A Case-Control Study Of HIV-Seropositivity Among Men Who Have Sex With Men

Objectives:To identify risk factors for HIV infection among men who have sex with men(MSM) and to provide theoretical basis for the study of prevention,control and intervention of HIV-positive among MSM.Methods:Between December2011and August2012,a case-control study was adopted and collected MSM who had AIDS voluntary consultation detection in Yunnan Rainbow Sky Working Team as samples, and choosed MSM cases who had confirmed HIV-positive in AIDS Department of Yunnan CDC,HIV-negative MSM as control group.Collected the research objects’ exposure of every possible risk factors by the methods of questionnaire survey and qualitative interview,and compared the exposure differences between case group and control group,explored the risk factors of HIV infection among MSM.Results:1The awareness of AIDS and anlysis on the Influence factorsThe overall awareness rate of AIDS was94%. The awareness rate of the case group was92%,and that of the control group was94.5%. The results of multivariate logistic regression analysis show that profession for farmer(OR=1.419,95%CI:1.053～2.241) and having entered into the circle of MSM less then5years (OR=3.316,95%CI:1.992～6.751) wre the risk factors of unacquaintance about AIDS.in marriage(OR=0.032,95%CI:0.004～0.637), college degree or above (OR=0.296,95%CI:0.012-0.885), staff/cadre (OR=0.029,95%CI:0.000-0.535),had counseling and detection for AIDS (OR=0.696,95%CI:0.039-0.871), inspection and therapy for STD(OR=0.753,95%CI:0.306～0.917), receiving publicity materials (OR=0.571,95%CI:0.202～0.937),knowledge about AIDS coming from consulting service(OR=0.023,95%CI:0.001～0.450), and the Internet(OR=0.225,95%CI:0.000～0.516) these factors were protective factors of unacquaintance about AIDS among MSM..2The status of using of condom and anlysis on the Influence factorsThe case group,compared with the control group,has statistical significance (p <0.05) among these three factors:the using of condom in the latest anal sex with=10.851,p=0.001), the using of condom in the latest commercial sex (x25.091, p=0.024), and the using of condom in the anal sex with gay in past six months (x2=23.257, p<0.01). The control group’s rate of using of condom was higher than the case group. Those above factors have eventually entered into equation in the multivariate logistic regression analysis as follows:cohabitation(OR=1.162,95%CI:1.212～4.308), primary school education background(OR=2.267,95%CI:1.663～8.206), migrant workers (OR=2.432,95%CI:1.254～9.008), finding sex partners from park, public toilet (OR=1.041,95%CI:1.004～3.057) this four factors were the risk factors of did’t using of condom;in marriage(OR=0.642,95%CI:0.053～0.811),the average monthly income above4000(OR=0.261,95%CI:0.068～0.622), having infected sex partners (OR=0.659,95%CI:0.107～0.976), finding sex partners from the Internet (OR=0.351,95CI:0.252～0.457), having entered into the circle of MSM more than10years (OR=0.235,95%CI:0.060～0.915),the awareness of AIDS (OR=0.085,95%CI:0.014～0.512) this six factors were the protective factors of did not using of condom.3Analysis on the risk factors of HIV infectionThe result of conditional logistic regression shows that the following factors were the influencing factors of HIV infection:average monthly income between2001and3000yuan (OR=6.341,95%CI:1.714～12.544)), sometimes used condoms when having anal sex with men in the last six months (OR=7.601,95%CI:1.359～23.083), had HIV-positive sex partners (OR=5.273,95%CI:1.572～17.691), rectal trauma with bleeding in the last six months (OR=2.947,95%CI:1.308～6.638), did not use condoms at last sex (OR=1.278,95%CI:1.012～5.595), engaged in commercial sex (OR=5.925,95%CI:1.923～13.890), number of sex partners in the last six months more than15(OR=1.175,95%CI:1.021～1.353) these seven factors were the risk factors of HIV infection (OR>1).However, had anal sex less than10times in the last one month (OR=0.002,95%CI:0.000～0.287)and insertive anal sex (OR=0.116,95%CI:0.000～0.236) were the protecting factors of HIV infection among MSM (OR<1)4The social demand of MSM The main social demands among MSM are as follows:to get social identity, understanding and lower discrimination,countries provide free high quality condom,confidential VCT services,to provide care and psychological support after infection;relaxed and harmonious medical environment, health education of AIDS knowledge, the treatment after opportunistic infection; HIV-positive effective management and Legal support. The case group and the control group were compared, and in these demands have statistically significant(p<0.01) as provide care and psychological support after infection (x2=11.241, p=0.00), the treatment after opportunistic infection (x2=10.006, p=0.00), HIV-positive effective management=14.021, p=0.00).And have difference(p<0.05) in medical environment (x2=4.120,p=0.046) and health education (x2=7.813, p=0.031)Conclusions:MSM have awareness of AIDS, but the control group is higher than that of the case group.We should enhance the health education of AIDS on the internet, increase the quantity of free publicity materials, peer education, HIV and STD voluntary counseling and testing. Meanwhile, enhancing intervention among farmer and having entered into the circle of less then5years. The condom utilization rate of the case group is lower than that of the control group. We Should strengthen the behavior intervention of MSM who in cohabitation, elementary school culture, migrant workers and find sex partners from the park and public toilet to improve the utilization rate of using of condom.This study shows that used condoms sometimes or not when having anal sex with men, had HIV-positive sex partner,rectal trauma with bleeding, engaged in commercial sex service and the number of sex partners in the last six months is more than5were the risk factors for HIV infection among MSM.On the contrary,low frequency of anal sex(the times of anal sex in the last one month<10) and insertive were the protecting factors. The social demands of MSM mainly are health needs, the social care and the social support this three aspects. We should according to the demands in the process of HIV/AIDS prevention and behavior intervention services among MSM.