Health Status And Health Service Utilization In A Sample Of HIV-positive Men Who Have Sex With Men In Shanghai

Objectives This study investigated the status of incidence of syphilis, CD4~+lymphocyte count,mental health and health service utilization in a sample of HIV-positive men who have sex withmen (MSM) and to determine the factors associated with them.Methods This survey was conducted in Shanghai using cross-sectional method. A total of200eligible participants were recruited by “snowballing” with the criteria including male who wereabove18years of age, living in the city and after confirm infected by MSM，willing to complete thesurvey, and result of testing was positive. After the informed consent, we carried out face-to-facesurveys.After the informed consent, we carried out face-to-face surveys. The main information including:1) demographic varieties.2) AIDS related health service utilization.3) CD4cell count detecting,including detecting interval and results of detecting.4) Mental health condition, anxietysymptom was evaluated using SAS and depression symptom was evaluated using CES-D.5)High risk sex behavior. In the last, we also collected5ml blood to detect syphilis.EpiData3.0software was used to establish a data-base. Chi-Square tests, Logistic RegressionAnalysis were used in this study.Results Among all participants, low CD4~+cell count (<350/mm3) prevalence was69.4%(132/190), and syphilis prevalence was16.9%(33/195). the rate of anxiety symptom and depression symptom was15.5%（31/200）and24.0%（48/200）respectively.28.0%(56/200) ofthe participants unreceived antiviral therapy,91.5%（183/190）have CD4~+cell detection half ayear at least.44.0%（88/190）joined CD4cell detection and79.5%（159/200）request dependentdemand on their’s own initiative,Consult frequency is one time in1-3months highest.In thosepassively accepted participants, the highest proportion is AIDS treat knowledge promotion，freecondoms distribution，received assisted living is6%（12/200）. Homosexual anal sex behaviourand heterosexual sex behaviour is57.5%and13.5%respectively.36.5%had more than2homosexual sexual partners with anal sex. In the last six months, the rate of not use condom inevery sex act with man and sex act with women was16.0%and3.5%respectively.Multivariate logistic regression analysis for standardized follow-up CD4testing indicatedthat receiving ART (OR=6.358,95%CI=2.683-15.067), actively telling others know the HIVinfection status within10days after knowing they were infected (OR=4.473,95%CI=1.426-14.029) were more likely to receive standardized follow-up CD4testing. Comparingwith those go to test CD4~+count through medical staff notice, those through sex partnerrecommend were less likely to receive standardized follow-up CD4testing（OR=0.087,95%CI=0.013-0.580）Multivariate logistic regression analysis for no standardized antiviral treatment indicatedthat those had lower score of ART related knowledge (score less then10) were more likely toreceive standardized antiviral treatment when it compared to those had higher score (score greatthan or equal to10)OR=2.749,95%CI=1.032-7.325）. Actively telling their boy friends knowthe HIV infection status after knowing they are infected （OR=3.923，95%CI=1.480-10.399)were4times more likely to receive standardized antiviral treatment.Multivariate logistic regression analysis for infection rate of syphilis indicated that thoseconsidering the HIV infectious status of their sexual partner when they have sex with them(OR=2.595,95%CI=1.165-5.780) were2.595times more likely to be infected by syphilis when it compared to those no care. Those looked for sex partner in bars and clubs were more likely tobe infected by syphilis when it compared with those in other places (OR=3.899,95%CI=0.880-17.284). When it compared with those have sex with boy friends, those had sexwith casual or commercial sexual partner were more likely be infected by syphilis (OR=12.406,95%CI=1.535-100.269).Multivariate logistic regression analysis indicated that CD4~+count less then350/mm3associated with active detecting CD4~+count (OR=2.505,95%CI=1.228-5.112), neverreceiving free condom in the past year（OR=3.302,95%CI=1.639-6.654）, considering the HIVinfectious status when they had sex with sex partner(OR=2.304,95%CI=1.055-5.029), lookingfor sexual partner through other approach but not internet (OR=2.284,95%CI=1.066-4.894),the interval after identified HIV-positive less than or equal to0.5year (OR=4.855,95%CI=0.998-23.621). Multivariate logistic regression analysis for detection rate of anxietysymptom indicated that those had sex with sexual partner at home were more likely to bedetected as anxiety symptom （OR=6.214，95%CI=0.814-47.415）. Multivariate logisticregression analysis for high risk sexual behavior indicated that those who had a little drunk inthe last sex were more likely to have high risk sexual behavior when it compared with those hadno (OR=4.270，90%CI:1.676-10.881). Using rush before sex act in the past six month were3.4times more likely to had high risk sexual behavior (OR=3.397，90%CI:1.564-7.377). The timeafter be identified as HIV-positive less than0.5year were4.2times more likely to had high risksexual behavior (OR=4.181，90%CI:1.939-9.013) when it compare with more than or equal to0.5year. Those who had male casual sexual partner were2.951(1.278-5.252) times more likelyto had high risk sexual behavior when it compared with those had no.Conclusions The CD4~+count is generally low, and syphilis infection rate and psychologicalsymptom report rate are higher among HIV-positive MSM. HIV-positive MSM are short ofawareness of protecting their sexual partner from be infected, and they have higher ratio ofhigh risk sexual behavior, which indicate that there are week links in health service regarding prevent and treatment of AIDS, therefore we need carrying out relevant health service andpromoting service quality and expanding service coverage to promote their life quality anddecrease high risk sexual behavior.