The Study Of HIV-Risk Behavior Among MSM In A District Of Shandong, China

AIDS dissemination has become the most important public health and social problem all over the world,and HIV has diffused from high risk population to general population.Men who have sex with men(MSM)become bridge population because they have many sex partners and unprotected sex.At present,the HIV infection rate of MSM is 1%～4%.Propaganda and intervention of AIDS among MSM are effective strategies to delay the spreading of HIV to general population.As the sensitive population,MSM are afraid of being rejected and discrimination.Since they are not willing to open their identity in public and their behavior is hidden,they are called hidden population.In the study of MSM,it is difficult to get representative samples and lack of effective intervention model.Using appropriate sampling method and exploring effective intervention model are significant for HIV prevention among MSM.Objective:1.To explore the application of respondent-driven sampling(RDS)to recruit men who have sex with men(MSM)and provide reference for the sampling study of the population.2.To understand the demography character and status of MSM in the district and provide baseline data for future study.3.To obtain effective and suitable intervention measures for MSM,and explore the effective intervention model.4.To increase the frequency of condom usage among MSM with face to face intervention.Method:1.MSM were recruited by respondent-driven sampling and recruitment began with 10 seeds,only 2 seeds extended the referral chain.3 coupons were given to every seed to recruit their peers.The people who were recruited by seeds recruited others, and so on.The coupons labeled by letter and figure,for example,A2 stood for the second participant recruited by the first seed.2.MSM were educated with face to face intervention,including propagandizing HIV prevention knowledge,playing slides,performing how to use condom correctly, HIV counseling and testing.3.Data was collected through questionnaire including information,motivation, behavioral skills and preventive behavior.4.Informed consent ran through the process of investigation,questionnaires were filled anonymously and reviewed by specialized researcher.Result:1,Evaluation of RDS A total of 204 questionnaires was collected.When the sample size came to 132,the weighted mean absolute discrepancies between the actual and equilibrium sample compositions were less than the recommended cutoff point(2.0%).There were no significance between actual sample compositions and the estimated population compositions.The sample compositions converged and reached equilibrium,which were also representative of the target population.2,The status of HIV-risk behavior among MSM2.1 General description In terms of demographical character,the features of MSM were younger,lower education,half of whom were married,the majority of them were workers and commercial server,lower income.In regard to the knowledge of AIDS,the HIV/AIDS knowledge knowing rates of most problems were more than 60%.As far how to use condom properly,the rate of MSM who mastered four or above processes is 67.6%.Majority MSM got HIV/AIDS information from newspaper,magazine,TV and broadcast,and received HIV/AIDS intervention through condom and brochure delivering.32.8%were regarded as gay,while 41.2% were bisexual.About half of MSM had first sex at the age of 20～25(mean was 20.67). Most MSM found sex partners by network.The number of their sex partners in the last six months is equal or under 2.The rate of condom usage was very low,even though that was higher when they had sex with commercial sex workers than with partners.The rates of condom usage when MSM had oral and anal sex in the last six months were 20.5%and 24.4%respectively.2.2 Correlation analysis of indicators1)The correlation analysis indicated MSM who answered some questions right were likely to use condom than those who gave wrong answers.There was a relationship between the number of anal sex partners and HIV/AIDS consultation.2)No correlation was found between the rate of condom usage and education level,as well as HIV/AIDS consultation.Companion education had no relation with the rate of condom usage and the number of anal sex partners.2.3 Logistic analysis indicated that age was a factor which influenced the rate of condom usage in anal sex,and HIV/AIDS knowledge and preventive behavior were disjunctive among this population,because the OR value of HIV/AIDS knowledge was 0.799 in the logistic regression.3,Information-Motivation-Behavioral Skills Model The result of Information-Motivation-Behavioral Skills Model could be acceptable(x~2=111.65,df=50, RMSEA=0.088,CFI=0.95,NNFI=0.93,GFI=0.90,NFI=0.90).The regression coefficient of preventive motivation to preventive behavioral skills was 0.83,which indicated that preventive motivation had great impact on preventive behavioral skills. The regression coefficient between the preventive behavioral skills and preventive behavior was 0.49,which indicated that preventive behavioral skills explained 49%of preventive behavior.However,the regression coefficient was low between the factor of information and preventive behavioral skills.Conclusion:1.It is feasible to recruit MSM by RDS,which has unique feature.RDS can be used in other districts or fields with its continual development and perfection.2.As the bridge population of HIV dissemination,MSM are the target population of HIV prevention,which play an important role in HIV dissemination and prevalence.3.The rate of condom usage was very low in MSM,knowledge and preventive behavior were disjunctive,HIV prevention knowledge was not enough for HIV prevention.4.MSM didn't understand HIV/AIDS knowledge completely,and health education which had affect on reducing risk behaviors should be strengthened.5.Information,motivation and behavioral skills model was fit for the study of HIV/AIDS prevention among MSM,but the result had some difference with abroad study.6.The result of IMB analysis showed that preventive behavioral skills had great impact on the practice of preventive behavior.Preventive motivation could promote the formation of preventive behavioral skills.Preventive motivation and preventive behavioral skills were the emphases of HIV prevention.Discussion and suggestion:1.In order to reduce the number of sex partners and risk behaviors,many intervention measures should be taken and companion education should be strengthened.2.The low rate of condom usage in MSM had its own reasons,and propaganda of using condom should be strengthened.3.In order to promote the act of preventive behavior among MSM,it was important to emphasize preventive motivation and train preventive behavioral skills in HIV intervention.4.Voluntary counseling and testing(VCT)should be convenient to MSM.8.It is important to regard MSM with a scientific attitude and reduce HIV dissemination through the cooperation between departments.