基于轨迹模型的青少年男男性行为者HIV感染风险及影响因素

田家玮; 黄丹钦; 魏礼清; 蒋清青; 翟萌曦; 朱标; 郭孟兰; 尹晓红; 廖昱; 俞斌; 燕虹

doi:10.16462/j.cnki.zhjbkz.2022.12.001

基于轨迹模型的青少年男男性行为者HIV感染风险及影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.12.001

1.
430072 武汉，武汉大学公共卫生学院预防医学系
2.
430079 武汉，湖北省疾病预防控制中心传染病防治研究所

基金项目:

国家自然科学基金 81673196

详细信息

通讯作者:
燕虹，E-mail: yanhmjxr@whu.edu.cn

中图分类号: R512.91
计量
- 文章访问数: 483
- HTML全文浏览量: 273
- PDF下载量: 235
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-15
- 修回日期: 2022-04-14
- 网络出版日期: 2022-12-30
- 刊出日期: 2022-12-10

Risk and influencing factors of HIV infection among adolescent men who have sex with men based on trajectory model

1.
Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan 430072, China
2.
Institute of Infectious Disease Prevention and Control, Hubei Province Center for Disease Control and Prevention, Wuhan 430079, China

Funds:

National Natural Science Foundation of China 81673196

More Information

Corresponding author: YAN Hong, E-mail: yanhmjxr@whu.edu.cn

摘要

摘要: 目的探究青少年男男性行为者(young men who have sex with men, YMSM)HIV感染风险发展轨迹，并分析HIV感染风险的影响因素。方法基于在湖北省、湖南省、江西省3地开展的动态随访队列，运用基于群组轨迹模型(group-based trajectory model, GBTM)分析YMSM人群HIV感染风险的发展轨迹，使用广义估计方程(generalized estimation equation, GEE)分析与HIV感染风险相关的因素。结果 2017年9月20日―2018年1月21日共460名HIV阴性YMSM被纳入随访，GBTM识别出3组HIV感染风险发展轨迹，分别为低风险组、中风险组、高风险组，风险越高组的YMSM首次同性性行为年龄越低、农村户口比例更高，差异均有统计学意义(均有P＜0.05)。GEE结果显示首次性行为年龄、抑郁量表得分、同性恋歧视、心理韧性均与HIV感染风险存在关联(均有P＜0.05)。结论 YMSM人群普遍存在HIV感染风险且感知歧视水平高者HIV感染风险高，应关注YMSM人群的心理健康。
- 青少年男男性行为者 /
- 歧视 /
- HIV /
- 队列研究 /
- 群组轨迹模型
Abstract: Objective To explore the trajectory of HIV infection risk among young men who have sex with men (YMSM), and to analyze associated factors of HIV infection risk. Methods A dynamic cohort among YMSM was conducted in Hubei, Hunan and Jiangxi Provinces. The group-based trajectory model (GBTM) was used to explore the trajectory of HIV infection risk of YMSM, and the generalized estimation equation (GEE) was performed to analyze the risk factors related to HIV infection. Results A total of 460 HIV-negative YMSM were included in the cohort from September 20, 2017 to January 21, 2018. Three groups were identified by GBTM, including low-risk group, medium-risk group and high-risk group. The YMSM were in the group with higher risk, the lower the age at which they first had sex debut, and the higher proportion of rural residents (all P < 0.05).The results of GEE showed that the age of sexual debut, depression, sexual minority stigma and resilience were associated with HIV infection risk (all P < 0.05). Conclusions YMSM were generally at the risk of HIV infection, and those who with high level of stigma were at a higher risk of HIV infection. Importance should be attached to the mental health of YMSM.
- Young men who have sex with men /
- Stigma /
- HIV /
- Cohort study /
- Group-based trajectory model

HTML全文

图 1 YMSM HIV感染风险发展轨迹

Figure 1. Trajectories of HIV infection risk for YMSM

下载: 全尺寸图片幻灯片

表 1 2017―2020年YMSM HIV感染相关高危行为特征

Table 1. Characteristics of HIV-related risk behaviors among YMSM between 2017-2020

变量	基线调查(n=460)	第一次随访(n=376)	第二次随访(n=330)	第三次随访(n=214)	χ²值	P值
近6个月同性性伴数					5.712	0.769
＜2	255(55.43)	202(54.01)	177(53.64)	112(52.34)
2~＜6	180(39.13)	147(39.30)	132(40.00)	85(39.72)
6~＜10	12(2.61)	17(4.55)	12(3.64)	7(3.27)
≥10	13(2.83)	8(2.14)	9(2.73)	10(4.67)
近6个月同性性行为角色					8.027	0.236
只做插入方	159(34.57)	139(36.97)	108(32.73)	77(35.98)
两者皆有	225(48.91)	153(40.69)	155(46.97)	96(44.86)
只做被插入方	76(16.52)	84(22.34)	67(20.30)	41(19.16)
近6个月性伴HIV感染					2.820	0.831
无	321(69.78)	271(72.08)	229(69.39)	158(73.83)
有	15(3.26)	14(3.72)	10(3.03)	8(3.74)
不详	124(26.96)	91(24.20)	91(27.58)	48(22.43)
近6个月商业性行为					1.213	0.751
无	437(95.00)	360(95.74)	317(96.06)	207(96.73)
有	23(5.00)	16(4.26)	13(3.94)	7(3.27)
近6个月新型毒品使用						0.612 ^a
无	450(97.83)	371(98.67)	321(97.27)	210(98.13)
有	10(2.17)	5(1.33)	9(2.73)	4(1.87)
近6个月无保护性肛交					6.651	0.355
无	288(62.61)	249(66.22)	211(63.94)	121(56.54)
有时	151(32.83)	111(29.52)	103(31.21)	78(36.45)
一直	21(4.56)	16(4.26)	16(4.85)	15(7.01)
近6个月其他性病感染					19.384	0.001
无	448(97.39)	347(92.29)	304(92.12)	209(97.66)
有	12(2.61)	29(7.71)	26(7.88)	5(2.34)
注：^a Fisher确切概率法。

下载: 导出CSV

表 2 不同HIV感染风险轨迹组个体特征[n(%)]

Table 2. Characteristics of different HIV infection risk trajectory groups [n(%)]

变量	低风险组(n=35)	中风险组(n=310)	高风险组(n=115)	χ²/F值	P值
HIV阳转人数					0.511 ^a
是	0(0.00)	8(2.58)	5(4.35)
否	35(100.00)	302(97.42)	110(95.65)
民族					0.423 ^a
汉族	31(88.57)	287(92.58)	103(89.57)
少数民族	4(11.43)	23(7.42)	12(10.43)
是否为在读学生				3.383	0.192
是	24(68.57)	177(57.10)	59(51.30)
否	11(31.43)	133(42.90)	56(48.70)
性取向					0.023 ^a
异性恋	3(8.57)	1(0.32)	0(0.00)
同性恋	24(68.57)	253(81.61)	90(78.26)
双性恋	6(17.14)	41(13.23)	19(16.52)
不确定	2(5.72)	15(4.84)	6(5.22)
是否向家人出柜				2.413	0.299
是	9(25.71)	67(21.61)	33(28.70)
否	26(74.29)	243(78.39)	82(71.30)
是否认同自己的生理性别					0.849 ^a
是	33(94.29)	284(91.61)	104(90.43)
否	0(0.00)	12(3.87)	5(4.35)
不确定	2(5.71)	14(4.52)	6(5.22)
文化程度					0.028 ^a
高中及以下	2(5.71)	53(17.10)	30(26.09)
本科或大专	28(80.00)	230(74.19)	79(68.69)
研究生以上	5(14.29)	27(8.71)	6(5.22)
父亲文化程度				16.907	0.002
初中及以下	6(17.14)	122(39.95)	55(47.83)
高中或中专	13(37.14)	120(38.71)	41(35.65)
大专及以上	16(45.72)	68(21.94)	19(16.52)
母亲文化程度				23.741	＜0.001
初中及以下	7(20.00)	154(49.68)	74(64.35)
高中或中专	17(48.57)	111(35.81)	28(24.35)
大专及以上	11(31.43)	45(14.51)	13(11.30)
户口类型				10.721	0.005
城市	25(71.43)	168(54.19)	48(41.74)
农村	10(28.57)	142(45.81)	67(58.26)
抑郁量表得分(分)				12.718	0.002
＞16	15(42.86)	151(48.71)	77(66.96)
≤16	20(57.14)	159(51.29)	38(33.04)
性取向相关歧视得分(x±s, 分)	15.00±0.56	15.01±0.79	16.10±0.41	3.691	0.026
心理韧性得分(x±s, 分)	39.00±1.33	36.29±0.46	34.21±0.79	5.267	0.005
首次同性性行为年龄(x±s, 分)	19.23±2.13	18.48±2.25	17.93±2.11	5.242	0.006
注：^a Fisher确切概率法。

下载: 导出CSV

表 3 YMSM HIV感染风险评分的多因素广义估计方程分析结果

Table 3. Results of multivariable generalized estimating equation in YMSM HIV risk score

变量	β值	s_x值	Wald值	OR(95% CI)值	P值
户口
农村				1.000
城市	0.256	0.210	1.490	1.291(0.856~1.948)	0.222
文化程度
高中及以下				1.000
本科或大专	-0.519	0.287	3.275	0.543(0.350~0.841)	0.070
研究生以上	-0.561	0.390	2.066	0.571(0.266~1.226)	0.151
父亲文化程度
初中及以下				1.000
高中或中专	0.033	0.229	0.020	1.033(0.660~1.618)	0.886
大专及以上	-0.202	0.307	0.433	0.817(0.477~1.492)	0.511
母亲文化程度
初中及以下				1.000
高中或中专	-0.611	0.224	7.473	0.543(0.350~0.841)	0.006
大专及以上	-0.602	0.358	2.820	0.548(0.271~1.106)	0.093
抑郁量表得分(分)
≤16				1.000
＞16	0.509	0.188	7.304	1.664(1.150~2.406)	0.007
首次同性性行为年龄	-0.207	0.046	26.730	0.813(0.743~0.889)	＜0.001
性取向相关歧视	0.313	0.096	9.401	1.368(1.132~1.653)	0.001
心理韧性	-0.182	0.095	4.222	0.834(0.692~0.993)	0.040

下载: 导出CSV

参考文献(20)

[1]	Mao X, Wang Z, Hu Q, et al. HIV incidence is rapidly increasing with age among young men who have sex with men in China: a multicentre cross-sectional survey[J]. HIV medicine, 2018, 19(8): 513-522. DOI: 10.1111/hiv.12623.
[2]	The Joint United Nations Programme on HIV/AIDS. Global AIDS Update 2020[EB/OL]. (2020-07-06)[2021-08-12]. https://www.unaids.org/en/resources/documents/2020/global-aids-report.
[3]	王丽艳, 秦倩倩, 丁正伟, 等. 中国艾滋病全国疫情数据分析[J]. 中国艾滋病性病, 2017, 23(4): 330-333. DOI: 10.13419/j.cnki.aids.2017.04.16. Wang LY, Qin QQ, Ding ZW, et al. Current situation of AIDS epidemic in China[J]. Chin J AIDS STD, 2017, 23(4): 330-333. DOI: 10.13419/j.cnki.aids.2017.04.16.
[4]	李玲玲, 江震, 宋炜路, 等. 应用德尔菲法构建男男性行为者个体HIV感染风险评估工具[J]. 中华流行病学杂志, 2017, 38(10): 1426-1430. DOI: 10.3760/cma.j.issn.0254-6450.2017.10.026. Li LL, Jiang Z, Song WL, et al. Development of HIV infection risk assessment tool for men who have sex with men based on Delphi method[J]. Chin J Epidemiol, 2017, 38(10): 1426-1430. DOI: 10.3760/cma.j.issn.0254-6450.2017.10.026.
[5]	Neilands TB, Steward WT, Choi KH. Assessment of stigma towards homosexuality in China: a study of men who have sex with men[J]. Arch Sex Behav, 2008, 37(5): 838-844. DOI: 10.1007/s10508-007-9305-x.
[6]	章婕, 吴振云, 方格, 等. 流调中心抑郁量表全国城市常模的建立[J]. 中国心理卫生杂志, 2010, 24(2): 139-143. DOI: 10.3969/j.issn.1000-6729.2010.02.015. Zhang J, Wu ZY, Fang G, et al. Development of Chinese age norms of CES-D in urban area[J]. Chinese Mental Health Journal, 2010, 24(2): 139-143. DOI: 10.3969/j.issn.1000-6729.2010.02.015.
[7]	Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor-davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience[J]. J Trauma Stress, 2007, 20(6): 1019-1028. DOI: 10.1002/jts.20271.
[8]	Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research[J]. Annu Rev Clin Psychol, 2010, (6): 109-138. DOI: 10.1146/annurev.clinpsy.121208.131413.
[9]	钱晓涵, 郑敏, 张玉琼, 等. 贵州省男男性行为人群个体HIV感染风险评估工具应用与预测能力分析[J]. 中华流行病学杂志, 2021, 42(4): 672-676. DOI: 10.3760/cma.j.cn112338-20200923-01180. Qian XH, Zheng M, Zhang YQ, et al. Analysis on prediction power of HIV infection risk assessment tool in men who have sex with men in Guizhou Province[J]. Chin J Epidemiol, 2021, 42(4): 672-676. DOI: 10.3760/cma.j.cn112338-20200923-01180.
[10]	Storholm ED, Huang W, Siconofl DE, et al. Sources of resilience as mediators of the effect of minority stress on stimulant use and sexual risk behavior among young black men who have sex with men[J]. AIDS Behav, 2019, 23(12): 3384-3395. DOI: 10.1007/s10461-019-02572-y.
[11]	Jefferies WLT, Flores SA, Rooks-Peck CR, et al. Experienced homophobia and HIV infection risk among U.S. gay, bisexual, and other men who have sex with men: a meta-analysis[J]. LGBT Health, 2021, 8(1): 1-10. DOI: 10.1089/lgbt.2020.0274.
[12]	Altman D, Aggleton P, Williams M, et al. Men who have sex with men: stigma and discrimination[J]. Lancet, 2012, 380(9839): 439-445. DOI: 10.1016/S0140-6736(12)60920-9.
[13]	Choi KH, Steward WT, Miege P, et al. Sexual stigma, coping styles, and psychological distress: a longitudinal study of men who have sex with men in Beijing, China[J]. Arch Sex Behav, 2016, 45(6): 1483-1491. DOI: 10.1007/s10508-015-0640-z.
[14]	Meyer IH. Minority stress and mental health in gay men[J]. J Health Soc Behav, 1995, 36(1): 38-56.
[15]	Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence[J]. Psychol Bull, 2003, 129(5): 674-697. DOI: 10.1037/0033-2909.129.5.674.
[16]	Rendina HJ, Gamarel KE, Pachankis JE, et al. Extending the minority stress model to incorporate HIV-positive gay and bisexual men's experiences: a longitudinal examination of mental health and sexual risk behavior[J]. Ann Behav Med, 2017, 51(2): 147-158. DOI: 10.1007/s12160-016-9822-8.
[17]	Fu H, Feng T, Wang T, et al. Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004-2018: a systematic review and meta-analysis[J]. J Affect Disord, 2020, 277: 192-203. DOI: 10.1016/j.jad.2020.08.011.
[18]	Wu F, Zhang A, Babbitt A, et al. Overcoming HIV stigma? A qualitative analysis of HIV cure research and stigma among men who have sex with men living with HIV[J]. Arch Sex Behav, 2018, 47(7): 2061-2069. DOI: 10.1007/s10508-017-1062-x.
[19]	林荣, 王洪涛, 程晓松, 等. 烟台市青年学生男男性行为人群首次同性性行为特征分析[J]. 中华疾病控制杂志, 2020, 24(12): 1428-1432. DOI: 10.16462/j.cnki.zhjbkz.2020.12.013. Lin R, Wang HT, Cheng XS, et al. Analysis of the characteristics of the first homosexual behavior among young male students who have sex with men in Yantai City[J]. Chin J Dis Control Prev, 2020, 24(12): 1428-1432. DOI: 10.16462/j.cnki.zhjbkz.2020.12.013.
[20]	Liu Y, Qian HZ, Amico KR, et al. Subsequent sexual risks among men who have sex with men may differ by sex of first partner and age at sexual debut: a cross-sectional study in Beijing, China[J]. AIDS Behav, 2017, 21(10): 2913-2923. DOI: 10.1007/s10461-017-1677-x.