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(x2=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 de-scriptive epidemiological methods were used to analyse differences in population characteristics,and logis-tic 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 consist-ently 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,commer-cial same-sex sex in the last 6 months,heterosexual sex,use of psychoactive substances,and HIV anti-body 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 statisti-cally significant(x2=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-prov-ince 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 pro-portion of commercial sex and a high risk of UAI;In-school adolescent MSM have a low proportion of pri-or human immunodeficiency virus(HIV)testing,and both have different characteristics and factors asso-ciated with the occurrence of UAI.Therefore,differentiated interventions should be explored to reduce the risk of HIV transmission.
关键词
人类免疫缺陷病毒/校内青少年/校外青少年/男男性行为者
Key words
Human immunodeficiency virus/In-school adolescent/Out-of-school adolescents/Men who have sex with men
维普
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