Impact of childhood sexual abuse on risky sexual behaviors among men who have sex with men in Guangzhou
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摘要:
目的 了解广州市男男性行为者（men who have sex with men，MSM）的儿童期性虐待（childhood sexual abuse，CSA）情况，分析CSA对成年后高危性行为的影响。 方法 采用非概率抽样方法招募广州市≥ 18周岁的MSM，通过电子问卷收集调查对象的社会人口学资料、CSA经历和近6个月高危性行为情况。采用χ2检验比较不同社会人口学特征的MSM的CSA经历和近6个月的高危性行为情况，用Logistic回归分析模型分析探讨CSA对高危性行为的影响。 结果 调查对象的平均年龄为（28.35±6.83）岁。26.95%（263/976）的MSM遭受过CSA，近6个月多性伴（multiple sexual partners，MSP）率和无保护肛交（unprotected anal intercourse，UAI）率分别为61.68%（602/976）和47.95%（468/976）。调整了年龄、民族、户籍、本地居住时间、婚姻状况、文化程度、工作状况、个人月收入和性取向之后，有CSA者近6个月发生MSP的风险高于无CSA者（aOR=1.62，95% CI：1.19~2.22），但近6个月UAI与CSA关联的差异无统计学意义。 结论 广州市MSM经历CSA的比例较高，CSA可增加成年后的高危性行为的风险，因此，制定MSM高危性行为干预措施可能需要考虑CSA的影响。 Abstract:Objective To explore the experience of childhood sexual abuse (CSA) among men who have sex with men (MSM) in Guangzhou, and to evaluate its impact on risky sexual behaviors in adulthood. Methods A non-probability sampling method was used to recruit MSM aged 18 years and over in Guangzhou. Sociodemographic characteristics, experience of CSA and risky sexual behaviors during the past 6 months were collected using an electronic questionnaire. χ2 tests were used to compare the prevalence of CSA and risky sexual behaviors during the past 6 months among different sociodemographic characteristics. Logistic regressions were performed to assess the impact of CSA on risky sexual behaviors. Results Overall, 976 MSM were included with an average age of (28.35±6.83) years old. Nearly one-third (26.95%, 263/976) of MSM experienced CSA. Participants having multiple sexual partners (MSP) and unprotected anal intercourse (UAI) during the past 6 months accounted for 61.68% (602/976) and 47.95% (468/976), respectively. After adjusting age, ethnicity, household registration, local residence time, marital status, education, employment status, monthly income and sexual orientation, the results of multivariate Logistic regression showed that MSM who experienced CSA were likely to have MSP during the past 6 months (aOR=1.62; 95%CI: 1.19-2.22) than those did not experience CSA. But the association between UAI and CSA was not statistically significant. Conclusions The prevalence of CSA among MSM in Guangzhou is high. CSA can substantially increase the risk of risky sexual behaviors in adulthood. Intervention to reduce the risk of sexual risk behaviors may need to be tailored for MSM who experienced CSA. -
表 1 不同社会人口学特征的调查对象CSA经历比较[n(%)]
Table 1. Comparison of sociodemographic characteristics among participants by experience of CSA[n(%)]
变量 人数 CSA经历 χ2值 P值 有 无 年龄(岁) 5.478 0.019 ≤29 656(67.21) 192(29.27) 464(70.73) ＞29 320(32.79) 71(22.19) 249(77.81) 民族a 3.803 0.051 汉族 928(97.07) 244(26.29) 684(73.71) 其他 28(2.93) 12(42.86) 16(57.14) 户籍 0.001 0.973 本市 348(35.66) 94(27.01) 254(72.99) 非本市 628(64.34) 169(26.91) 459(73.09) 本地居住时间(年) 0.034 0.853 ≤1 112(11.48) 31(27.68) 81(72.32) ＞1 864(88.52) 232(26.85) 632(73.15) 婚姻状况 1.050 0.306 未婚 849(86.99) 224(26.38) 625(73.62) 在婚/同居/
离异/丧偶127(13.01) 39(30.71) 88(69.29) 文化程度 9.128 0.003 高中及以下 241(24.69) 83(34.44) 158(65.56) 大专及以上 735(75.31) 180(24.49) 555(75.51) 工作状况b 5.052 0.025 在职/兼职 787(80.72) 63(33.51) 125(66.49) 非在职/非兼职 188(19.28) 200(25.41) 587(74.59) 个人月收入(元) 11.365 0.001 ≤3 000 214(21.93) 77(35.98) 137(64.02) ＞3 000 762(78.07) 186(24.41) 576(75.59) 性取向 1.562 0.458 同性恋 723(74.08) 189(26.14) 534(73.86) 双性恋 208(21.31) 63(30.29) 145(69.71) 异性恋/其他 45(4.61) 11(24.44) 34(75.56) 注：a民族缺失20人；b工作状况缺失1人。 
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表 2 不同社会人口学特征的调查对象近6个月高危性行为情况比较[n(%)]
Table 2. Comparison of sociodemographic characteristics among participants by risky sexual behaviors in the past 6 months [n(%)]
变量 近6个月MSPa χ2值 P值 近6个月UAIb χ2值 P值 有 无 有 无 年龄(岁) 4.801 0.028 0.575 0.448 ≤29 389(59.30) 267(40.70) 309(47.10) 347(52.90) ＞29 213(66.56) 107(33.44) 159(49.69) 161(50.31) 民族c 0.461 0.497 3.181 0.075 汉族 571(61.53) 357(38.47) 438(47.20) 490(52.80) 其他 19(67.86) 9(32.14) 18(64.29) 10(35.71) 户籍 0.034 0.853 2.963 0.085 本市 216(62.07) 132(37.93) 154(44.25) 194(55.75) 非本市 386(61.46) 242(38.54) 314(50.00) 314(50.00) 本地居住时间(年) 0.050 0.823 0.746 0.388 ≤1 68(60.71) 44(39.29) 58(51.79) 54(48.21) ＞1 534(61.81) 330(38.19) 410(47.45) 454(52.55) 婚姻状况 3.578 0.059 0.610 0.435 未婚 514(60.54) 335(39.46) 403(47.47) 446(52.53) 在婚/同居/离异/丧偶 88(69.29) 39(30.71) 65(51.18) 62(48.82) 文化程度 0.129 0.7202 0.454 < 0.001 高中及以下 151(62.66) 90(37.34) 146(60.58) 95(39.42) 大专及以上 451(61.36) 284(38.64) 322(43.81) 413(56.19) 工作状况d 0.421 0.517 0.101 0.751 在职/兼职 489(62.13) 298(37.87) 375(47.65) 412(52.35) 非在职/兼职 112(59.57) 76(40.43) 92(48.94) 96(51.06) 个人月收入(元) 0.227 0.634 2.112 0.146 ≤3 000 129(60.28) 85(39.72) 112(52.34) 102(47.66) ＞3 000 473(62.07) 289(37.93) 356(46.72) 406(53.28) 性取向 5.855 0.054 1.082 0.582 同性恋 444(61.41) 279(38.59) 353(48.82) 370(51.18) 双性恋 137(65.87) 71(34.13) 96(46.15) 112(53.85) 异性恋/其他 21(46.67) 24(53.33) 19(42.22) 26(57.78) 注：aMSP指≥2个同性性伴；bUAI指至少一次与同性性伴发生肛交性行为时未使用安全套；c民族缺失20人；d工作状况缺失1人。
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表 3 CSA经历对高危性行为影响的Logistic回归分析结果
Table 3. Logistic regression analysis of impact of CSA on risky sexual behaviors among participants
变量 近6个月MSPa P值e 近6个月UAIb P值e cORc(95%CI)值 aORd(95%CI)值 cOR(95%CI)值 aOR(95%CI)值e CSA 无 1.00 1.00 < 0.001 1.00 1.00 0.228 有 1.61(1.19~2.17) 1.62(1.19~2.22) 1.28(0.97~1.70) 1.20(0.89~1.61) 注：a表示≥2个同性性伴；b表示至少一次与同性性伴发生肛交性行为时未使用安全套；c表示粗比值比；d表示调整比值比，为调整年龄、民族、户籍、本地居住时间、婚姻状况、文化程度、工作状况、个人月收入和性取向后的结果，e表示多因素Logistic回归分析中的P值。
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