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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (3): 511-520. doi: 10.19723/j.issn.1671-167X.2023.03.018

• 论著 • 上一篇    下一篇

中国成都男男性行为人群HIV暴露前预防用药行为-认知偏差现状及其影响因素

林浩1,李菁华2,杨潇2,陈晓婷2,史宇晖1,常春1,郝元涛1,2,曹望楠1,*()   

  1. 1. 北京大学公共卫生学院社会医学与健康教育系, 北京 100191
    2. 中山大学公共卫生学院医学统计学系, 广州 510080
  • 收稿日期:2023-02-28 出版日期:2023-06-18 发布日期:2023-06-12
  • 通讯作者: 曹望楠 E-mail:wangnancao@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81803334);国家科技重大专项(2018ZX10715004);广东省基础与应用基础研究基金自然科学基金(2023A1515030093);北京大学医学部学科建设项目人才专项(BMU2022RCZX032)

Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China

Hao LIN1,Jing-hua LI2,Xiao YANG2,Xiao-ting CHEN2,Yu-hui SHI1,Chun CHANG1,Yuan-tao HAO1,2,Wang-nan CAO1,*()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-02-28 Online:2023-06-18 Published:2023-06-12
  • Contact: Wang-nan CAO E-mail:wangnancao@bjmu.edu.cn
  • Supported by:
    National Natural Sciences Foundation of China(81803334);National Science and Technology Major Project(2018ZX10715004);Guangdong Basic and Applied Basic Research Foundation(2023A1515030093);Peking University Faculty Startup Research Grant(BMU2022RCZX032)

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摘要：

目的: 探索中国成都男男同性性行为人群(简称“男同”)人类免疫缺陷病毒(human immunodeficiency virus，HIV)暴露前预防用药(pre-exposure prophylaxis，PrEP)行为-认知偏差的现状和影响因素，以明确PrEP干预的重点人群并设计实施有针对性的干预来缩小这个偏差。方法: 在2021年11—12月期间开展了一项面向HIV阴性男同的横断面调查，由中国成都本地男同社区组织招募和筛选研究对象。收集研究对象的社会人口学特征、PrEP认知和PrEP适用性评价指标等信息。遵循《中国HIV暴露前预防用药专家共识》，本研究中PrEP适用的高危行为学指标包括(在过去6个月有以下行为之一)：没有一直使用安全套、有HIV阳性性伴、确诊性传播疾病、药物滥用和使用过暴露后预防用药(post-exposure prophylaxis，PEP)。采用Logistic回归模型进行单因素和多变量分析。结果: 在纳入的622名研究对象中，52.6%(327/622)客观符合PrEP的高危行为学指标，但只有37.9%(124/327)认为自己是PrEP的适用对象，余下的62.1%(203/327)存在行为-认知偏差；85.9%(281/327)听说过PrEP，其中14.2%(40/281)以医务人员作为PrEP信息获取渠道。在327名行为导向PrEP使用适宜对象中，47.1%知晓如何获取PrEP药物，33.0%有过正规PrEP咨询经历，93.3%周围没有或少有使用PrEP的朋友，54.1%PrEP知识得分在8分及以上，66.7%报告过去6个月有2位及以上同性性伴。在控制年龄、研究对象招募来源等背景变量后，能够正确判断自身为PrEP使用对象(即不存在PrEP行为-认知偏差)的6个促进因素包括：PEP使用史[调整后的优势比(adjusted odds ratio，ORA)=2.20，95%置信区间(confidence interval，CI)：1.33~3.63]、PrEP可及性(ORA=1.69，95%CI：1.06~2.68)、认识更多正在使用PrEP的朋友(ORA=4.92，95%CI：1.77~13.65)、PrEP知识(ORA=2.21，95%CI：1.38~3.56)、多性伴关系(ORA=1.77，95%CI：1.07~2.94)以及自评高HIV感染风险(ORA=4.02，95%CI：1.73~9.32)。药物滥用和PrEP信息获取渠道等与PrEP行为-认知偏差无统计学关联。结论: 中国成都男同人群PrEP行为-认知偏差高。PrEP行为干预与促进项目应重点考虑辅助男同正确评估自身HIV感染风险，提升PrEP知识，提供规范PrEP咨询和培育男同社群同伴支持环境等。

关键词: 同性恋, 男性, 性行为, 暴露前预防, HIV感染, 认知不协调, 风险感知

Abstract:

Objective: To explore the discrepancy between behavioral-indicated candidacy and perceived candidacy (behavioral-perceived gap) and its associated factors of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM), so as to identify the focus population of PrEP interventions and to design and implement targeted interventions. Methods: We recruited a sample of 622 HIV-negative MSM who were regular clients of a community-based organization located in Chengdu, China, from November to December 2021. A cross-sectional questionnaire was used to collect the participants' information on social demographics, PrEP-related knowledge and cognitions, and risk behaviors. In this study, behaviorally eligible for PrEP was defined as performing at least one type of high-risk behavior in the past six months, including inconsistent condom use, sex with an HIV-positive partner, confirmed sexual transmitted infections (STI) diagnosis, substance use, and post-exposure prophylaxis (PEP) experience. Logistic regression models were fitted, and multivariate analyses were adjusted for social demographics. Results: Among the 622 eligible participants, 52.6% (327/622) were classified as behaviorally eligible for PrEP. Only 37.9% (124/327) of the participants perceived themselves as appropriate candidates for PrEP and 62.1% (203/207) had discrepancy between behavioral-indicated and perceived candidacy. 85.9% (281/327) had heard of PrEP, and 14.2% (40/281) accessed PrEP information through health care providers. Of the 327 participants eligible for behavior-indicated PrEP use, about half (47.1%) knew how to obtain PrEP medication and 33.0% had a professional PrEP counseling experience. The majority (93.3%) had no or few friends using PrEP. 54.1% scored eight or above in PrEP knowledge level. 66.7% reported having two or more sexual partners in the past six months. After adjusting for age and recruitment channel, we found six factors that were associated with perceived candidacy for PrEP, including PEP use [adjusted odds ratio (ORA)=2.20; 95% confidence interval (CI): 1.33-3.63], PrEP availability (ORA=1.69; 95%CI: 1.06-2.68), a greater number of PrEP-using friends (ORA=4.92; 95%CI: 1.77-13.65), PrEP know-ledge (ORA=2.21; 95%CI: 1.38-3.56), multiple sexual partnership (ORA=1.77; 95%CI: 1.07-2.94), and perceiving a higher risk of HIV infection (ORA=4.02; 95%CI: 1.73-9.32). Substance use during sex and PrEP information channel were not statistically associated with this beha-vioral-perceived gap. Conclusion: We observed a high discrepancy between behavioral-indicated and perceived candidacy for PrEP among Chengdu MSM in China. Future PrEP implementation efforts should be made in skills training in assessing HIV infection risk, increasing PrEP knowledge, providing professional PrEP counselling, and fostering PrEP support environment.

Key words: Homosexuality, male, Sexual behavior, Pre-exposure prophylaxis, HIV infections, Cognitive dissonance, Risk perception

中图分类号: 

  • R167

表1

行为导向PrEP使用适宜对象的社会人口学特征"

Items Total (n=327) No behavioral-perceived gap (n=124) Behavioral-perceived gap (n=203)
Recruitment channel
  MSM activity venues 52 (15.9) 13 (10.5) 39 (19.2)
  MSM peer network 169 (51.7) 70 (56.5) 99 (48.8)
  MSM community organization 106 (32.4) 41 (33.1) 65 (32.0)
Age
  18-24 years 92 (28.1) 34 (27.4) 58 (28.6)
  25-35 years 165 (50.5) 69 (55.6) 96 (47.3)
  >35 years 70 (21.4) 21 (16.9) 49 (24.1)
Current relationship status
  Single 48 (14.7) 21 (16.9) 27 (13.3)
  Relationship with a man 246 (75.2) 88 (71.0) 158 (77.8)
  Married 33 (10.1) 15 (12.1) 18 (8.9)
Education level
  College degree and below 176 (53.8) 62 (50.0) 114 (56.2)
  Undergraduate and above 151 (46.2) 62 (50.0) 89 (43.8)
Employment status
  Unemployed/part-time/retired/student 107 (32.7) 38 (30.6) 69 (34.0)
  Full-time 220 (67.3) 86 (69.4) 134 (66.0)
Personal monthly income
  ≤4 000 yuan 111 (33.9) 42 (33.9) 69 (34.0)
  4 001-6 000 yuan 107 (32.7) 45 (36.3) 62 (30.5)
  6 001-8 000 yuan 109 (33.3) 37 (29.8) 72 (35.5)
Sexual orientation
  Homosexual 274 (83.8) 106 (85.5) 168 (82.8)
  Bisexual/heterosexual/other 53 (16.2) 18 (14.5) 35 (17.2)

表2

行为导向PrEP使用适宜对象的PrEP及性行为相关特征"

Items Total (n=327) No behavioral-perceived gap (n=124) Behavioral-perceived gap (n=203)
Any condomless anal intercourse
  No 151 (46.2) 61 (49.2) 90 (44.3)
  Yes 176 (53.8) 63 (50.8) 113 (55.7)
Have HIV-positive partner(s)
  No 298 (91.1) 115 (92.7) 183 (90.1)
  Yes 29 (8.9) 9 (7.3) 20 (9.9)
Ever STI diagnosis
  No 303 (92.7) 118 (95.2) 185 (91.1)
  Yes 24 (7.3) 6 (4.8) 18 (8.9)
Substance use
  No 206 (63.0) 70 (56.5) 136 (67.0)
  Yes 121 (37.0) 54 (43.5) 67 (33.0)
PEP user
  No 231 (70.6) 76 (61.3) 155 (76.4)
  Yes 96 (29.4) 48 (38.7) 48 (23.6)
PrEP awareness
  No 46 (14.1) 15 (12.1) 31 (15.3)
  Yes 281 (85.9) 109 (87.9) 172 (84.7)
Sources of PrEP information
  Others 241 (85.8) 104 (83.9) 183 (90.1)
  HCP 40 (14.2) 20 (16.1) 20 (9.9)
PrEP availability
  No 173 (52.9) 58 (46.8) 115 (56.7)
  Yes 154 (47.1) 66 (53.2) 88 (43.3)
PrEP counseling experience with HCP
  No 219 (67.0) 79 (63.7) 140 (69.0)
  Yes 108 (33.0) 45 (36.3) 63 (31.0)
Peers who are on PrEP
  Many 22 (6.7) 15 (12.1) 7 (3.4)
  Few 166 (50.8) 59 (47.6) 107 (52.7)
  None 139 (42.5) 50 (40.3) 89 (43.8)
PrEP knowledge scorea
  ≤7 155 (45.9) 41 (33.1) 109 (53.7)
  >7 177 (54.1) 83 (66.9) 94 (46.3)
Sexual roleb
  Insertive 104 (31.8) 33 (26.6) 71 (35.0)
  Receptive 100 (30.6) 42 (33.9) 58 (28.6)
  Both 107 (32.7) 44 (35.5) 63 (31.0)
  No anal sex 16 (4.9) 5 (4.0) 11 (5.4)
Multiple homosexual partnershipb
  No 109 (33.3) 33 (26.6) 76 (37.4)
  Yes 218 (66.7) 91 (73.4) 127 (62.6)
Engagement in group sexb
  No 189 (57.8) 82 (90.1) 107 (84.3)
  Yes 29 (8.9) 9 (9.9) 20 (15.7)
Engagement in transactional sexb
  No 288(88.1) 112 (90.3) 176 (86.7)
  Yes 39 (11.9) 12 (9.7) 27 (13.3)
HIV test historyb
  No 82 (25.1) 33 (26.6) 49 (24.1)
  Yes 245 (74.9) 91 (73.4) 154 (75.9)
Perceived risk of HIV infectionc
  High-risk 29 (8.9) 18 (14.5) 11 (5.4)
  Medium-risk 85 (26.0) 34 (27.4) 51 (25.1)
  Low-risk 213 (65.1) 72 (58.1) 141 (69.5)

表3

与自我感知PrEP使用适宜性相关的背景特征"

Items Row% ORu (95%CI)
Recruitment channel
  MSM activity venues 25.0 1.00
  MSM peer network 41.4 2.12 (1.06-4.27)*
  MSM community organization 38.7 1.89 (0.90-3.96)?
Age
  18-24 years 37.0 1.37 (0.70-2.66)
  25-35 years 41.8 1.68(0.92-3.05)?
  >35 years 30.0 1.00
Current relationship status
  Single 43.8 1.00
  Relationship with a man 35.8 0.72 (0.38-1.34)
  Married 45.5 1.07 (0.44-2.61)
Education level
  College degree and below 35.2 1.00
  Undergraduate and above 41.1 1.28 (0.82-2.01)
Employment status
  Unemployed/part-time/retired/student 35.5 1.00
  Full-time 39.1 1.17 (0.72-1.88)
Personal monthly income
  ≤4 000 yuan 37.8 1.00
  4 001-6 000 yuan 42.1 1.19 (0.69-2.05)
  6 001-8 000 yuan 33.9 0.84 (0.49-1.47)
Sexual orientation
  Homosexual 38.7 1.00
  Bisexual/heterosexual/other 34.0 0.82 (0.44-1.51)

表4

自我感知PrEP使用适宜对象相关因素的单因素分析"

Items Row% ORu (95%CI) ORA (95%CI)a
Any condomless anal intercourse
  No 40.4 1 1
  Yes 35.8 0.82 (0.53-1.29) 0.87 (0.55-1.37)
Have HIV-positive partner(s)
  No 38.6 1 1
  Yes 31 0.72 (0.32-1.63) 0.79 (0.33-1.87)
Ever STI diagnosis
  No 38.9 1 1
  Yes 25 0.52 (0.20-1.35) 0.71 (0.26-1.93)
Substance use
  No 34 1 1
  Yes 44.6 1.57 (0.99-2.48) 1.42 (0.88-2.29)
PEP user
  No 32.9 1 1
  Yes 50 2.04 (1.26-3.31)** 2.20 (1.33-3.63)**
PrEP awareness
  No 32.6 1 1
  Yes 38.8 1.31 (0.68-2.54) 1.29 (9.66-2.51)
Sources of PrEP information
  Others 36.2 1 1
  HCP 50 1.76 (0.91-3.42) 1.60 (0.82-3.15)
PrEP availability
  No 33.5 1 1
  Yes 42.9 1.49 (0.95-2.33) 1.69 (1.06-2.68)*
PrEP counseling experience with HCP
  No 36.1 1 1
  Yes 41.7 1.27 (0.79-2.03) 1.43 (0.88-2.32)
Peers who are on PrEP
  None 36 1 1
  Few 35.5 0.98 (0.61-1.57) 1.05 (0.65-1.70)
  Many 68.2 3.81 (1.46-9.98)** 4.92 (1.77-13.65)**
PrEP knowledge score (total 9)
  ≤7 27.3 1 1
  >7 46.9 2.35 (1.48-3.74)*** 2.21 (1.38-3.56)**
Sexual roleb
  Insertive 31.7 1 1
  Receptive 42 1.56 (0.88-2.76) 1.58 (0.88-2.83)
  Both 41.1 1.50 (0.85-2.64) 1.45 (0.82-2.56)
  No anal sex 31.3 0.98 (0.31-3.04) 0.92 (0.29-2.92)
Multiple homosexual partnershipb
  No 30.3 1 1
  Yes 41.7 1.65 (1.01-2.69)* 1.77 (1.07-2.94)*
Engagement in group sexb
  No 43.4 1 1
  Yes 31 0.59 (0.25-1.36) 0.64 (0.27-1.51)
Engagement in transactional sexb
  No 38.9 1 1
  Yes 30.8 0.70 (0.34-1.44) 0.71 (0.34-1.51)
HIV test historyb
  No 40.2 1 1
  Yes 37.1 0.88 (0.53-1.46) 0.89 (0.53-1.49)
Perceived risk of HIV infectionc
  Low-risk 33.8 1.00 1.00
  Medium-risk 40.0 1.31 (0.78-2.19) 1.35 (0.79-2.29)
  High-risk 62.1 3.21 (1.44-7.15)** 4.02 (1.73-9.32)**
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