【作者】 朱军礼；

【导师】 张洪波； 吴尊友；

【作者基本信息】 安徽医科大学 ， 儿少卫生与妇幼保健学， 2008， 硕士

【摘要】 目的了解合肥市男男性行为人群社会网络特征及其与HIV和梅毒传播间关系,探索男男性行为人群艾滋病危险行为同伴干预方法的可行性与有效性。方法采用应答者驱动的招募(respondent driven sampling, RDS)方法,在合肥市招募过去12个月内有男男性行为(肛交或口交)的18～25岁的男性为研究对象。先由培训合格的筛查员,按研究对象纳入标准进行筛查,在获得研究对象的知情同意后,再由培训合格的调查人员对调查对象进行匿名的面对面问卷调查,共有193名男男性行为者接受了问卷调查。调查内容包括最近6个月核心社会网络(指在工作和学习以外的业余时间里,经常和自己在一起的18周岁以上的人,总数量不超过5人)、性伴及性行为等特征。调查结束后,对193名男男性行为者采集静脉血液标本5ml进行HIV和梅毒抗体检测。最后,使用Logistic回归方法,分析核心社会网络特征与艾滋病危险行为间的关系,分析核心社会网络特征与HIV和梅毒近期感染间的关系。在上述研究的基础上进行男男性行为人群同伴干预研究,首先,在合肥市上述研究对象中招募16名在男男性行为人群活动场所有影响力的男男性行为者作为“发起人”,采用同伴网络招募同伴的方法,在男男性行为人群中招募了223名过去12个月内有男男性行为(肛交或口交)的、18～25岁的男性,建立10个干预活动小组。然后,通过培训6名志愿者(来自江淮同心志愿者小组),由他们组织实施4个HIV高危行为主题干预活动(危险行为评估、制定安全性行为计划、行为改变实践及行为强化),干预活动为期1个月。最后,通过比较干预前和干预后3个月干预对象艾滋病基本知识水平、安全套使用率、最近2个月性伴数和最近3个月HIV检测率等指标,评估干预效果。结果核心社会网络的网络大小为6、5、4、3、2分别占44.6%,14.0%,19.1%,16.6%,5.7%,网络密度均数为(0.76±0.23);网络成员均为男性的网络占网络总数的52.3%;网络成员年龄均在25岁及以下的网络占网络总数的58.5%;网络成员文化程度均在大学文化程度以下的网络占网络总数的13.5%;网络成员中无同性性取向者的网络占网络总数的10.9%;调查对象与网络成员间(如父母、兄弟姐妹、朋友、同事、同学及邻居等社会关系)仅存有1种社会关系的网络占60.6%;调查对象与网络成员曾发生过性关系的网络占网络总数的46.6%;调查对象性取向在其网络成员中100%公开化的网络占53.4%;核心社会网络成员均支持调查对象性取向者占43.0%。与年轻男男性行为人群最近6个月同性肛交性伴数相关联的社会网络特征有,核心社会网络成员的性别构成、调查对象与网络成员间社会关系类别数、核心社会网络成员文化程度构成、网络成员对调查对象性取向的支持度、调查对象与网络成员间有无性关系;增加年轻男男性行为人群最近6个月发生无保护肛交的危险社会网络因素有,核心社会网络男性成员构成比为50%～100%、调查对象与网络成员有性关系;HIV和梅毒近期感染的危险因素有最近6个月有2个及以上同性肛交性伴、最近6个月发生了无保护肛交、网络大小被聚为6。通过干预后3个月的随访调查与干预前基线调查的相关指标比较分析,“发起人主导和同伴驱动相结合的行为干预”方法,提高了干预对象艾滋病基本知识水平,提高最近3次和最近1次安全套使用率,降低了最近2个月拥有3个及以上同性性伴的报告率,提高了最近2个月拥有男性固定性伴的报告率,降低了最近2个月拥有男性偶然性伴的报告率,提高了最近3个月HIV检测率。结论年轻男男性行为人群社会网络是HIV/STDs传播重要影响因素,男男性行为人群的同伴群是开展艾滋病健康教育和行为干预工作重要途径。“发起人主导和同伴驱动相结合的行为干预”方法可以促进男男性行为者安全套使用,提高男男性行为人群的HIV检测率,减少同性性伴数。更多还原

【Abstract】 Objectives To describe the characteristics of social network, and to determine the associations between HIV/STDs transmission and characteristics of social network, and to examine the feasibility and effectiveness of initiator-leading and peer-driven behavior intervention among young men who have sex with men.Methods 193 eligible young MSM( aged 18 to 25, and having anal or oral sex with men in last year) were recruited to participate in the study by Respondent-Driven Smapling way in Hefei. An informed consent was administered and only those who agreed to participate were interviewed on face to face. Trained interviewers using questionnaires collected information on participants’sociodemographic characteristics, and number of homosexual partners and sexual behavior during the previous 6 months. Core social networks were enumerated and network size and density were calculated. Additionally, participants were collected 5 ml blood specimen for HIV snd syphilis anti-body testing. Logistic regression was used to analyze the associations between HIV-risk behaviors and HIV & syphilis infection and chacteristics of social network.Based on study above, initiator-leading and peer-driven behavior intervention was conducted among young MSM in Hefei. The 16 young MSM were selected as initiators in MSM venues. Through their peer referral chains, 223 eligible MSM (aged 18 to 25, and having anal or oral sex with men in last year) were recruited to participate in intervention cohort. All participants were divided into 10 intervention groups based on intitiators and their recruitment chains. Baseline survey was self-administered before intervention. Six MSM volunteers were trained by following guidance of intervention and then they conducted four session intervention programme with every group within one month. Assessment was surveyed after two months of intervention finished. Effectiveness evaluation of the intervention was made by comparing baseline with assessement.Results Proportions of network sizes for 2,3,4,5 and 6 were 5.7%,16.6%,19.1%,14.0%,44.6% respectively. Mean of network density was 0.76(SD=0.23). Proportion of networks which consisted of male member only was 52.3%, and member under 25 years old only was 58.5%, and member under college education level only was 13.5%. There no homosexual orientation among member of network accounted for 10.9%. The proportion of social networks with one type of relationship between participant and his network member was 60.6%. Of 193 participants, 46.6% reported having sex with their members of social network, and 53.4%disclosed their same-sexorientation to member of social network. 43.0% participants acquired support for their same-sexorientation from their member of social network.Of characteristics of social network, factors associated with number of anal sex partners including (1) the proportion of male member, (2) the number of sorts of relationship between participant and his network member, (3) the proportion of member accepted college education, (4) the proportion of member fully supporting same-sexorientaion, and (5) having sex with his network member or not. Factors could increase the likelihood of having unprotected anal intercourse involving in the proportion of male member which reached to50% and not to100%, and having sex with his network member. Risk factors of infection of HIV & syphilis were determined as having 2 and more male sexual partners during the previous 6 months and having unprotected anal intercourse as well as network size was 6 during the previous 6 months.The results revealed that IPBI could increase the knowledge related to HIV/AIDS and promote condom use with variety of male partner in the last three anal sex and the last anal sex. Meanwhile, IPBI could increase the rate of having regular male partner and decrease the rate of having 3 and more male sexual partners and the rate of having casual male partner during previous 2 months. IPBI also could promote HIV testing .Conclusions Young MSM’s social network played an important role in HIV/STDs transmission.“Initiator-Leading and Peer-driven Behavior Intervention”model could be acceptable among young MSM and could increase condom use and decrease number of male sexual partners and promot HIV testing.更多还原