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。

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.