Study On HIV Prevention Related Influence Factors In Men Who Have Sex With Men, Based On Qualitative Interview And Structural Equation Model

Objective: A qualitative interview was conducted to discussing the related problems of HIV prevention in Men who have Sex with Men(MSM). A quantitative research was implied according to the relative information and experience of HIV prevention,Knowledge-motivation-psychological model was set up and tested through structural equation model. Qualitative research was combined with quantitative research to find out the influence factors of HIV prevention and to provide evidence on HIV prevention related strategy in MSM. Methods: In qualitative interview, Semi-structured focus group interviews method was used to interview a group of core leader of MSM and a group of common MSM respectively to discuss the condition of condoms using, Voluntary Counseling and Testing(VCT) using, Pre-Exposure Prophylaxis(PrEP) drug using and the development of Non-Governmental Organization(NGO) in MSM. Interviews audios was transcribed to the text. Interview content was studied by using MAXQDA 11 software after thematic framework analysis. In quantitative interview, snowball sampling method was used to recruit a total of 550 MSM volunteers from two MSM NGO in Urumqi,Xinjiang Province. HIV prevention related information on MSM was collected through a questionnaire survey of National Science and Technology Major Project of China. A total of 477 volunteers showed with complete information. HIV prevention related Knowledge-motivation-psychological model was built under related experience and literature. Relations between knowledge, motivation and psychological was studied, using a ‘structural equation model’ with data from the fitting questionnaires and modification of the model. Results: According to the qualitative interview, the rate of condoms using was low in MSM. The influence factors of condoms using were safety awareness, behaviorhabit, substance abusing, social environment, outreach activities et al. Condoms using rate would not rising quickly if safety consciousness was lost or behavioral habit was lacked.Peer education was the best way to promoting the rate of condoms using and HIV VCT using. But there were still many troubles such as timeless, insufficient fund, short-staffed and acceptance lake of MSM when peer education was implemented. The HIV related knowledge popularizing rate was high in MSM, but it was not thorough enough. The impact of HIV related knowledge on HIV prevention behavior changing was limited.Social environment was related to condoms using rate. Outreaching social work need to implement more economy and efficiency. The influence factors of VCT using were safety awareness, privacy protection, peer education, psychological problems, propaganda work et al. Safety consciousness lost and psychological obstacle of MSM hindered the development of VCT. The influence factors of PrEP taking were convenience and side-effect and propaganda work. Acceptability of Pre-Exposure Prophylaxis drug using was favorable, but most of MSM could not taken drugs insistently for worry about side-effect. The influence factors of MSM asking NGO for helping were credibility,perception of affiliation, public praise, influence. The influence factors of NGO development were professionalization, detail oriented, personnel training, cultural development, internet technology using, financial Support. The work pattern of MSM NGOs were singleness. They always pay more attention to HIV prevention, but less in subculture development of MSM with less economy supporting. In quantitative research,9measured variables were match to 3 latent variables by using exploratory factor analysis.Structural equation model presented good fitting results. After revising the fitting index:RMSEA was 0.035, NFI was 0.965 and RFI was 0.920. Thereafter the exogenous latent variables would include knowledge, motivation and psychological effects. The endogenous latent variable appeared as prevention related behaviors. The standardized total effects of motivation, knowledge, psychological on prevention behavior were 0.44,0.14 and 0.17 respectively. Correlation coefficient of motivation and psychological effects was 0.16. Correlation coefficient on knowledge and psychological effects was-0.17(P<0.05). Correlation coefficient of knowledge and motivation did not show statistical significance. Conclusion: Different HIV prevention behavior have different influence factors. Peer education should be strengthen with more thorough publicity and education of HIV prevention to rising the condom using and to change HIV prevention conscious knowledge and behavioral habit in MSM. The strategy of outreaching social work should be improved by paying more attention to public toilets and bathrooms which MSMaggregation. Safety conscious, psychological, privacy protection are related to VCT using rate. PrEP taking could be improved by making more convenience with less side-effect.Subculture should be development by NGO to improve self-identification in MSM. From qualitative research, knowledge and motivation are the most important influence factors of HIV prevention. Knowledge of HIV and motivation of HIV prevention do not show any accordance in MSM population. It is necessary to increase the awareness and to improve the motivation of HIV prevention in MSM population.