哈尔滨市2009-2018年男男性行为人群HIV感染状况分析

目的分析2009-2018年哈尔滨市MSM的HIV感染状况、时间变化趋势及其相关因素,为MSM艾滋病综合干预提供参考依据。方法采用横断面调查方法,2009-2018年每年4-7月在哈尔滨市通过滚雪球方法招募MSM作为研究对象,使用统一的调查问卷收集其人口学、行为学及血清学相关信息。运用SPSS 23.0软件进行统计学分析,运用Joinpoint 4.8.0.1软件计算各变量年度变化百分比(APC),采用Joinpoint回归模型进行时间趋势分析。结果2009-2018年调查MSM共4813人,HIV抗体阳性率为11.3%(543/4813)。Joinpoint回归分析结果显示,以2015年为分界点,2009-2015年HIV抗体阳性率呈上升趋势(Z=4.2,P<0.05),2015-2018年呈下降趋势(Z=-1.3,P=0.3)。梅毒抗体阳性率为12.9%(621/4813),Joinpoint回归分析结果显示,2009-2013年哈尔滨市MSM梅毒抗体阳性率呈快速下降趋势(Z=-2.8,P<0.05),2013-2018年呈缓慢下降趋势(Z=-0.7,P=0.5)。多因素logistic回归分析结果显示,MSM感染HIV危险因素包括网络招募(aOR=1.307,95%CI:1.057~1.617)、年龄≥30岁(aOR=1.905,95%CI:1.235~2.939)和梅毒抗体阳性(aOR=4.728,95%CI:3.751~5.961);保护因素包括艾滋病知识知晓(aOR=0.598,95%CI:0.433~0.825)和最近6个月同性肛交坚持使用安全套(aOR=0.683,95%CI:0.550~0.850)。结论2009-2018年哈尔滨市MSM的HIV阳性率呈先上升后下降的趋势,2015年达到峰值,梅毒抗体阳性率呈下降趋势,基于社交软件、年龄≥30岁及梅毒抗体阳性的干预模式需重点探索,并促进使用安全套和梅毒转诊治疗。

Status of HIV infection among men who have sex with men in Harbin, 2009-2018

Objective To explore the status of HIV infection, time trends and related factors of MSM in Harbin from 2009 to 2018 and provide evidences for comprehensive prevention and control strategies of MSM HIV/AIDS. Methods From April to July during 2009-2018, continuous cross-sectional studies were conducted on MSM recruited through snowball sampling. The unified questionnaire was used to collect demographic, behavioral, and serological information. The SPSS 23.0 software was used for statistical analysis, and the Joinpoint 4.8.0.1 software was applied to the annual percent change (APC) for time trends analysis using the Joinpoint regression model. Results A total of 4 813 MSM were surveyed in Harbin from 2009 to 2018. The overall HIV antibody positive rate was 11.3% (543/4 813). Joinpoint regression analysis showed that there was an increase in the HIV antibody positive rate from 2009 to 2015, while the segmentation point was in 2015 (Z=4.2, P<0.05) but, there was a decrease from 2015 to 2018(Z=-1.3, P=0.3). The positive rate of syphilis antibody was 12.9% (621/4 813). There was a decrease in the positive rate of syphilis antibodies from 2009 to 2013 (Z=-2.8,P<0.05). There was a decrease in the positive rate of syphilis antibodies from 2013 to 2018 (Z=-0.7,P=0.5). Results from multiple logistic aggression analysis showed that the risk factors associated with the prevalence of HIV infection including network recruitment (aOR=1.307, 95%CI:1.057-1.617), age 30 and above (aOR=1.905, 95%CI:1.235-2.939) and syphilis antibody positive (aOR=4.728, 95%CI:3.751-5.961). Protective factors appeared:knowledge of HIV/AIDS (aOR=0.598, 95%CI:0.433-0.825) and consistent use of condom during anal sex in the past six months (aOR=0.683, 95%CI:0.550-0.850). Conclusions The HIV antibody positive rate peaked in 2015 among MSM in Harbin from 2009 to 2018, first increased and then decreased. The positive rate of syphilis antibody showed a decreasing trend. Intervention models based on social media software, age 30 and above and syphilis antibody-positive need to be explored. It also promotes condom use and referral for syphilis among MSM.