HIV阳性男男性行为者对男性固定性伴性传播危险分析

目的 了解有高危性行为的HIV阳性男男性行为人群（men who have sex with men，MSM）对男性固定性伴的性传播危险状况，探讨对固定性伴性传播危险相关联的因素。方法 采用滚雪球抽样方法，在上海和成都市招募有高危性行为的HIV阳性MSM作为研究对象，运用匿名方式，进行一对一问卷调查。结果 研究对象中，最近6个月对男性固定性伴有性传播危险的比例为26.9%（83/308）；多因素分析显示，确认HIV感染时间<1年者对男性固定性伴传播危险，分别是HIV感染确认时间在1～2年和≥3年者的3倍（OR=0.34，95%CI：0.15～0.79）和6倍（OR=0.17，95%CI：0.06～0.49）；将HIV感染状况告知全部男性固定性伴的调查对象，对男性固定性伴的传播危险是全部未告知者的1/25（OR=0.04，95%CI：0.01～0.13）；家人知晓HIV感染状况者对男性固定性伴传播危险降低到1/4（OR=0.24，95%CI：0.10～0.55）；通过互联网寻找性伴者对男性固定性伴的传播危险是其它途径的3倍（OR=0.33，95%CI：0.14～0.78）。结论 HIV阳性MSM与男性固定性伴间存在的性传播危险可能加速HIV在MSM人群中的扩散。强化性伴告知、及早抗病毒治疗及新媒体干预等方法可望发挥遏制HIV继续传播的作用。

Survey on risk of HIV-sexual transmission from HIV-positive men who have sex with men to their male primary sexual partners through unprotected sexual behaviors

Objective To investigate the risk of HIV-sexual transmission to primary partners among HIV-positive men who have sex with men(MSM) who engaged in unprotected sexual behaviors and to determine the contributions of its factors to HIV transmission risk. Methods Participants were recruited by "snowball" sampling in Shanghai and Chengdu of China. The survey was administered face-to-face by well trained staff in a confidential room. All participants completed questionnaire anonymously. Results Approximately 26.9 percent (83/308) of participants had the sexual transmission risk to their primary partners. The results of multiple Logistic regression showed that HIV-sexual transmission risk among participants who were diagnosed HIV infection within one year was 3 times(OR=0.34,95% CI:0.15-0.79) and 6 times(OR=0.17,95% CI:0.06-0.49), respectively, than that of the ones diagnosed between 1-2 years and more than 3 years. Furthermore, disclosure of HIV infection to their family and all their primary sexual partners were protective factors for the HIV-sexual transmission risk, OR=0.24 (95% CI:0.10-0.55) and OR=0.04 (95% CI:0.01-0.13) respectively. In addition, the risk of HIV-sexual transmission to primary sexual partners among participants who looked for sexual partners by internet increased 3 times of that among participants by other ways(OR=0.33,95% CI:0.14-0.78). Conclusions HIV-sexual transmission risk between HIV-positive MSM and their male primary sexual partners could accelerate HIV spread among MSM, thus, intervention practice of early ART, sexual partner notification and family disclosure, as well as new media intervention are urgently needed.