KAP Investigation And Evaluation Of The Regular Follow-up Linterventions Among Men Who Have Sex With Men In Jinhua City

1.BackgroundIn recent years,the epidemic reports in the world shown that the AIDS epidemic among men who have sex with men(MSM)are very grim.In China,both the proportion of male homosexual transmission and the HIV positive detection rate of MSM are increasing year by year.Because of the widespread risk factors for HIV infection among them,the spread of HIV from high-risk groups to low-risk or risk-free general population is obvious.The AIDS epidemic has become a major social public health problem.It is becoming a hot research topic area on the effect of effective behavioral intervention on high-risk behavior change amon MSM.This study was conducted to understand the knowledge level of AIDS,occurrence of high-risk behaviors and infection of HIV and syphilis among MSM population in jinhua city,and then analyze the influencing factors;Compared with the new HIV infection rate,the knowledge of AIDS and the behavior change between the intervention group and control group,and then evaluate the effect of the interventions of regular follow-up service conducted.2.Material and Method2.1 Study populationIn the baseline survey,the subjects inclued MSM aged 18 years and older,who had male homosexual acts in the last 6 months.In the follow-up survey,the subjects were negative for HIV antibody detection at baseline investigation.2.2 InterventionsThe intervention group received a follow-up every 3 months,and accepted a questionnaire investigation and serological detection.2.3 Data collection and statistical analysisA database was establised by Epidata3.1 software,and statistically analyzed by SPSS 19.0.Chi-square test was performed for comparing between two qualitative variables.Fisher's exact test was used when the expected frequency was less than 5.T test was done for comparing between two means.Unconditioned Logistic regression analysis was used to analyze the influence factors of HIV infection.Odds ratio(OR)and its 95%confident interval(CI)was estimated as comparing risk between the two groups.The comparison of new infections was by Kaplan Meier method analysis.3.Results3.1 baseline survey related indicatorsIn the baseline survey,15 were hiv-positive of 238 MSM,and the positive rate was 6.3%(95%CI 3.4%-10.3%).The positive rate of syphilis antibody was 18,and the positive rate was 7.6%(95%CI 4.6%?12.2%).The total knowledge of AIDS was 83.2%(95%CI 78.5%?87.9%).There was no statistically significant difference between AIDS awareness rate and HIV infection(chi-square =0.000,P=1.000).In the last three months,there were 79.8%(190/238)of non-commercial sexual activity,with an average number of 1.89±1.41(1?10 persons).59.2%(140/238)had a temporary partner of the same sex,with 42.5%(60/141)of condom-use each time;48.7%(116/238)had sex with regular partner of the same sex,with 37.9%(44/116)of condom-use each time;There were 10.1%(24/238)of commercial sex with the same sex,and 54.2%(13/24)of them used condoms every time.Of them,heterosexual sex was 16.8%(40/238),with only 17.5%(7/40)of condoms being used each time.2.1%(5/238)admitted to have illicit drugs.10.9%(26/238)had been diagnosed sexually transmitted disease.In recent 3 months,45.8%(109/238)received medical staff/partner to provide face-to-face AIDS awareness education,38.7%(92/238)had done testing,84.8%(78/92)of them know the test results.The impact factor analysis showed that the local residence time>7 months was the protective factor for HIV infection,wit the OR of 0.38(95%CI:0.29-0.78,P=0.006).In the last 3 months,the OR of multiple sexual partners was 3.96 times higher than that of<2 persons(95%CI:1.86?14.98,P=0.012).Non-temporary partner was the protective factor for HIV infection,with the Or of 0.46 times(95%CI:0.30?0.81,P=0.003).The OR of who use condoms every time with a temporary partner was 0.16 times t of those never used/sometimes used(95%CI:0.10?0.76,P=0.001).The OR of non-sexually transmitted diseases(STD)was 0.29 times than that of who had(95%CI:0.17-0.55,P=0.031).The OR of who had never been tested for HIV was 4.43 times than that had previous tested(95%CI:1.20-17.88,P=0.023).3.2 evaluation of intervention effectsAt the end of observation,the total observation time of the intervention group was 329.2 person-years,with 7 cases of HIV serum antibody positive transfer,and the positive rate of HIV antibody was 2.1/100 person-years(95%CI:0.55?3.65).In the control group,the total observation time was 296.6 person-years,8 cases of HIV antibody positive,and the HIV infection rate was 2.7/100 person-years(95%CI:0.86?4.54).There was no statistically significant difference between the two groups(chi-square = 0.250,P= 0.617).The syphilis infection rate of intervention group was 3.0%(3/99),with the control group of 6.6%(6/91),there was no statistically significant difference(chi-square = 1.088,P= 0.297).In the intervention group,the knowledge of AIDS before and afer intervention was 82.7%,94.9%,respectively,and the difference was statistically significant(x2=7,658,P=0.006).After intervention,the knowledge of AIDS in the control group was 84.6%,and the difference between the intervention group and the intervention group was statistically significant(x2 =5.626,P=0.018).After the intervention,poeple in the intervention group taking protective measures both with fixed and temporary sexual partners increased significantly in last 3 months(P<0.05).Compared with the control group,the difference between the two groups was statistically significant(x2=3.991,P=0.046).In the intervention group,the condom use rate recently increased with the number of follow-up visits.Before and after intervention,the number of homosexual noncommercial partners in the last 3 months of the intervention group was 1.98±1.59(1?10 persons),1.46 ±0.80(1?5 persons),and the difference was statistically significant(t=2.762,P=0.006).4.ConclusionIn the baseline survey,the knowledge of AIDS and safety sex were not highamong MSM population in jinhua city.Multiple sexual partners,non-history of HIV testing were risk factors for HIV infection.And local residence time>7 months,no temporary sexual behavior and sexual history,use of condoms every time when casual sex were the protection factors of HIV infection.After the implementation of the intervention measures of "regular follow-up and testing",the knowledge level of AIDS among MSM population in jinhua city was significantly improved,the behavior improved significantly,and the rate of new HIV infections was low.Therefor,it is a very effective intervention measures to perform periodic follow-up and duplicate detection among MSM population.Consequently,this experience is worthy to be popularized and applied in areas where no MSM fixed activities such as no bath,bar,square,park and so on.