黑龙江省四市MSM人群艾滋病相关高危行为及其影响因素分析

目的了解黑龙江省四市男男性行为人群（MsM）艾滋病相关高危行为及其影响因素，为制定针对性干预策略提供建议。方法采用同伴推动法和分类滚雪球抽样法招募MSM，进行一对一问卷调查，并采血检测艾滋病病毒（HIV）、梅毒、丙型肝炎病毒（HCV）抗体。以不安全性行为为应变量，人口学特征、艾滋病知识知晓情况、干预服务覆盖情况、高危性行为情况等因素为自变量，进行多因素逐步向前Logistic回归分析。结果共调查1353名MSM。最近6个月，83．8％的MSM与男性发生过肛交性行为，56．7％有2个以上男性伴，无保护肛交率55．4％；7．5％发生过商业性行为，无保护肛交率44．7％；22．1％与女性发生过性行为，无保护率70．2％。最近1年干预服务覆盖率80．6％。月收入高于2000元、从浴池、公园类场所寻找性伴、艾滋病知识不知晓、首次与男性性行为年龄小于25岁，是发生多男性伴行为的危险因素；月收入低于2000元、干预未覆盖、首次与男性发生性行为年龄小于18岁、浴池、公园类场所寻找性伴，是与男性发生无保护肛交行为的危险因素；初中及以下低文化、非同性恋取向、艾滋病知识不知晓、有多男性伴行为，是与男性发生商业性行为的危险因素；已婚、与男性有无保护肛交行为是与女性发生无保护性行为的危险因素。结论四市MsM人群干预覆盖率低，促成HIV传播的高危性行为情况较严重，急需在相关方面加强。四市目前所开展的干预服务促进了男男性行为的安全套使用，但使用水平较低，且对多男性伴行为、商业性性行为、与女性性行为的安全性均无明显影响，需要在干预的有效性上下功夫，在干预内容上加以完善。

An analysis of HIV/AIDS related high-risk behavior,infection status and impact factors among MSM in Heilongjiang Province

Objective To understand the HIV/AIDS related high-risk behaviors and impact factor among MSM in four cities of Heilongjiang Province , and give some suggestions for development of targeted intervention policy. Methods A face-to-face structure questionnaire interview was conducted among MSM recruited by using RDS（Re- spondent Driven Sampling） and snowball sampling, and. blood samples were taken to test HIV, syphilis and HCV antibodies. Unsafe sexual behaviors as dependent variable,demographic features, H IV awareness, intervention coverage and high-risk behaviors as independent variable were analyzed by multivariate-factor forward stepwise logistic regression （a入 =0.10,a出 =0.15）. Results A total of 1353 MSM were tested. During the past six months, the rate of unprotected anal sex was 83.8%, among which 56.7% had more than two male sex partners and 55.4% had un- protected anal sex, 7.5% was engaged in commercial sex trade and 44.7% had unprotected anal sex, 22.1% had sex with females and 70.2% had unprotected sex. In the past year, the coverage of intervention service was 80.6%. The risk factors for multiple-male-partner sex included：monthly incomes above 2000 yuan,looking for sex partners in inns, bathrooms, public parks or other entertainment venues, poor AIDS knowledge,first sex with males below 25 years of age. Monthly incomes below 2000 yuan, without interventions, first sex with males below 18 years of age and looking for sex partners in bathrooms/parks were the risk factors for unprotected anal sex with males. The risk factors for sex trade with males were low education background/below junior or high schooling,non-homosexual orientation, poor AIDS knowledge and multiple male sex partners. The risk factors for unprotected sex with females included having married and unprotected anal sex with men. Conclusions The present status of MSM in four cities in- cludes poor intervention coverage and serious high risk sexual behaviors contributing to HIV spread, which should be given high attention. At