Characteristics of MSM with heterosexual behavior and analysis on related factors of their HIV infection in Fuzhou from 2016 to 2021
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摘要:
目的 了解福州市发生异性性行为的男男性行为者(men who have sex with men，MSM)人群特征及HIV感染相关因素，为开展有效的干预措施提供参考依据。 方法 2016-2021年通过互联网招募≥15岁，近1年与男性发生过口交或肛交性行为的MSM至现场检测点, 筛选最近6个月与异性发生性行为的MSM，分析其社会人口学和行为学特征、HIV感染状况。 结果 共调查13 829名MSM，其中2016-2021年各年度发生异性性行为的MSM人群分别为156、207、314、352、338、241人。MSM人群发生异性性行为的多因素logistic回归分析模型分析显示：>25岁年龄组(OR=1.298，95% CI：1.091~1.544)、在婚/同居(OR=9.283，95% CI：8.025~10.739)、高中/中专(OR=1.259，95% CI：1.021~1.552)、异性恋(OR=37.311，95% CI：25.204~53.126)、双性恋(OR=7.266，95% CI：6.325~8.347)、性取向未确定(OR=4.394，95% CI：3.001~6.433)、场所寻找男性伴(OR=1.370，95% CI：1.080~1.738)是发生异性性行为的危险因素(均P＜0.05); 本地居住时间1~2年(OR=0.733，95% CI：0.553~0.971)、本地居住时间>2年(OR= 0.809，95% CI：0.670~0.977)、未吸毒(OR= 0.459，95% CI：0.228~0.924)是发生异性性行为的保护因素(均P＜0.05)。监测发生异性性行为的MSM人群HIV抗体阳性率为4.17%(67/1 608)，历年HIV抗体阳性率呈下降趋势(趋势χ2 =6.959，P=0.008)。发生异性性行为的MSM HIV感染的多因素logistic回归分析模型结果显示：性取向不确定(OR=3.133，95% CI：1.112~8.826)是危险因素; 高中/中专(OR=0.469，95% CI：0.247~0.889)、大专及以上(OR=0.330，95% CI：0.178~0.613)、未发生肛交或每次都使用安全套(OR=0.184，95% CI：0.063~0.539)、肛交有时使用安全套(OR=0.304，95% CI：0.103~0.897)、未吸毒(OR=0.228，95% CI：0.059~0.883)是保护因素。 结论 福州市发生异性性行为的MSM人群坚持使用安全套比例低，应加强干预宣传，提高安全套使用率，减少AIDS向普通女性传播流行的风险。 Abstract:Objective To understand the characteristics of MSM with heterosexual behavior and related factors of their HIV infection in Fuzhou, and to provide reference basis for effective intervention measures. Methods From 2016 to 2021, MSM aged 15 and over who had oral or anal sex with men in the last year were recruited. MSM who had sex with the female in the past 6 months were selected, and their sociolect-demographic, behavioral characteristics and HIV infection status were analyzed. Results 13 829 MSM were investigated, of which the respondents with heterosexual behavior from 2016 to 2021 was 156, 207, 314, 352, 338 and 241 respectively. Multivariate logistic regression analysis of heterosexual behavior showed that >25 age group (OR=1.298, 95% CI: 1.091-1.544), married/cohabiting (OR=9.283, 95% CI: 8.025-10.739), education level of high school or technical secondary school (OR=1.259, 95% CI: 1.021-1.552), heterosexuality (OR=37.311, 95% CI: 25.204-53.126), bisexuality (OR= 7.266, 95% CI: 6.325-8.347), undetermined sexual orientation (OR=4.394, 95% CI: 3.001-6.433), finding male sex partners through places (OR=1.370, 95% CI: 1.080-1.738) were risk factors (all P < 0.05); MSM who lived in Fuzhou for 1-2 years (OR=0.733, 95% CI: 0.553-0.971), MSM who lived in Fuzhou for more than two years (OR=0.809, 95% CI: 0.670-0.977), non-drug users (OR=0.459, 95% CI: 0.228-0.924) were protective factors (all P < 0.05). The HIV antibody positive rate of MSM with heterosexual behavior was 4.17% (67/1 608). The HIV antibody positive rate of MSM showed a downward trend (trend χ2 =6.959, P=0.008). The results of multivariate logistic regression analysis showed that undetermined sexual orientation (OR=3.133, 95% CI: 1.112-8.826) was risk factors; education level of high school or technical secondary school (OR=0.469, 95% CI: 0.247-0.889), education level of junior college or below (OR=0.330, 95% CI: 0.178-0.613), never having anal sex or using condom every time (OR=0.184, 95% CI: 0.063-0.539), sometimes using condom (OR=0.304, 95% CI: 0.103-0.897), non-drug users (OR=0.228, 95% CI: 0.059-0.883) were protective factors (all P < 0.05). Conclusions The proportion of insisting condom use among MSM with heterosexual behavior is low. The intervention of MSM with heterosexual behavior should be strengthened to enhance the utilization rate of condoms and reduce the risk of AIDS spreading to women. -
Key words:
- HIV /
- Men who have sex with men /
- Heterosexual behavior /
- Characteristics /
- Influencing factors
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表 1 福州市2016-2021年MSM人群发生异性性行为相关因素的logistic回归分析
Table 1. Logistic regression analysis of factors associated with heterosexual behavior among MSM in Fuzhou, 2016-2021
因素Considerations 调查人数No. people surveyed 异性性行为发生比例/% Proportion of heterosexual bahavior/% 单因素分析Univariate analysis 多因素分析Multivariate analysis χ2值value P值value OR值value (95% CI) P值value 年龄组/岁Age group/year 378.421 ＜0.001 15~25 5 186 4.78 1.000 >25 8 643 15.74 1.298(1.091~1.544) 0.003 婚姻状况Marital status 2 493.389 ＜0.001 未婚/离异/丧偶Unmarried/Divorced/Widowed 11 323 5.24 1.000 在婚/同居In marriage/Cohabitation 2 506 40.50 9.283(8.025~10.739) ＜0.001 户籍地Household register 2.618 0.106 福建Fujian 11 472 11.43 外省Other provinces 2 357 12.60 文化程度Educational level 240.749 ＜0.001 初中及以下Junior high school and below 1 151 21.98 1.000 高中或中专High school or technical secondary school 3 029 16.01 1.259(1.021~1.552) 0.031 大专及以上College or above 9 649 9.02 0.957(0.786~1.165) 0.661 在本地居住时间/年Length of local residence/year 15.434 ＜0.001 0~＜1 1 456 14.63 1.000 1~2 1 201 10.32 0.733(0.553~0.971) 0.031 >2 11 172 11.38 0.809(0.670~0.977) 0.028 自认为的性取向Self-perceived sexual orientation 2 260.853 ＜0.001 同性恋Homosexuality 11 758 6.41 1.000 异性恋Heterosexuality 178 67.42 37.311(25.204~53.126) ＜0.001 双性恋Bisexual 1 691 40.63 7.266(6.325~8.347) ＜0.001 未确定Uncertain 202 23.27 4.394(3.001~6.433) ＜0.001 寻找男性伴方式How to find a male partner 97.511 ＜0.001 网络Online 13 204 11.04 1.000 场所Place 625 24.00 1.370(1.080~1.738) 0.010 是否吸毒Drug use or not 8.634 0.003 是Yes 70 22.86 1.000 否No 13 759 11.57 0.459(0.228~0.924) 0.029 知晓AIDS知识Knowledge of AIDS 32.568 ＜0.001 是Yes 13 318 11.32 否No 511 19.57 
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表 2 福州市2016-2021年发生异性性行为的MSM人群特征变化情况
Table 2. Changes in characteristics of MSM with heterosexual behavior in Fuzhou from 2016 to 2021
因素Consideration 年份[人数(占比/%)] Year[Number of people (proportion/%)] 趋势χ2值Trend χ2 value P值value 2016 2017 2018 2019 2020 2021 年龄组/岁Age group/year 7.579 0.006 15~25 13(8.33) 37(17.87) 34(10.83) 65(18.47) 48(14.20) 51(21.16) >25 143(91.67) 170(82.13) 280(89.17) 287(81.53) 290(85.80) 190(78.84) 婚姻状况Marital status 23.238 ＜0.001 未婚/离异/丧偶Unmarried/divorced/widowed 28(17.95) 78(37.68) 106(33.76) 133(37.78) 146(43.20) 102(42.32) 在婚/同居In marriage/cohabitation 128(82.05) 129(62.32) 208(66.24) 219(62.22) 192(56.80) 139(57.68) 自认为的性取向Self-perceived sexual orientation 135.409 ＜0.001 同性恋Homosexuality 92(58.97) 140(67.63) 229(72.93) 142(40.34) 87(25.74) 64(26.56) 异性恋Heterosexuality 5(3.21) 1(0.48) 1(0.32) 33(9.37) 63(18.64) 17(7.05) 双性恋Bisexual 57(36.54) 64(30.92) 83(26.43) 166(47.16) 164(48.52) 153(63.49) 未确定Uncertain 2(1.28) 2(0.97) 1(0.32) 11(3.13) 24(7.10) 7(2.90) 寻找男性伴方式How to find a male partner 19.674 ＜0.001 网络Online 118(75.64) 186(89.86) 299(95.22) 313(88.92) 208(61.54) 234(97.10) 场所Place 38(24.36) 21(10.14) 15(4.78) 39(11.08) 30(8.88) 7(2.90) 最近6个月发生过肛交性行为Anal sex in the last 6 months 76.673 ＜0.001 是Yes 138(88.46) 176(85.02) 260(82.80) 234(66.48) 221(65.38) 146(60.58) 否No 18(11.54) 31(14.98) 54(17.20) 118(33.52) 117(34.62) 95(39.42) 最近6个月最近一次肛交性行为使用安全套Use a condom for the last anal sex in the last 6 months 14.798 ＜0.001 是Yes 123(89.13) 140(79.55) 217(83.46) 174(74.36) 163(73.76) 108(73.97) 否No 15(10.87) 36(20.45) 43(16.54) 60(25.64) 58(26.24) 38(26.03) 最近6个月肛交性行为安全套使用频率Frequency of condom use during anal sex in the last 6 months 5.416 0.020 从未使用Never 5(3.62) 9(5.11) 5(1.94) 5(2.14) 3(1.36) 2(1.37) 有时使用Sometime 38(27.54) 57(32.39) 106(40.70) 94(40.17) 103(46.61) 66(45.21) 每次都用Everytime 95(68.84) 110(62.50) 149(57.36) 135(57.69) 115(52.03) 78(53.42) 最近6个月与异性发生过性行为安全套使用频率Frequency of condom use with the opposite sex in the last 6 months 15.449 ＜0.001 从未使用Never 29(18.59) 76(36.71) 137(43.63) 111(31.54) 68(20.12) 52(21.58) 有时使用Sometime 88(56.41) 52(25.12) 92(29.30) 106(30.11) 148(43.79) 56(23.24) 每次都用Everytime 39(25.00) 79(38.17) 85(27.07) 135(38.35) 122(36.09) 103(42.74) 既往是否接受AIDS抗体检测Whether to receive HIV antibody test in the past 36.263 ＜0.010 是Yes 17(10.90) 29(14.01) 32(10.19) 98(27.84) 62(18.34) 76(31.54) 否No 139(89.10) 178(85.99) 282(89.81) 254(72.16) 276(81.66) 165(68.46) AIDS知识知晓Knowledge of AIDS 7.432 0.006 是Yes 149(95.51) 200(96.62) 304(96.82) 323(91.76) 306(90.53) 226(93.78) 否No 7(4.49) 7(3.38) 10(3.18) 29(8.24) 32(9.47) 15(6.22)
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表 3 福州市2016-2021年发生异性性行为的MSM人群HIV感染的logistic回归分析模型分析
Table 3. Logistic regression analysis on related factors of HIV infection among MSM with heterosexual behavior in Fuzhou from 2016 to 2021
因素Consideration 调查人数No. people surveyed HIV阳性人数No. HIV positive HIV阳性比例/% HIV-positive proportion/% 单因素分析Univariate analysis 多因素分析Multivariate analysis χ2值value P值value OR值value (95% CI) P值value 年龄组/岁Age group/year 0.650 0.420 15~25 248 8 3.23 >25 1 360 59 4.34 婚姻状况Marital status 1.483 0.223 未婚/离异/丧偶Unmarried/divorced/widowed 593 20 3.37 在婚/同居In marriage/cohabitation 1 015 47 4.63 户籍地Household register 1.359 0.244 福建Fujian 1 311 51 3.89 外省Other provinces 297 16 5.39 文化程度Educational level 16.642 ＜0.001 初中及以下Junior high school and below 253 22 8.70 1.000 高中或中专High school or technical secondary school 485 20 4.12 0.469 (0.247~0.889) 0.020 大专及以上College or above 870 25 2.87 0.330 (0.178~0.613) ＜0.001 在本地居住时间/年Length of local residence/year 5.668 0.059 0~＜1 213 15 7.04 1~2 124 3 2.42 >2 1 271 49 3.86 自认为的性取向Self-perceived sexual orientation 10.915 0.012 同性恋Homosexuality 754 37 4.91 1.000 异性恋Heterosexuality 120 7 5.83 1.762 (0.742~4.181) 0.199 双性恋Bisexual 687 18 2.62 0.615 (0.343~1.105) 0.104 未确定Uncertain 47 5 10.64 3.133 (1.112~8.826) 0.031 寻找男性伴方式The way to find a male partner 0.932 0.334 网络Online 1 458 63 4.32 场所Place 150 4 2.67 最近6个月发生肛交性行为Had anal sex in the last 6 months or not 0.693 0.405 是Yes 1 175 46 3.91 否No 433 21 4.85 最近6个月肛交性行为安全套使用频率Frequency of anal condom use in the last 6 months 18.537 ＜0.001 从未使用Never 29 5 17.24 1.000 有时使用Sometime 464 27 5.82 0.304 (0.103~0.897) 0.031 未发生肛交行为或每次都使用Not having anal sex or using it every time 1 115 35 3.14 0.184 (0.063~0.539) 0.002 最近6个月与同性发生商业性行为Sexual intercourse with someone of the same sex within the last 6 months 0.066 0.798 是Yes 32 1 3.13 否No 1 168 47 4.02 最近6个月与异性发生过性行为安全套使用频率Frequency of condom use with the opposite sex in the last 6 months 4.719 0.094 从未使用Never 472 27 5.72 有时使用Sometime 573 23 4.01 每次都用Everytime 563 17 3.02 是否吸毒Drug use or not 8.607 0.003 是Yes 16 3 18.75 1.000 否No 1 592 64 4.02 0.228(0.059~0.883) 0.032 最近1年是否曾患过性病Had an sexually transmitted disease in the last year or not 4.192 0.041 是Yes 51 5 9.80 否No 1 557 62 3.98 知晓AIDS知识Knowledge of AIDS 9.087 0.003 是Yes 1 508 57 3.78 否No 100 10 10.00 最近1年接受AIDS干预服务Received AIDS intervention services in the last year or not 0.522 0.470 是Yes 1 189 47 3.95 否No 419 20 4.77 既往接受HIV抗体检测Received HIV antibody test in the past 1.520 0.218 是Yes 314 17 5.41 否No 1 294 50 3.86
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