年轻男男性行为者艾滋病相关行为自主性变化及影响因素

目的 了解年轻男男性行为者（young men who have sex with men,YMSM）艾滋病相关行为自主性变化及影响因素。方法 开展了YMSM前瞻队列研究,用滚雪球抽样法,在绵阳市招募15~24岁的YMSM进行艾滋病相关行为自主性的基线调查并建立随访队列,实施行为干预12个月后进行随访调查。通过广义估计方程分析YMSM行为自主性变化,采用χ²检验、Logistics回归分析其行为自主性变化的影响因素。结果 入组队列328人,随访调查198人（60.37%）。基线与随访调查相比：性伴相处坚持自我主张从79.9%上升到89.8%,近6个月肛交主动每次准备安全套从64.6%上升到79.8%、性伴不用安全套进行劝说从50.8%上升到70.5%、肛交没有安全套去买/非插入性行为从59.2%上升到84.4%（均P<0.05）。单因素分析显示焦虑症状,抑郁症状,风险认识,近6个月肛交主动每次准备安全套、劝说性伴使用安全套效果、性角色、有保护肛交、有保护固定性行为与行为自主性变化有关（均P<0.05）。多因素分析结果：有抑郁症状（OR=0.024）、有风险认识（OR=0.145）的行为自主性变化的可能性较小,近6个月有保护肛交的（OR=23.831）行为自主性变化的可能性较大。结论 绵阳市YMSM行为自主性变化明显,行为自主性变化与心理健康、风险认识和性行为保护有关,行为自主性变化能有效降低其行为风险。

AIDS-related behavioral autonomy changes and influencing factors of young men who have sex with men

Objective To understand AIDS-related behavioral autonomy changes and influencing factors of young men who have sex with men (YMSM). Methods A prospective cohort study of YMSM was conducted. The snowball sampling method was used to recruit YMSM aged 15-24 in Mianyang City to conduct a baseline survey of AIDS-related behavioral autonomy, and establish follow-up cohort, by 12 months after the implementation of behavioral interventions. The generalized estimation equation was used to analyze the change of YMSM′s behavioral autonomy, and the influencing factors of YMSM′s behavioral autonomy were analyzed by chi-square test and Logistic regression. Results Totally 328 people were enrolled in the cohort, and 198 were followed up (60.37%). Baseline compared with follow-up survey: the percentage of sexual partners who maintained self-esteem increased from 79.9% to 89.8%, in the past six months, active condom preparation increased from 64.6% to 79.8%, the percentage of condom persuasion by sexual partners increased from 50.8% to 70.5%, and the rate of condom purchase / non-penetration during anal intercourse increased from 59.2% to 84.4% (all P<0.05). Univariate analysis showed that anxiety symptoms; depression symptoms; risk perception; in the last 6 months, the active condom preparation, the effect of persuading partners to use condoms, sex role, protective anal sex, protective fixed behavior were related to behavioral autonomy changes (all P<0.05).Multivariate analysis: Those with depressive symptoms (OR=0.024) and risk perception (OR=0.145) were less likely to have behavioral autonomy changes, and those with anal protection in the last 6 months (OR=23.831) were more likely to have behavioral autonomy changes. Conclusion The behavioral autonomy of YMSM in Mianyang city changed significantly, which was related to mental health, risk awareness and sexual behavior protection, and the change of behavioral autonomy effectively reduced the behavioral risk.