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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (3): 511-517. doi: 10.19723/j.issn.1671-167X.2021.03.012

• 论著 • 上一篇    下一篇

青年学生男男性行为人群中人类免疫缺陷病毒阳性与阴性者获得性免疫缺陷综合征(艾滋病)相关知识与行为比较

李远骋,崔闻心,郭雪儿,朱璠,刘思辰,贾碧波,汪培,马迎华Δ()   

  1. 北京大学公共卫生学院,北京大学儿童青少年卫生研究所,北京 100191
  • 收稿日期:2021-02-28 出版日期:2021-06-18 发布日期:2021-06-16
  • 通讯作者: 马迎华 E-mail:yinghuama@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81673245)

Comparison of acquired immure deficiency syndrome-related knowledge and behavior between persons with and without human immunodeficiency virus-infection among young male students who have sex with men

LI Yuan-cheng,CUI Wen-xin,GUO Xue-er,ZHU Fan,LIU Si-chen,JIA Bi-bo,WANG Pei,MA Ying-huaΔ()   

  1. Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
  • Received:2021-02-28 Online:2021-06-18 Published:2021-06-16
  • Contact: Ying-hua MA E-mail:yinghuama@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81673245)

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摘要：

目的: 了解青年学生男男性行为人群(male students who have sex with men,MSM)中HIV阳性与阴性者在获得性免疫缺陷综合征(艾滋病)相关知识与行为上的差异,为针对该人群制定艾滋病防控干预策略提供依据。方法: 于2017 年4月—2018年3月,在哈尔滨、天津、西安、重庆4 个城市,采用滚雪球抽样和受试者推荐的混合抽样方法,对HIV感染青年学生社交圈(其中既包含HIV阳性者也包含HIV阴性者)中的MSM 进行横断面调查,使用卡方检验和二元Logistic回归分析比较HIV阳性与阴性者在艾滋病相关知识与行为上的差异。结果: 共获得问卷583 份,其中有效问卷548 份,有效率94.0%。接受教育为大专及以下(P=0.002)、月消费水平在2 000元以下(P=0.021)、主要居住地为校外(P=0.004)与HIV检测阳性间存在关联。在任何学段接受艾滋病预防教育都是HIV感染的保护因素[小学OR=0.203(0.073~0.561),初中OR=0.287(0.142~0.581),高中OR=0.271(0.142~0.518),大学OR=0.322(0.168~0.616)]。HIV阳性与阴性者对“国八条”(P=0.907)和“青八条”(P=0.782)的认知上差异无统计学意义,知晓率均约在90%,对某些具体知识的需求差异有统计学意义(“艾滋病防治政策”P=0.012,“识别并预防高危性行为的方法”P<0.001)。HIV阳性者首次性行为年龄较小(P=0.006),早期性伴较多(P<0.001)且安全套使用情况较差(P<0.001),但两者后期性伴数量(P=0.247)和安全套使用情况(对固定性伴P=0.735,对临时性伴P=0.765)差异无统计学意义,可能与HIV感染导致其性行为特征改变有关(对固定性伴P<0.001,对临时性伴P=0.006)。结论: 青年学生MSM中HIV阳性与阴性者在“国八条”和“青八条”的掌握上差异无统计学意义,且均低于国家要求的95%,但在知识需求上体现出了一定特异性;两者近期性行为特征差异无统计学意义,但HIV阳性者在早期性行为活动中更容易发生高危性行为,提示应该继续加强性教育和艾滋病预防教育,并将关口前移,有针对性地调整教育内容,尽早预防青年学生MSM发生高危性行为。

关键词: 获得性免疫缺陷综合征, 男男性行为人群, 学生, 知识, 行为

Abstract:

Objective: To understand the differences between young male students who have sex with men (MSM) with and without human immunodeficiency virus (HIV)-infection in acquired immure deficiency syndrome (AIDS)-related knowledge and behavior, and to provide a scientific reference to make targeted and effective measures in AIDS prevention. Methods: Using snow balling sampling combined with participants’ referral, we conducted a questionnaire survey among 548 young MSM students (in whom there were both HIV-positive and HIV-negative) in Harbin, Tianjin, Xi’an, and Chongqing cities from April 2017 to March 2018. The chi-square test and binary Logistic regression were used to compare the differences in AIDS-related knowledge and behavior between males with and without HIV-infection. Results: A total of 583 questionnaires were obtained, of which 548 were valid, with an effective rate of 94.0%. Having a junior college education or below (P=0.002), a monthly consumption level of less than 2 000 RMB (P=0.021), and living off campus (P=0.004) were associated with being tested positive for HIV. In any period of schooling, receiving AIDS prevention education was a protective factor for HIV infection [Primary school OR=0.203 (0.073-0.561), junior high school OR=0.287 (0.142-0.581), senior high school OR=0.271 (0.142-0.518), and university OR=0.322 (0.168-0.616)]. There was no statistical difference between HIV positive and negative young MSM students in the cognition of “AIDS-related Knowledge for Public”(P=0.907) and “AIDS-related Knowledge for Youth”(P=0.782), with the awareness rate all about 90%. There was a statistical difference in the need for some specific knowledge (For “AIDS prevention and treatment policy”, P=0.012, for “Ways to identify and prevent high-risk sexual behavior”, P<0.001). HIV-positive males had a younger age of first sexual activity (P=0.006), had more sexual partners in the early (P<0.001) and had lower frequency of condom use (P<0.001). However, there was no statistical difference in the later number of sexual partners (P=0.247) and the frequency of condom use (For regular sex partners, P=0.735, and for casual sex partners, P=0.765), which might be related to the change of sexual behavior characteristics caused by HIV infection (For regular sex partners, P<0.001, and for casual sex partners, P=0.006). Conclusion: There was no statistical difference between HIV positive and negative young MSM students in the cognition of “AIDS-related Knowledge for Public” and “AIDS-related Knowledge for Youth”, which were both lower than 95% required by the state. However, the specificity in the knowledge needs was certainly shown. There was no significant difference in the recent sexual behavior between the two groups, but HIV positive students were more likely to have high-risk sexual behaviors in the early stage, so we should strengthen and move forward the sex education and AIDS prevention education with adjusted contents, and prevent high-risk sexual behaviors within young MSM students in the early stage.

Key words: Acquired immune deficiency syndrome, Men who have sex with men, Students, Knowledge, Behavior

中图分类号: 

  • R183

表1

不同HIV感染状况青年学生MSM人口学特征差异比较"

Demographic characteristic HIV-positive HIV-negative χ2 P
n % n %
Nationality 0.055 0.815
Han 170 95.0 343 94.5
Other 9 5.0 20 5.5
Education 14.516 0.002
High school or less 15 8.5 12 3.3
Junior college 35 19.9 45 12.5
Undergraduate 106 60.2 240 66.5
Graduate student or higher 20 11.4 64 17.7
Major 5.886 0.117
Liberal arts 62 36.9 115 33.0
Science and engineering 79 47.0 186 53.4
Medicine 5 3.0 19 5.5
Art and athletics 22 13.1 28 8.0
Monthly consumption/Yuan 7.694 0.021
<1 000 35 19.7 48 13.1
1 000-1 999 120 67.4 242 65.9
≥2 000 23 12.9 77 21.0
Main residence 8.239 0.004
On campus 107 61.1 269 73.3
Off campus 68 38.9 98 26.7

表2

不同HIV感染状况青年学生MSM回答艾滋病相关知识的Logistic回归分析 (n=537)"

AIDS-related knowledge β SE Wald χ2 P OR 95%CI
①AIDS can be cured -0.380 0.220 2.982 0.084 0.684 0.445-1.053
②At present, the prevalence of AIDS among youth students is growing rapidly in
China. The main transmission mode is homosexual orientation among men,
followed by heterosexual behavior		 0.266 0.232 1.316 0.251 1.305 0.828-2.054
③HIV-positive individuals can be recognized from his appearance 0.544 0.359 2.303 0.129 1.723 0.853-3.481
④Eating meal with HIV-positive individuals can get infected with HIV -0.284 0.319 0.794 0.373 0.753 0.403-1.406
⑤The correct use of condoms can reduce the risk of getting infected with HIV -0.179 0.515 0.120 0.729 0.836 0.305-2.296
⑥Using new-type drugs (such as methamphetamine) can increase the risk of
getting infected with HIV		 0.066 0.289 0.052 0.820 1.068 0.606-1.882
⑦After unprotected sexual behavior, one should take HIV testing and counseling
actively		 -0.972 0.627 2.401 0.121 0.379 0.111-1.293
⑧The rights and interests of marriage, employment and being educated of HIV-
positive individuals are protected by laws in China		 -0.321 0.255 1.580 0.209 0.725 0.440-1.197
⑨Insect bites can spread HIV 0.852 0.281 9.203 0.002 2.344 1.352-4.064
⑩Sharing syringes with HIV-positive individuals can get infected with HIV -0.440 0.558 0.621 0.431 0.644 0.216-1.923
?The HIV-positive women may give birth to a HIV-positive baby -0.121 0.370 0.108 0.743 0.886 0.429-1.829
?Transfusing blood with HIV can get infected with HIV -0.228 0.610 0.139 0.709 0.796 0.241-2.633
?Having sexual relations with only one sexual partner can reduce the risk of
getting infected with HIV		 -0.287 0.223 1.666 0.197 0.750 0.485-1.161

图1

全13条总分筛选不同HIV感染状况青年学生MSM的ROC曲线"

表3

开始接受艾滋病预防教育学段对HIV感染影响的Logistic回归分析 (n=545)"

Initiatory phase of receiving AIDS prevention education β SE Wald χ2 P value OR 95%CI
Primary school -1.595 0.519 9.434 0.002 0.203 0.073-0.561
Junior high school -1.248 0.360 12.032 0.001 0.287 0.142-0.581
Senior high school -1.307 0.331 15.615 <0.001 0.271 0.142-0.518
University -1.133 0.331 11.741 0.001 0.322 0.168-0.616

表4

不同HIV感染状况青年学生MSM性行为差异比较"

Sexual behavior HIV-positive HIV-negative χ2 P
n % n %
Age of first penetrative sex behavior 7.574 0.006
Before 20 years old 133 76.4 234 64.6
At or older than 20 years old 41 23.6 128 35.4
Number of sexual partners before college 18.481 <0.001
1 or less 87 52.4 257 71.6
more than 1 79 47.6 102 28.4
Number of sex partners after college* 1.338 0.247
1 or less 16 13.6 55 18.3
more than 1 102 86.4 246 81.7
Using condom every sexual act with regular sex partners 3 months before diagnosis of
AIDS		 49.733 <0.001
Yes 33 31.4 170# 72.0#
No 72 68.6 66# 28.0#
Using condom every sexual act with casual sex partners 3 months before diagnosis of
AIDS		 40.167 <0.001
Yes 21 27.3 131# 69.7#
No 56 72.7 57# 30.3#
Using condom every sexual act with regular sex partners in recent 3 months 0.115 0.735
Yes 46 74.2 170 72.0
No 16 25.8 66 28.0
Using condom every sexual act with casual sex partners in recent 3 months 0.089 0.765
Yes 21 72.4 131 69.7
No 8 26.7 57 30.3
The frequency of sexual behavior in recent 3 months (times each month) 86.462 <0.001
0 89 51.4 51 14.3
1 37 21.4 134 37.6
2-5 40 23.1 162 45.5
6-10 4 2.3 6 1.7
More than 10 3 1.7 3 0.8
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ISSN 1671-167X
CN 11-4691/R
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