Risk and influencing factors of HIV infection among adolescent men who have sex with men based on trajectory model
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摘要:
目的 探究青少年男男性行为者(young men who have sex with men, YMSM)HIV感染风险发展轨迹,并分析HIV感染风险的影响因素。 方法 基于在湖北省、湖南省、江西省3地开展的动态随访队列,运用基于群组轨迹模型(group-based trajectory model, GBTM)分析YMSM人群HIV感染风险的发展轨迹,使用广义估计方程(generalized estimation equation, GEE)分析与HIV感染风险相关的因素。 结果 2017年9月20日―2018年1月21日共460名HIV阴性YMSM被纳入随访,GBTM识别出3组HIV感染风险发展轨迹,分别为低风险组、中风险组、高风险组,风险越高组的YMSM首次同性性行为年龄越低、农村户口比例更高,差异均有统计学意义(均有P<0.05)。GEE结果显示首次性行为年龄、抑郁量表得分、同性恋歧视、心理韧性均与HIV感染风险存在关联(均有P<0.05)。 结论 YMSM人群普遍存在HIV感染风险且感知歧视水平高者HIV感染风险高,应关注YMSM人群的心理健康。 Abstract:Objective To explore the trajectory of HIV infection risk among young men who have sex with men (YMSM), and to analyze associated factors of HIV infection risk. Methods A dynamic cohort among YMSM was conducted in Hubei, Hunan and Jiangxi Provinces. The group-based trajectory model (GBTM) was used to explore the trajectory of HIV infection risk of YMSM, and the generalized estimation equation (GEE) was performed to analyze the risk factors related to HIV infection. Results A total of 460 HIV-negative YMSM were included in the cohort from September 20, 2017 to January 21, 2018. Three groups were identified by GBTM, including low-risk group, medium-risk group and high-risk group. The YMSM were in the group with higher risk, the lower the age at which they first had sex debut, and the higher proportion of rural residents (all P < 0.05).The results of GEE showed that the age of sexual debut, depression, sexual minority stigma and resilience were associated with HIV infection risk (all P < 0.05). Conclusions YMSM were generally at the risk of HIV infection, and those who with high level of stigma were at a higher risk of HIV infection. Importance should be attached to the mental health of YMSM. -
Key words:
- Young men who have sex with men /
- Stigma /
- HIV /
- Cohort study /
- Group-based trajectory model
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表 1 2017―2020年YMSM HIV感染相关高危行为特征
Table 1. Characteristics of HIV-related risk behaviors among YMSM between 2017-2020
变量 基线调查(n=460) 第一次随访(n=376) 第二次随访(n=330) 第三次随访(n=214) χ2值 P值 近6个月同性性伴数 5.712 0.769 <2 255(55.43) 202(54.01) 177(53.64) 112(52.34) 2~<6 180(39.13) 147(39.30) 132(40.00) 85(39.72) 6~<10 12(2.61) 17(4.55) 12(3.64) 7(3.27) ≥10 13(2.83) 8(2.14) 9(2.73) 10(4.67) 近6个月同性性行为角色 8.027 0.236 只做插入方 159(34.57) 139(36.97) 108(32.73) 77(35.98) 两者皆有 225(48.91) 153(40.69) 155(46.97) 96(44.86) 只做被插入方 76(16.52) 84(22.34) 67(20.30) 41(19.16) 近6个月性伴HIV感染 2.820 0.831 无 321(69.78) 271(72.08) 229(69.39) 158(73.83) 有 15(3.26) 14(3.72) 10(3.03) 8(3.74) 不详 124(26.96) 91(24.20) 91(27.58) 48(22.43) 近6个月商业性行为 1.213 0.751 无 437(95.00) 360(95.74) 317(96.06) 207(96.73) 有 23(5.00) 16(4.26) 13(3.94) 7(3.27) 近6个月新型毒品使用 0.612 a 无 450(97.83) 371(98.67) 321(97.27) 210(98.13) 有 10(2.17) 5(1.33) 9(2.73) 4(1.87) 近6个月无保护性肛交 6.651 0.355 无 288(62.61) 249(66.22) 211(63.94) 121(56.54) 有时 151(32.83) 111(29.52) 103(31.21) 78(36.45) 一直 21(4.56) 16(4.26) 16(4.85) 15(7.01) 近6个月其他性病感染 19.384 0.001 无 448(97.39) 347(92.29) 304(92.12) 209(97.66) 有 12(2.61) 29(7.71) 26(7.88) 5(2.34) 注:a Fisher确切概率法。 表 2 不同HIV感染风险轨迹组个体特征[n(%)]
Table 2. Characteristics of different HIV infection risk trajectory groups [n(%)]
变量 低风险组(n=35) 中风险组(n=310) 高风险组(n=115) χ2/F值 P值 HIV阳转人数 0.511 a 是 0(0.00) 8(2.58) 5(4.35) 否 35(100.00) 302(97.42) 110(95.65) 民族 0.423 a 汉族 31(88.57) 287(92.58) 103(89.57) 少数民族 4(11.43) 23(7.42) 12(10.43) 是否为在读学生 3.383 0.192 是 24(68.57) 177(57.10) 59(51.30) 否 11(31.43) 133(42.90) 56(48.70) 性取向 0.023 a 异性恋 3(8.57) 1(0.32) 0(0.00) 同性恋 24(68.57) 253(81.61) 90(78.26) 双性恋 6(17.14) 41(13.23) 19(16.52) 不确定 2(5.72) 15(4.84) 6(5.22) 是否向家人出柜 2.413 0.299 是 9(25.71) 67(21.61) 33(28.70) 否 26(74.29) 243(78.39) 82(71.30) 是否认同自己的生理性别 0.849 a 是 33(94.29) 284(91.61) 104(90.43) 否 0(0.00) 12(3.87) 5(4.35) 不确定 2(5.71) 14(4.52) 6(5.22) 文化程度 0.028 a 高中及以下 2(5.71) 53(17.10) 30(26.09) 本科或大专 28(80.00) 230(74.19) 79(68.69) 研究生以上 5(14.29) 27(8.71) 6(5.22) 父亲文化程度 16.907 0.002 初中及以下 6(17.14) 122(39.95) 55(47.83) 高中或中专 13(37.14) 120(38.71) 41(35.65) 大专及以上 16(45.72) 68(21.94) 19(16.52) 母亲文化程度 23.741 <0.001 初中及以下 7(20.00) 154(49.68) 74(64.35) 高中或中专 17(48.57) 111(35.81) 28(24.35) 大专及以上 11(31.43) 45(14.51) 13(11.30) 户口类型 10.721 0.005 城市 25(71.43) 168(54.19) 48(41.74) 农村 10(28.57) 142(45.81) 67(58.26) 抑郁量表得分(分) 12.718 0.002 >16 15(42.86) 151(48.71) 77(66.96) ≤16 20(57.14) 159(51.29) 38(33.04) 性取向相关歧视得分(x±s, 分) 15.00±0.56 15.01±0.79 16.10±0.41 3.691 0.026 心理韧性得分(x±s, 分) 39.00±1.33 36.29±0.46 34.21±0.79 5.267 0.005 首次同性性行为年龄(x±s, 分) 19.23±2.13 18.48±2.25 17.93±2.11 5.242 0.006 注:a Fisher确切概率法。 表 3 YMSM HIV感染风险评分的多因素广义估计方程分析结果
Table 3. Results of multivariable generalized estimating equation in YMSM HIV risk score
变量 β值 sx值 Wald值 OR(95% CI)值 P值 户口 农村 1.000 城市 0.256 0.210 1.490 1.291(0.856~1.948) 0.222 文化程度 高中及以下 1.000 本科或大专 -0.519 0.287 3.275 0.543(0.350~0.841) 0.070 研究生以上 -0.561 0.390 2.066 0.571(0.266~1.226) 0.151 父亲文化程度 初中及以下 1.000 高中或中专 0.033 0.229 0.020 1.033(0.660~1.618) 0.886 大专及以上 -0.202 0.307 0.433 0.817(0.477~1.492) 0.511 母亲文化程度 初中及以下 1.000 高中或中专 -0.611 0.224 7.473 0.543(0.350~0.841) 0.006 大专及以上 -0.602 0.358 2.820 0.548(0.271~1.106) 0.093 抑郁量表得分(分) ≤16 1.000 >16 0.509 0.188 7.304 1.664(1.150~2.406) 0.007 首次同性性行为年龄 -0.207 0.046 26.730 0.813(0.743~0.889) <0.001 性取向相关歧视 0.313 0.096 9.401 1.368(1.132~1.653) 0.001 心理韧性 -0.182 0.095 4.222 0.834(0.692~0.993) 0.040 -
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