Screening Out The High Risk Group Of The HIV-negative Ones Among MSM And Analyzing Their Willingness To Use Prep

Objective The situation of AIDS among the men who have sex withmen(MSM) is severe in western China. The pre-exposure prophylaxis(PrEP)is a useful biomedical prevention for high risk population by reducingHIV-infection among HIV-negative ones. By conducting HIV tests andinvestigating their knowledge, attitudes and behaviors towards AIDS amongthe MSM who reported HIV-negative by themselves or who knew nothingabout the infection in some parts of Chongqing and Sichuan province, weunderstood the situation and influencing factors of HIV infection,established the risk model and screened out the high-risk group amongMSM. Then we analyzed their willingness and influencing factors to usePrEP, and the results could lay a foundation for the later clinicalinterventions, provide information to support for the AIDS prevention andfinally achieve the purpose of reducing HIV infection rate.Method The anonymous questionnaire and the HIV testing wereconducted among qualified objects by non-probabilistic sampling in parts ofChongqing and Sichuan province. Multiple correspondence analysis was used for selecting variables and logistic regressions were adopted to exploreinfluencing factors of HIV infection. The risk model predicted the risk ofbeing HIV infection from HIV-negative ones and then the high-riskobjectives were selected. Factor and correlation analysis was conducted toassess the reliability and validity of the scale of willingness to use PrEP. Atlast, the path of influencing factors of willingness and its effect wereexplored by multiple linear regression and path analysis.Results915MSM volunteers in total were selected into the researchaccording to inclusion and exclusion criteria and their ages mainly rangedfrom20to30. Most MSM were well-education, unmarried, having a job andurban residency, with strong awareness of AIDS and good mood; but thepreventive measures towards AIDS were barely utilized by them, and theyusually had several sexual partners and had unprotected anal intercourse. Afew MSM had ever suffered from sexually transmitted diseases (STD), somehad commercial sex exchange and some even used drugs. The HIV infectionrate was20.77%among MSM. Results from logistic regression showed theinfluencing factors were education(junior high school or below/university or above: AOR=3.462,P<0.0001;junior college/university orabove: AOR=1.824,P=0.0201), the average monthly income(3000yuan andbelow/more than3000yuan: AOR=1.519, P=0.0417),the score of AIDSknowledge(<11/≥11: AOR=2.334,P=0.0022), the fear about AIDS(afraid/not afraid: AOR=1.609,P=0.0116), the role of making sex(passive/initiative: AOR=2.280,P=0.0003; uncertain/initiative: AOR=2.254,P=0.0003), thetimes of insertion sex with male partners in the last month（>=3/<3:AOR=1.599,P=0.011）, drugs usage in last six months（using/not using：AOR=5.259,P=0.0202）. The fitting and predictive effects of risk modelwere good and the negative predictive value was80.37%. So the modelcould estimate HIV infection risk of negative ones. Based on these results,168high risk targets were chosen to analyze their willingness. Thecronbach’s alpha was0.451and the content and construct validity were goodin the reliability and validity evaluation. In the path analysis, the confidencehad the largest direct effect with the value of0.296. Age and commercial sexcases followed. The factors, such as education, awareness of HIV infectionrisk, drink frequency, the attitude of male partners of using PrEP andwhether the attitude could influence the medication choice or not, also couldindirectly influence on the willingness through the confidence, and all thesefactors values were below0.1. The remaining path coefficients were above0.8, which suggested that there might be other larger factors and a furtherresearch was needed.Conclusion1.The infection rate of HIV is relatively high and AIDSsituation is severe in parts of Chongqing and Sichuan province. Theuncontrollable factors are education, the average monthly income and therole of making sex. The controllable factors are the score of AIDSknowledge, high-risk sexual behaviors, risk perception and drug usage. Therefore, we need to strengthen the controllable factors among MSM whohave different characteristics and pay more attention to the high risk onesand provide them with more prevention suggestions, in order to reduce theHIV infection.2.The willingness score of high risk MSM is lower than thatof the low risk ones, and it is also influenced by age, high-risk sexualbehaviors and psychological factors. So we may improve the propaganda,application and popularization among these people.3.Based on these results,we may take different measures among different groups, and form the modelgathering the efforts from all society and multi-departments, eventuallylowering the HIV infection rate among MSM.