Factors associated with unprotected anal sex behavior among adolescent boys who have sex with men in and out of school in Fuzhou City
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摘要:
目的 分析福州市校内与校外青少年男男性行为者(men who have sex with men, MSM)特征及发生无保护肛交(unprotected anal intercourse, UAI)的相关因素，为制定青少年MSM艾滋病(acquired immune deficiency syndrome, AIDS)防控策略提供依据。 方法 2022年4―12月，通过网络招募年龄为15~24岁、最近6个月与男性发生口交/肛交性行为的MSM，按照校内和校外分组，采用描述性流行病学方法分析人群特征差异，采用logistic回归分析模型分析发生UAI的相关因素差异。 结果 共调查2 276名15~24岁MSM，其中校内1 306人，校外970人。校内和校外青少年MSM AIDS知识知晓率分别为88.51%(1 156/1 306)和86.08%(835/970)。校内青少年MSM最近6个月肛交和异性性行为中坚持使用安全套的比例高于校外青少年；校外青少年MSM初中及以下学历、最近6个月商业性同性行为、异性性行为、使用精神活性物质、最近1年接受人类免疫缺陷病毒(human immunodeficiency virus, HIV)抗体检测的比例高于校内青少年，差异均有统计学意义(均P < 0.05)。校内和校外青少年MSM发生UAI的比例分别为49.81%(530/1 064)和56.16%(488/869)，差异有统计学意义(χ2 =7.724, P=0.005)。校内青少年MSM发生UAI的相关因素：首次性行为年龄＞18~24岁是15~18岁的0.742(95% CI：0.580~0.950)；最近1周发生肛交1~2次是未发生的1.775倍(95% CI：1.353~2.330)；未使用精神活性物质是使用的0.611(95% CI：0.440~0.849)。校外青少年MSM发生UAI的相关因素：省外户籍是福建省户籍的1.867倍(95% CI：1.365~2.555)；大专及以上文化水平是初中及以下的0.545(95% CI：0.350~0.848)；网络寻找性伴是场所的0.564(95% CI：0.329~0.967)；最近1周发生肛交1~2次是未发生的1.858倍(95% CI：1.353~2.553)；最近1周发生肛交>2次是未发生的1.711倍(95% CI：1.085~2.698)；最近6个月未发生异性性行为是发生的0.705(95% CI：0.517~0.962)。 结论 校外青少年MSM学历低、首次性行为年龄小、坚持使用安全套比例低，但发生商业性行为比例高、发生UAI的风险高；校内青少年MSM既往接受HIV检测比例低，应探索差异化干预方式，降低HIV传播风险。 Abstract:Objective To analyze the characteristics of in-school and out-of-school adolescent men who have sex with men (MSM) populations and factors associated with the occurrence of unprotected anal intercourse (UAI) in Fuzhou City, and to provide a basis for the development of acquired immune deficiency syndrome(AIDS) prevention and control strategies for adolescent MSM. Methods From April to December 2022, MSM aged 15 to 24 years who had engaged in oral/anal sex with men in the last 6 months were recruited online and grouped according to in-school and out-of-school subgroups, and descriptive epidemiological methods were used to analyse differences in population characteristics, and logistic regression models were used to analyse differences in the factors associated with the occurrence of UAI. Results A total of 2 276 MSM aged 15-24 years were surveyed, including 1 306 in-school and 970 out-of-school. The HIV knowledge rates of in-school and out-of-school adolescent MSM were 88.51% (1 156/1 306) and 86.08% (835/970), respectively. The proportion of in-school adolescent MSM who consistently used condoms in anal sex and heterosexual sex in the last 6 months was higher than that of out-of-school; the proportion of out-of-school adolescent MSM with junior high school education or less, commercial same-sex sex in the last 6 months, heterosexual sex, use of psychoactive substances, and HIV antibody testing in the last year was higher than that of out-of-school, and the differences were statistically significant (all P < 0.05). The proportions of in-school and out-of-school adolescents MSM experiencing UAI were 49.81% (530/1 064) and 56.16% (488/869), respectively, and the difference was statistically significant (χ2 =7.724, P=0.005). Factors associated with the occurrence of UAI among in-school adolescent MSM: age at first sexual intercourse > 18-24 years was 0.742 of 15-18 years (95% CI: 0.580-0.950); 1-2 episodes of anal sex in the last week was 1.775 times higher than no episodes (95% CI: 1.353-2.330); and no use of psychoactive substances was 0.611 of users (95% CI: 0.440-0.849).Factors associated with the occurrence of UAI among out-of-school adolescent MSM: out-of-province household registration was 1.867 times more common than Fujian Province household registration (95% CI: 1.365-2.555); college and above education level was 0.545 of junior high school and below (95% CI: 0.350-0.848); internet searching for a sexual partner was 0.564 of place (95% CI: 0.329-0.967); having anal intercourse in the last week 1-2 times was 1.858 (95% CI: 1.353-2.553) times more likely to not have occurred; having anal sex >2 times in the last week was 1.711 (95% CI: 1.085-2.698) times more likely to not have occurred; and not having heterosexual sex in the last 6 months was 0.705 (95% CI: 0.517-0.962) of have occurred. Conclusions Out-of-school adolescent MSM have low educational attainment, low age at first sex, and low adherence to condom use, but have a high proportion of commercial sex and a high risk of UAI; In-school adolescent MSM have a low proportion of prior human immunodeficiency virus(HIV) testing, and both have different characteristics and factors associated with the occurrence of UAI. Therefore, differentiated interventions should be explored to reduce the risk of HIV transmission. -
表 1 福州市15~24岁校内和校外青少年MSM特征比较
Table 1. Comparison of MSM characteristics among in-school and out-of-school adolescents aged 15-24 years in Fuzhou CIty
特征
Characteristics总调查数
Total number of surveys① (n=2 276)校内青少年
In-school youth MSM① (n=1 306)校外青少年
Out-of-school youth MSM① (n=970)χ2值
valueP值
value户籍地Household registration 3.596 0.058 福建省Fujian Province 1 638(71.97) 960(73.51) 678(69.90) 外省Other provinces 638(28.03) 346(26.49) 292(30.10) 本地居住时间/年Length of local residence/year 1.324 0.250 ≤1 1 193(52.42) 671(51.38) 522(53.81) >1 1 083(47.58) 635(48.62) 448(46.19) 文化水平Education level 177.787 < 0.001 初中及以下Junior high school and below 165(7.25) 18(1.38) 147(15.15) 高中或中专High school or junior college 385(16.92) 195(14.93) 190(19.59) 大专及以上College and above 1 726(75.83) 1 093(83.69) 633(65.26) 自认为的性取向Self-perceived sexual orientation 5.022 0.081 同性恋Homophobic 1 449(63.66) 818(62.63) 631(65.05) 双性恋Bisexual 515(22.63) 317(24.27) 198(20.41) 其他Other 312(13.71) 171(13.10) 141(14.54) 寻找性伴侣方式How to find a sex partner 51.658 < 0.001 网络Online 2 126(93.41) 1 262(96.63) 864(89.07) 场所Place 150(6.59) 44(3.37) 106(10.93) 首次性行为年龄/岁Age at first sexual intercourse/years 3.137 0.077 15~18 1 082(47.54) 600(45.94) 482(49.69) ＞18 ~24 1 194(52.46) 706(54.06) 488(50.31) 最近6个月同性肛交Homosexual anal sex in the last 6 months 28.655 < 0.001 是Yes 1 933(84.93) 1 064(81.47) 869(89.59) 否No 343(15.07) 242(18.53) 101(10.41) 最近1周肛交/次Anal sex in the last week/times 33.456 < 0.001 0 1 444(63.44) 877(67.15) 567(58.45) 1~2 620(27.24) 344(26.34) 276(28.45) >2 212(9.32) 85(6.51) 127(13.10) 最近6个月肛交用套频率Frequency of condom use for anal sex in the last 6 months 13.185 0.001 每次使用Everytime 915(47.34) 534(50.19) 381(43.84) 有时使用Sometime 897(46.40) 455(42.76) 442(50.86) 从未使用Never 121(6.26) 75(7.05) 46(5.30) 最近6个月发生商业性同性行为Commercial same-sex behavior in the last 6 months 14.939 < 0.001 是Yes 117(5.14) 47(3.60) 70(7.22) 否No 2 159(94.86) 1 259(96.40) 900(92.78) 商业性行为类别Type of commercial sex act 21.595 < 0.001 购买服务方Purchaser of services 78(66.67) 21(44.68) 57(81.43) 提供服务方Service provider 27(23.08) 21(44.68) 6(8.57) 购买/提供服务均有Both purchase/provision of services 12(10.25) 5(10.64) 7(10.00) 最近6个月发生异性性行为Heterosexual sex in the last 6 months 22.754 < 0.001 是Yes 657(28.87) 326(24.96) 331(34.12) 否No 1 619(71.13) 980(75.04) 639(65.88) 最近6个月异性性行为安全套使用频率Frequency of condom use during heterosexual sex in the last 6 months 13.849 0.001 每次使用Everytime 292(44.45) 161(49.39) 131(39.58) 有时使用Sometime 245(37.29) 123(37.73) 122(36.86) 从未使用Never 120(18.26) 42(12.88) 78(23.56) 精神活性物质使用Psychoactive substance use 32.880 < 0.001 是Yes 438(19.24) 198(15.16) 240(24.74) 否No 1 838(80.76) 1 108(84.84) 730(75.26) 既往患有性病Pre-existing STDs 28.764 < 0.001 是Yes 268(11.78) 113(8.65) 155(15.98) 否No 2 008(88.22) 1 193(91.35) 815(84.02) 最近1年接受HIV抗体检测HIV antibody testing in the last year 43.696 < 0.001 是Yes 1 338(58.79) 691(52.91) 647(66.70) 否No 938(41.21) 615(47.09) 323(33.30) 注：MSM, 男男性行为者; HIV, 人类免疫缺陷病毒。
①以人数(占比/%)表示。
Note：MSM, men who have sex with men; HIV, human immunodeficiency virus.
①Number of people(proportion/%).
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表 2 福州市15~24岁校内校外青少年MSM AIDS知晓情况
Table 2. Awareness of HIV knowledge among in-school and out-of-school adolescents aged 15-24 years old with MSM in Fuzhou City
知识
Knowledge正确率Correct answer rate χ2值
valueP值
value总调查数
Total number of surveys① (n=2 276)校内青少年
In-school youth MSM① (n=1 306)校外青少年
Out-of-school youth MSM① (n=970)AIDS是一种不可治愈的严重传染病
AIDS is a serious and incurable epidemic disease1 814(79.70) 1 039(79.56) 775(79.90) 0.040 0.841 男男性行为人群是我国受AIDS影响最严重的人群吗
Are men who have sex with men the most affected by AIDS in this country1 931(84.84) 1 111(85.07) 820(84.54) 0.123 0.726 通过外表可以判断1个人是否感染AIDS吗
Can you tell if a person has AIDS by their appearance1 702(74.78) 1 007(77.11) 695(71.65) 8.786 0.003 感染其他性病会增加AIDS感染的风险吗
Does contracting other STDs increase the risk of HIV infection1 665(73.15) 933(71.44) 732(75.46) 4.590 0.032 坚持正确使用安全套可以减少AIDS感染的风险吗
Can consistent and correct condom use reduce the risk of HIV infection2 208(97.01) 1 277(97.78) 931(95.98) 6.223 0.013 使用新型毒品会增加AIDS感染的风险吗
Does the use of new drugs increase the risk of HIV infection1 901(83.52) 1 095(83.84) 806(83.09) 0.228 0.633 高危行为后要主动寻求AIDS咨询和检测吗
Should you proactively seek HIV counseling and testing after high-risk behavior2 162(94.99) 1 253(95.94) 909(93.71) 5.820 0.016 故意传播AIDS需要承担法律责任吗Are you legally liable for intentionally spreading AIDS 2 222(97.63) 1 279(97.93) 943(97.22) 1.232 0.267 是否知晓(答对6题) Awareness (6 correct answers) 1 991(87.48) 1 156(88.51) 835(86.08) 3.006 0.083 是否知晓(答对8题) Awareness (8 correct answers) 847(37.21) 490(37.52) 357(36.80) 0.122 0.727 注：MSM, 男男性行为者; AIDS, 艾滋病; HIV, 人类免疫缺陷病毒。
①以人数(占比/%)表示。
Note：MSM, men who have sex with men; AIDS, acquired immune deficiency syndrome; HIV, human immunodeficiency virus.
① Number of people(proportion/%).
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表 3 福州市15~24岁校内青少年MSM无保护肛交相关因素logistic回归分析
Table 3. Logistic regression analysis of factors associated with unprotected anal sex among in-school adolescents aged 15-24 years old MSM in Fuzhou City
变量
Variable调查人数
Number of surveysUAI人数
Number of UAI①单因素分析
Univariate analysis多因素分析
Multivariate analysisOR值value
(95% CI)P值
valueOR值value
(95% CI)P值
value户籍地Household registration 福建省Fujian Province 787 384(48.79) 1.000 ― 外省Other provinces 277 146(52.71) 1.170(0.889~1.539) 0.263 ― 文化水平Education level 初中及以下Junior high school and below 18 12(66.67) 1.000 ― 高中或中专High school or junior college 145 74(51.03) 0.521(0.186~1.464) 0.216 ― 大专及以上College and above 901 444(49.28) 0.486(0.181~1.306) 0.152 ― 本地居住时间/年Length of local residence/year < 1 558 285(51.08) 1.000 ― ≥1 506 245(48.42) 0.899(0.707~1.144) 0.387 ― 自认为的性取向Self-perceived sexual orientation 同性恋Homophobic 676 354(52.37) 1.000 ― 双性恋Bisexual 264 118(44.70) 0.735(0.552~0.978) 0.035 ― 其他Other 124 58(46.77) 0.799(0.545~1.173) 0.253 ― 首次性行为年龄/岁Age at first sexual intercourse/years 15~18 499 270(54.11) 1.000 1.000 ＞18~24 565 260(46.02) 0.723(0.568~0.921) 0.009 0.742(0.580~0.950) 0.018 寻找性伴侣方式How to find a sex partner 场所Place 43 23(53.49) 1.000 ― 网络Online 1 021 507(49.66) 0.858(0.465~1.581) 0.623 ― 最近1周肛交/次Anal sex in the last week/times 0 647 287(44.36) 1.000 1.000 1~2 337 202(59.94) 1.877(1.436~2.452) < 0.001 1.775(1.353~2.330) < 0.001 >2 80 41(51.25) 1.319(0.828~2.099) 0.244 1.193(0.745~1.912) 0.463 最近6个月发生异性性行为Heterosexual sex in the last 6 months 是Yes 287 147(51.22) 1.000 ― 否No 777 383(49.29) 0.926(0.706~1.214) 0.577 ― 最近6个发生商业性同性行为Commercial same-sex behavior in the last 6 months 是Yes 47 27(57.45) 1.000 ― 否No 1 017 503(49.46) 0.725(0.401~1.309) 0.286 ― 既往患有性病Pre-existing STDs 是Yes 97 51(52.58) 1.000 ― 否No 967 479(49.53) 0.885(0.583~1.345) 0.568 ― 精神活性物质使用Psychoactive substance use 是Yes 191 119(62.30) 1.000 1.000 否No 873 411(47.08) 0.538(0.390~0.742) < 0.001 0.611(0.440~0.849) 0.003 最近1年接受HIV抗体检测HIV antibody testing in the last year 是Yes 614 291(47.39) 1.000 ― 否No 450 239(53.11) 1.257(0.985~1.604) 0.066 ― 知晓AIDS知识Knowledge of AIDS 是Yes 950 464(48.84) 1.000 ― 否No 114 66(57.89) 1.440(0.972~2.133) 0.069 ― 注：MSM, 男男性行为者; UAI, 无保护肛交; HIV, 人类免疫缺陷病毒; AIDS, 艾滋病; “―”，无统计学意义。
①以人数(占比/%)表示。
Note：MSM, men who have sex with men; UAI, unprotected anal intercourse; HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; "―" no statistical significance.
①Number of people(proportion/%).
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表 4 福州市15~24岁校外青少年MSM无保护肛交相关因素logistic回归分析
Table 4. Logistic regression analysis of factors associated with unprotected anal sex among out-of-school adolescents MSM aged 15-24 years old in Fuzhou City
变量
Variable调查人数
Number of surveysUAI人数
Number of UAI①单因素分析
Univariate analysis多因素分析
Multivariate analysisOR值value
(95% CI)P值
valueOR值value
(95% CI)P值
value户籍地Household registration 福建省Fujian Province 607 316(52.06) 1.000 1.000 外省Other provinces 262 172(65.65) 1.760(1.303~ 2.377) < 0.001 1.867(1.365~ 2.555) < 0.001 文化水平Education level 初中及以下Junior high school and below 137 100(72.99) 1.000 1.000 高中或中专High school or junior college 172 102(59.30) 0.539(0.332~0.875) 0.012 0.702(0.421~1.171) 0.175 大专及以上College and above 560 286(51.07) 0.386(0.256~ 0.583) < 0.001 0.545(0.350~0.848) 0.007 本地居住时间/年Length of local residence/year < 1 470 283(60.21) 1.000 ― ≥1 399 205(51.38) 0.698(0.533~0.914) 0.009 ― 自认为的性取向Self-perceived sexual orientation 同性恋Homophobic 572 324(56.64) 1.000 ― 双性恋Bisexual 172 95(55.23) 0.944(0.670~1.331) 0.744 ― 其他Other 125 69(55.20) 0.943(0.639~1.392) 0.768 ― 首次性行为年龄/岁Age at first sexual intercourse/years 15~18 443 263(59.37) 1.000 ― ＞18~24 426 225(52.82) 0.766(0.586~1.002) 0.052 ― 寻找性伴方式How to find a sex partner 场所Place 104 79(75.96) 1.000 1.000 网络Online 765 409(53.46) 0.364(0.227~0.583) < 0.001 0.564(0.329~0.967) 0.037 最近1周肛交/次Anal sex in the last week/times 0 473 235(49.68) 1.000 1.000 1~2 272 168(61.76) 1.636(1.207~2.217) 0.001 1.858(1.353~2.553) < 0.001 >2 124 85(68.55) 2.207(1.451~3.359) < 0.001 1.711(1.085~2.698) 0.021 最近6个月发生异性性行为Heterosexual sex in the last 6 months 是Yes 314 204(64.97) 1.000 1.000 否No 555 284(51.17) 0.565(0.425~0.752) < 0.001 0.705(0.517~0.962) 0.027 最近6个月发生商业性同性行为Commercial same-sex behavior in the last 6 months 是Yes 70 57(81.42) 1.000 ― 否No 799 431(53.94) 0.267(0.144~0.496) < 0.001 ― 既往患有性病Pre-existing STDs 是Yes 140 95(67.86) 1.000 ― 否No 729 393(53.91) 0.554(0.378~0.813) 0.003 ― 精神活性物质使用Psychoactive substance use 是Yes 228 148(64.91) 1.000 ― 否No 641 340(53.04) 0.611(0.446~0.835) 0.002 ― 最近1年接受HIV抗体检测HIV Antibody testing in the last year 是Yes 594 323(54.38) 1.000 ― 否No 275 165(60.00) 1.259(0.941~1.682) 0.121 ― 知晓AIDS知识Knowledge of AIDS 是Yes 751 419(55.79) 1.000 ― 否No 118 69(58.47) 1.116(0.753~1.654) 0.585 ― 注：MSM, 男男性行为者; UAI, 无保护肛交; HIV, 人类免疫缺陷病毒; AIDS, 艾滋病; “―”，无统计学意义。
①以人数(占比/%)表示。
Note：MSM, men who have sex with men; UAI, unprotected anal intercourse; HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; "―" no statistical significance.
①Number of people(proportion/%).
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