持使用率的关系有统计学意义;梅毒感染(OR=3.17,95%CI=1.25～7.99)与HIV感染的关系具有统计学意义。结论苏州市MSM人群无保护性性行为及多性伴现象较为普遍,HIV和梅毒感染率较高,需要进一步加强对该人群的行为干预以防止艾滋病在该人群中的蔓延以及传播至一般人群。     

男男性行为人群新型毒品使用情况和HIV感染调查分析

目的了解天津市男男性行为(men who have sex with men,MSM)人群新型毒品的使用情况、高危性行为及人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染状况,分析HIV感染的影响因素,为MSM人群艾滋病防治策略的调整提供科学依据。方法于2016年采用非概率抽样方法在社区采用滚雪球方式招募MSM 222名作为研究对象。进行问卷调查,调查内容包括一般人口学特征、新型毒品使用情况和最近3个月内性行为情况,采集静脉血测定HIV,对于初筛阳性者进行确证检测。采用SPSS 18.0进行χ~2检验和多因素logistic回归。结果 222名MSM调查对象中,54.5%有新型毒品滥用史(121/222),Rush Po PPers的使用比例为52.3%(116/222),HIV感染率为5.0%(11/222)。与不使用新型毒品者相比,单独使用和混合使用新型毒品者中40岁以下、月收入≥5 000元和同性性取向的比例较高,差异均有统计学意义(P0.05,P0.01)。单独使用和混合使用新型毒品者的性行为频次每周1次、性伴数2个及与配偶以外的固定性伴发生无保护性行为的比例高于不使用新型毒品者,差异均有统计学意义(P0.01)。多因素logistic回归分析显示,与临时性伴发生无保护肛交性行为对HIV感染的影响具有统计学意义(OR=8.022,95%CI:1.540~41.784)。结论天津市新型毒品滥用的MSM人群发生感染HIV高危性行为比例较高,建议严格管控Rush Po PPers等新型毒品的生产和销售,针对滥用新型毒品现象制定干预措施,重点进行宣传教育。     

2013年南阳市卧龙区男男性接触者行为特征及HIV感染的影响因素

目的了解南阳市卧龙区男男性接触者(MSM)人群的行为特点、人类免疫缺陷病毒(HIV)的感染情况及感染的影响因素。方法通过网络及同伴推动等方式招募调查对象,对调查对象开展问卷调查并采集血样。结果调查对象未婚占36.73%,已婚占54.68%。寻找性伴选择网络联系的比例为46.93%。最近6个月,与男性发生过肛交性行为的占79.61%,男性性伴中位数为2个,2个及以上者占62.98%。多因素logistic回归分析结果显示,最近6个月内男性性伴总数大于等于6个,有性病相关症状和感染梅毒是HIV感染的危险因素。结论卧龙区MSM已成为艾滋病由高危人群向一般人群传播的桥梁人群。HIV在MSM人群中正迅速蔓延,HIV流行形势十分严峻,探讨有效干预模式和推广干预措施已迫在眉睫。     

2008年聊城市男男性行为者艾滋病高危行为调查

[目的]了解男男性行为者(MSM)的社会学特征、艾滋病高危性行为、知识知晓及HIV感染情况。[方法]2008年6～9月应用同伴推动抽样法(RDS)对聊城市的MSM进行抽样,通过现场问卷调查和血清学检测了解其高危行为因素及HIV感染等情况,资料分析使用RDSAT、Excel软件完成。[结果]调查204名MSM,有58.33%的自我认同为同性恋;艾滋病防治知识知晓率为61.27%;有76.47%的MSM与同性发生过口交性行为,有78.38%的MSM与同性发生过肛交性行为,有60.29%的MSM与异性发生过性关系。发生以上高危性行为的MSM,最近6个月内,有89.32%与多个同性发生过肛交,有89.71%与多个同性发生过口交,有86.99%与异性发生过性行为,但最近6个月肛交性行为时安全套使用率仅为25.53%;检出HIV感染者2例,感染率为1.51%。[结论]聊城市MSM人群有较强的认同感,艾滋病知识知晓率低,性伴多且不固定,安全套使用率低,存在HIV在MSM人群中传播的危险。     

223例男男性行为者艾滋病高危行为与HIV感染影响因素分析

目的了解男男性行为者(MSM)艾滋病高危行为与艾滋病病毒(HIV)感染的影响因素,为疾病防控提供依据。方法对惠州市2015—2016年各艾滋病自愿咨询检测点咨询检测的223例MSM进行艾滋病知识知晓情况和行为特征调查,检测其HIV抗体,了解其高危行为,分析HIV感染的影响因素。结果艾滋病知识知晓率79.8%。HIV抗体阳性率10.8%(24/223)。单因素分析显示,婚姻状况、同性性行为中的性角色、最近1次肛交时使用安全套、最近6个月肛交时自己出血和对方出血等因素与HIV感染有关;多因素logistic回归分析显示,最近6个月肛交时自己出血(OR=4.29)是感染HIV的危险因素,最近1次肛交时使用安全套(OR=0.30)是保护性因素。结论应开展以VCT为切入点的MSM高危行为干预,引导该人群改变高危行为,以遏制疫情传播。     

深圳市男男性接触者异性性行为特征及影响因素研究

目的了解深圳市男男性接触者(MSM)异性性行为的特征及其影响因素,为制定HIV/STD的干预措施提供科学依据。方法采用自愿咨询检测和现场调查相结合的方法,于2008年6—9月在深圳市自愿咨询检测(VCT)点和MSM经常活动的桑拿、酒吧、公园、会所对MSM进行问卷调查,调查内容包括社会人口学和高危性行为特征,同时抽血检测艾滋病和梅毒的感染情况。采用2检验及logistic回归分析方法对MSM异性性行为发生的影响因素进行单、多因素的分析。结果在调查的455名MSM中,29.9%(136/455)的人在近6个月内与女性发生过性行为,其中有89.7%(122/136)和69.9%(95/136)的人分别与固定女性性伴及与非固定女性性伴发生过性行为,其与固定女性性伴及与非固定女性性伴发生性行为时,每次都使用安全套的比例分别为28.7%(35/122)和38.9%(37/95)(P0.05)。在发生异性性行为的136名MSM中,HIV和梅毒的感染率分别为3.7%(5/136)和10.3%(14/136),未发生异性性行为的319名MSM中,HIV和梅毒的感染率分别为5.3%(17/319)和12.9%(41/319),HIV、梅毒感染率在2类人群中的差别均无统计学意义(P0.05)。多因素logistic回归分析显示,婚姻状况(相对于在婚和同居,其他婚姻状况的OR值为0.34)、性取向(相对于同性恋,异性恋和双性恋的OR值分别为16.56和2.79)、首次性交对象(相对于男性性伴,女性性伴的OR值为5.46)等3个变量对MSM人群近6个月发生异性性行为有影响(P0.01)。结论深圳市MSM人群中发生异性性行为的比例较高,而安全套的使用率较低,需加大对该人群的干预力度,提高安全套使用率,以控制HIV/STD通过该人群向女性传播的危险。     

2010年镇江市男男性行为者队列基线调查

目的了解江苏省镇江市男男性行为者(men who have sex with men,MSM)艾滋病高危行为特征、感染情况及其影响因素。方法采用分类滚雪球抽样的方法于2010年2—9月,在镇江市范围内招募MSM进行问卷调查,了解其社会人口学及艾滋病高危行为特征,并采集血样进行人类免疫缺陷病毒(HIV)抗体、梅毒抗体、丙型肝炎病毒(HCV)抗体的检测。结果共调查456名MSM,77.0%最近6个月发生过同性口交性行为,其中61.0%有多个同性口交性伴;87.1%最近6个月发生过同性肛交性行为,其中55.3%有多个同性肛交性伴,14.9%最近1周发生过多次同性肛交性行为;11.3%最近6个月与同性发生过商业性行为,34.9%与异性发生过性行为;最近6个月与同性发生口交性行为时坚持使用安全套的比例为16.0%,肛交时坚持使用安全套的比例是40.3%,与同性发生商业性行为时坚持使用安全套的比例是40.0%,与异性发生性行为时坚持使用安全套的比例为26.4%。456名调查者均采集血样进行了血清学检测,初筛HIV阳性人数40人,确证HIV阳性人数35人,阳性率为7.3%(95%CI 5.40%～10.51%);确证梅毒抗体阳性人数为48人,阳性率为10.5%(95%CI7.86%～13.71%);确证HCV抗体阳性人数为2人,阳性率为0.4%(95%CI0.05%～1.58%);确证HIV抗体与梅毒抗体合并阳性人数为4人,合并阳性率为0.9%(95%CI 0.24%～2.23%)。在多因素logistic回归模型中,月收入为1 000～3 000元(OR=0.40,95%CI 0.18～0.87)与HIV感染的关系具有统计学意义。结论镇江市MSM中无保护性性行为较为普遍,HIV和梅毒感染率较高,应在该人群中加强包括艾滋病宣传和安全套推广在内的艾滋病干预措施,控制艾滋病等性传播疾病的流行。     

Methotrexate and fertility in men

The possible deleterious effects of folic acid antagonist methotrexate on the fertility potential have been investigated in 26 male psoriatic patients. Examination for semen, testicular histology, and spermatogenic function using radioactive phosphorus revealed that methotrexate had no unfavorable effect on male fertility. A long follow up of the patients and their offspring is needed to exclude the possible teratogenic effect of the drug.     

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.     

Osteoporosis and hypogonadism in men

It is estimated that almost 1 in 10 men will suffer a fracture caused by osteoporosis after the age of 50 years. Among those are a considerable number of men who will fracture their hip. A number of therapies have demonstrated efficacy in improving bone density in men, and the issue of which therapy and when to institute it is addressed in this article.     

Adiposity and mortality in men

The relation between measures of adiposity and mortality has been a controversial topic. The authors examined prospectively the relation between several measures of adiposity and risks of overall and cause-specific mortality in 39,756 US men aged 40-75 years. During 10 years of follow-up (1986-1996), 1,972 deaths (747 from cancer, 423 from cardiovascular disease, and 802 from other causes) were documented. An elevated risk of death among the leanest men was partly accounted for by excess mortality during early follow-up and high mortality among those with a history of recent weight loss. After exclusion of men with substantial recent weight loss and deaths occurring during the first 4 years of follow-up, overall and cardiovascular disease mortality among men aged <65 years increased linearly with greater body mass index (BMI) (weight (kg)/height (m)2); multivariate relative risks for overall mortality were 1.0 (referent) for a BMI of <23, 1.21 for a BMI of 23-24.9, 1.19 for a BMI of 25-26.9, 1.39 for a BMI of 27-29.9, and 1.97 for a BMI of >30 (test for trend: p< 0.001). Among men aged > or =65 years, there were no significant relations between BMI and overall, cardiovascular disease, or cancer mortality risk. However, waist circumference strongly predicted risk of death from cardiovascular disease among the older men. These findings indicated that the relation between body fat and mortality was influenced by reverse causation and varied by age.     

男男性行为者心理弹性及其影响因素研究

目的　探讨家庭关怀、社会支持和常见心理症状对男男性行为者心理弹性的影响,为制定干预措施提供依据。方法 采用横断面研究设计,在阜阳市同性恋人群活动场所及自愿咨询检测门诊以方便抽样法招募研究对象,知情同意后进行问卷调查。结果　共调查105名男男性行为者（MSM）,收获有效问卷100份,年龄最小16岁,最大53岁,平均年龄(24.20±6.24)岁。高学历男男性行为者的心理弹性得分较高,其他人口学变量间弹性得分差异均无统计学意义;抑郁和孤独与心理弹性呈负相关（r=-0.361,P=0.010;r=-0.354,P=0.012）,社会支持和家庭关怀与心理弹性呈正相关（r=0.300,P=0.034;r=0.414,P=0.003）。多重线性回归显示,家庭亲密度越高、社会支持利用度越多的男男性行为者心理弹性越好。结论　家庭关怀和社会支持与男男性行为者心理弹性密切相关,应加大家庭社会对男男性行为者的关怀和支持力度,提升MSM心理发展弹性化。     

Gay men and other men who have sex with men in West Africa: evidence from the field

This paper presents a synthesis of lessons learned from field experiences in HIV prevention, treatment and care services for men who have sex with men in the four contiguous West African countries of the Gambia, Guinea-Bissau, Guinea-Conakry and Senegal. Service provision for men who have sex with men in these countries is contextualised by the epidemiology of HIV, as well as the socio-political environment. These countries share notable commonalities in terms of social structures and culture, though past approaches to the needs of men who have sex with men have varied greatly. This synthesis includes three distinct components. The first focuses on what is known about HIV epidemiology among men who have sex with men in these countries and provides an overview of the data gaps affecting the quality of service provision. The second aspect describes the HIV prevention and treatment services currently available and how organisations and strategies have evolved in their approach to working with men who have sex with men. Finally, an examination of the political and cultural climate highlights socio-cultural factors that enable or impede HIV prevention and treatment efforts for men who have sex with men. The review concludes with a series of recommendations for impactful research, advocacy and service provision to improve the health and human rights context for men who have sex with men in West Africa.     

Anorectal malignancies and dysplasia in HIV-positive men who have sex with men

Since the HIV epidemic, the incidence ofanorectal (pre)malignancies in men who have sex with men (MSM) is increasing. The incidence is likely to increase further in the coming years, given that HIV-positive MSM are living longer thanks to powerful antiretroviral treatment. Persistent human papillomavirus (HPV) infection is a major risk factor for the development of anal (pre)malignancies. Less is known about the natural history of anal intraepithelial neoplasia (AIN). Screening in HIV-positive and HIV-negative MSM for anorectal malignancies or dysplasia is cost-effective if the incidence is sufficiently high. Treatment options range from watchful waiting for asymptomatic grade-1 AIN to excision or radio(chemo)therapy for anorectal carcinoma. HPV vaccines are in development. Especially in HIV-positive MSM with anorectal complaints or genital warts in their medical history, one should consider these malignancies.