The Study Of HIV-Risk Behavior And Factors Among MSM In Liaocheng, Shandong Province, China

AIDS dissemination has brought about unprecedented impact to the world economic development and social progress. It has become the most important public health and social problem all over the world. In recent years, the spread of HIV has become more and more serious in China, which has diffused from high risk population to general population. Sexual transmission has become the main mode of transmission, in which Men who have sex with men (MSM) has risen quickly. The epidemic report of the Ministry of Health reveals that the proportion of MSM has risen from 5.9% in 2008 to 8.6% in 2009, even more than ten percent in some cities. So the AIDS dissemination in China is mostly depended on the control of the epidemic in MSM. It is reported that there is a great number of MSM in China, and 2/3 of them have anal sex without condom, more than half of them have sex with women. The MSM has become the bridge population in the spread of HIV. 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. In this study, we investigate the HIV-Risk Behavior among MSM in Liaocheng, Shandong province according to the "National HIV sentinel surveillance of implementation of the program (Trial) Operating Manual", and discuss the three recruitment methods.Objective:1. To use three different methods recruit person in the population of MSM, and increase the frequency of condom usage and awareness of HIV knowledge among MSM with face to face intervention. 2. To understand the MSM demography character, status, high-risk behaviors, and their identity conditions to the AIDS infected person or the patients in the district.3. To analysis the epidemic situation and factors of AIDS in MSM, and provide certain information to the estimates and projections of AIDS in this population.4. To obtain effective and suitable protection and intervention measures for MSM, and explore the effective intervention model.Method:1. MSM can be recruited by three methods:(1) Category snowball sampling. At first we can find the key informants in the community or the MSM known by the monitoring mechanism, and then we can find other person depend on them, until the completion of the necessary sample size. The primary research subject (also called "seed") had better have different character and behavior in order to avoid or diminish the selection bias.(2) Recruit from the MSM arena. According to the risk behavior among MSM, we divide the arena into two layers, such as:â‘ groggery, night club, tea house, public bath, Sauna Room, foot store, and so on;â‘¡public latrine, public park, and so on. We get sample according to the estimate scale of MSM population of each layer. It can be divided into the following three steps.First, we should draw the site map. The map should include the name, classification, location, distribution of the MSM population.Second, extract the investigation place according to the distribution marked in the map. If there are few places, then all the places can be integrated into the monitoring. If the places are ample, then we can divide the site into two layers, and randomly select appropriate places within each layer according to the proportion of the layer.Third, extract Sample in the study population. Using Cluster sampling extract the appropriate sample in the place selected before.(3) Network Recruitment:recruitment the sample by releasing recruitment information in the network forum, internet chat room, instant messenger of MSM population. At specified time and place, the respondent can join in the health club or health training or other activities organized by the investigators, in which they be investigated face to face and do certain serological test.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, high-risk behavior, knowledge of AIDS and routine of knowledge to obtain, identification of MSM population with AIDS infected person and patients, and the testing information.4. Informed consent ran through the process of investigation, questionnaires were filled anonymously and reviewed by specialized researcher.Result:1. MSM population recruitment and the questionnaire. A total of 219 questionnaires were collected, in which there are 100 copies category snowball samples,58 copies from the MSM arena,61 copies from network recruitment.2. The status of HIV-risk behavior among MSM.2.1 General description. In terms of demo graphical character, the features of MSM were younger, well educated, half of whom were married or cohabitant, the majority of them were workers and commercial server, lower income, local resident population. In regard to the knowledge of AIDS, the HIV/AIDS knowledge knowing rates of most problems were 83.1%, the major routine to obtain the knowledge are from the internet or the television. The majority of them could not speak out their sexual orientation to the doctors frankly.38% were regarded as gay, while 44% were bisexual.55%of them find sexual partner by internet.95.4% of them have a circle of friends. About 80.4% of MSM had first sex before the age of 23(mean was 21.47, the youngest was 12). The gender ratio of the first sex partner was 1:1. About 61.6% of MSM had first homosexual before the age of 23(mean was 23.74, the youngest was 16). The rates of condom usage when MSM had anal sex in the last time and six months were 54.8% and 34.1% respectively. In the last six months, the rate of providing commercial sex to men was 6.2%, in which using condom every time was 22.2%, having sex with heterosexual was 39.3%, in which using condom every time was 28.0%, and 39.3% could not have safe sex because of drinking,5.9% have had sexually transmitted disease before. The rate of HIV infection is 3.24% in this survey.2.2 Correlation analysis of indicators1) The Chi-square test indicated that HIV/AIDS knowledge knowing rates were different in different group of local residence, education, the site looking for partner (X2 was 8.488,15.729,12.794, and P was 0.004,0.000,0.008 respectively.).2) HIV/AIDS knowledge knowing rates were different in different group of MSM had anal sex or not in the last six months (x2 was 8.219, and P was 0.004).3) The frequency of using condom when had homosexual in the last time was different in different profession (X2 was 17.374, and P was 0.011).4) The frequency of using condom when had heterosexual in the last six months, MSM could not have safe sex because of drinking, the frequency of using condom when had anal sex in the last time was different in different groups (x2 was 11.279, 4.965, and P was 0.004,0.047 respectively.).5) The frequency of using condom when had heterosexual in the last six months, MSM could not have safe sex because of drinking, the frequency of using condom when had heterosexual in the last six months was different in different groups (x2 was 14.880,49.781, and P was 0.000,0.004 respectively.).6) Correlation analysis:Using social demographic factors as causal variable, and the score of identification of HIV/AIDS as outcome variable.Conclusion:1. Using three recruitment methods can ensure the sample size, and network recruitment and snowball sampling are use mostly in this area.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, and sustainable intervention mechanism should be build.4. Expand the participation of social organization and increase publicity and education are the important measures to induce the risk behavior. 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. Using integrated intervention, expanding the participation of social organization, promoting the implementation of prevention among MSM.4. Voluntary counseling and testing (VCT) and other measures should be convenient to MSM, and we should also expand monitoring coverage.