中国男男性行为群体HIV干预面临的挑战：基于社区和已发表证据的循证评价

目的对中国男男性行为人群中艾滋病干预面临的挑战进行初步循证评价。方法社区证据来源于对相关工作者、专家的访谈以及近5年对国内同志艾滋病防治活动的参与经验。已发表文献的证据，通过确定检索策略、人选标准和特定关键词，采用系统化的文献检索，收集与研究目的有关的文献，检索数据库包括中国生物医学文献数据库（1996—2007）、MEDLINE（1996—2007）及相关网页。结果以社区组织为基础和以“扩散理论”为指导的干预模式在知识传播、行为改变方面面临巨大挑战。表现为传递的教育信息质量低、教育娱乐化、安全套可及性不足，心理社会支持重视不够等问题。此外，普遍存在的滥用公共卫生术语“MSM”的现象。缺乏对MSM群体的社会及文化特征的研究。结论中国MSM群体中的艾滋病防治策略需要做大的调整和改进。需要建立高效的媒体反应机制以消除错误信息，应在政策上纳入反对性倾向歧视，大力倡导感染者参与，鼓励对MSM中不同群体的社会、心理需求进行更多研究，民间组织在促进男同性性行为者的自我认同、心理支持方面进行更多工作。应将循证项目评估原理和方法整合成项目评估体系。

Challenges on China's HIV/AIDS Intervention for Male Have Sex With Male: An Appraisal Based Evidence From Community, Behaviour and Sociological Research

Objective To systematically assess the barriers and gaps on HIV/AIDS intervention for male have sex with male (MSM). In the last five years, HIV infection has spread at a rapid rate among the MSM popu-lation. Methods Evidence is collected by systematically retrieve from computerized database as: MEDLINE (1996 - 2007), Chinese Bio-Medicine Database (CBM) and relevant websites. The interviews to community activists, volunteers and gay men people also have been conducted. Result The spread of the HIV epidemic shows no sign of slowing down. The evidence shows that big gaps existing. The current intervention model in China focuses on peer education, hotline counseling and outreach. Many of the intervention activities are not successful in providing concise information that participants could take home. Most of these interventions are project driven and lack sustainability. The outcome evaluation is very weak. There is an over reliance on physical distribution of condoms hut little attention is paid to the social and psychological reason for low con-dom usage. We need a big change on providing evidence-based intervention. Civil society and Chinese gov-emment have recognized community mobilization as an important part of HIV/AIDS campaign. However, the mobilization is still limited. Most member of the commu-nity are not participating, especially those who are living with HIV/AIDS. Another main challenge comes from the indiscriminate use of the term " MSM" which in the Chi-nese context enables the government and society at large to avoid confronting the issue of sexual minority and their plight. Conclusion It is urgently necessary to adjust the strategy and policy for China's MSM HIV/AIDS intervention. A high efficient media response mechanism should be established to stop the inaccurate information. The anti-discrimination policy should be integrated into national strategy and framwork to against the sexual orientation based discrimination. PLWHA population should be mobilized to participate HIV/AIDS campaign. More multi-disciplinary researches are very needed to discover the social and mental health needs at different groups of MSM. Civil society should input the works on self-identity and mental health support. An evidence-based approach should be integrated into the monitoring and evaluation process.