【摘要】 目的 了解MSM“坚持使用安全套”知行分离情况，并探讨其相关因素，为制定相关干预策略提供依据。方法 2022年8-10月，立意抽样与滚雪球抽样相结合，对成都市和周边市区281名MSM进行问卷调查，收集人口学特征、行为学特征和心理特征等资料，并进行HIV抗体检测。使用SPSS 29.0进行统计学描述、χ~2检验、Logistic回归分析。结果 符合纳入分析的275名MSM中，34.55%存在知行分离，64.36%性向为同性恋，40.00%性角色为插入方/被插入方；85.09%初次同性性行为年龄≥18岁，37.82%存在异性性行为；艾滋病歧视总得分范围为10～39分，中等水平者占43.27%；艾滋病知识知晓率为83.64%；安全套使用自我效能得分范围为13～65分，中等效能者占44.00%。Logistic回归分析结果显示，发生过异性性行为（aOR=4.18,95%CI:1.99～8.77）、初次同性性行为年龄<18岁（aOR=2.85,95%CI:1.13～7.18）、艾滋病歧视得分较高（aOR=2.55,95%CI:1.07～6.07）、年龄≥25岁（aOR=2.30,95%CI:1.08～4.89）的MSM发生知行分离的概率更高。安全套使用自我效能得分中等（aOR=0.13,95%CI:0.07～0.27）和较高（a OR=0.06,95%CI:0.03～0.17）、性向为双性恋/不确定（aOR=0.44,95%CI:0.21～0.91）的MSM发生知行分离的概率更低。结论成都市MSM“坚持使用安全套”知行分离现象较严重，应重点关注发生过异性性行为、初次男男性行为年龄<18岁、艾滋病歧视得分较高、年龄≥25岁、安全套使用自我效能得分较低、性向为同性恋的MSM，开展针对性干预，减少艾滋病歧视，并在新形势下进一步探索和发展提高安全套坚持使用率的宣教方式，促进“坚持使用安全套”知行合一。更多还原

【Abstract】 Objective To understand the situation of knowledge-behavior separation in the "consistent use of condoms" among men who have sex with men(MSM) and to explore its influencing factors, providing a basis for the development of relevant intervention strategies. Methods From August to October 2022, a combination of purposive and snowball sampling was used to conduct a questionnaire survey of 281 MSM in Chengdu City and its surrounding areas. Data on demographic, behavioral, and psychological characteristics were collected along with human immunodeficiency virus(HIV) antibody testing. Statistical descriptions, chi-square tests, and logistic regression analyses were performed using SPSS 29.0. Results Among the 275 MSM eligible for analysis, 34.55% exhibited a knowledge-behavior separation, 64.36% identified as homosexual, 40.00% engaged in insertive/receptive sexual roles, 85.09% initiated maleto-male sexual behavior at age ≥18, and 37.82% had heterosexual experiences.The total score of HIV-related discrimination ranged from 10 to 39, with 43.27% at a moderate level;the awareness rate of HIV knowledge was 83.64%;the self-efficacy score for condom use ranged from 13 to 65, with 44.00% at a moderate level. Logistic regression analysis showed that MSM who engaged in heterosexual behavior(aOR=4.18, 95%CI: 1.99-8.77), initiated male-to-male sexual behavior at age <18 years(aOR=2.85, 95%CI: 1.13-7.18), had higher HIV discrimination scores(aOR=2.55, 95%CI: 1.07-6.07), and were aged ≥25 years(aOR=2.30, 95%CI: 1.08-4.89) had a high probability of exhibiting knowledge-behavior separation. In contrast, MSM with moderate(aOR=0.13, 95%CI: 0.07-0.27) and high self-efficacy scores for condom use(aOR=0.06, 95%CI: 0.03-0.17), as well as those who were bisexual/uncertain(aOR=0.44, 95%CI: 0.21-0.91), had a low probability of exhibiting knowledgebehavior separation. Conclusions The phenomenon of knowledge-behavior separation in the "consistent use of condoms" among MSM is severe. It is necessary to focus on MSM who have engaged in heterosexual behavior, initiated male-to-male sexual behavior at age <18 years, have high HIV discrimination scores, are ≥25 years old, have low selfefficacy scores for condom use, and are homosexual, to carry out targeted interventions, reduce HIV-related discrimination, and further explore and develop educational approaches to improve consistent condom use in the new context, thereby promoting the integration of knowledge and practice in "consistent use of condoms."更多还原