HIV Incidence And Risk Factors Study Among Men Who Have Sex With Men In A Rural District,Chongqing

Objective: 1.Understand the incidence and influencing factors of MSM AIDS in a certain rural district of Chongqing.2.Analyze the epidemic trend of AIDS in a district for many years,and provide information for AIDS epidemic estimation and prediction.3.Provide a basis for formulating AIDS prevention strategies,intervention measures and effect evaluation in districts.Methods: Combine epidemiological investigation and laboratory testing methods,and collect data using questionnaires and experiments.1 Study object: Select MSM monitored by sentinel in a rural district of Chongqing as the survey object,and use snowball sampling to find the target population in MSM event sites or network.250 MSM every year.2 Research content:(1)Participate and complete the questionnaire of MSM sentinel surveillance population in a rural district of Chongqing from2016 to 2017 and the laboratory HIV infection and new infection test.(2)Collecting monitoring data of sentinel points in the district from 2013 to2015,supplementing and improving laboratory HIV infection and new infection testing.(3)Analyze the infection and new infection status and influencing factors of MSM in 2013-2017.3 Data processing and analysis methods: Epidata 3.02 was used for data double-entry.Establish a database using SPSS18.0 and performstatistical analysis.The general demographic data and behavioral information of the MSM population were descriptively analyzed.The influencing factors analysis of recent HIV infection and condom use was analyzed by chi-square test and multivariate logistic regression.P < 0.05 was considered statistically significant.Results: The study surveyed a total of 1,250 MSM populations monitored in the rural district from 2013 to 2017.1 Social demographic characteristics of the respondents84.88%(1061)of the 1250 MSM were recruited from the Internet;the average age was(26.33±7.39)years old(15~65 years old),of which47.68%(596)aged 15 to 24 years old,24 to 49 years old accounted for50.16%(627);the main marital status with women was unmarried,accounting for 87.60%(1095);Han nationality accounted for 98.00%(1225);the household registration accounted for 89.76%(1122).Those who lived in the local area for more than 2 years accounted for 83.04%(1038);those with a college degree or above accounted for 72.96%(912).2 AIDS-related knowledge92.88%(1161)MSM knew the AIDS knowledge.The awareness rate of AIDS among MSM population in 2013-2017 was 95.60%,89.60%,96.40%,88.00%,94.80%.The awareness of three AIDS knowledge were low,the severity of MSM epidemics(86.40%),sexually transmitted diseases(69.40%)and drugs use(83.40%)respectively.3 Sexual behaviorIn the past 5 years,more than 90.00% MSM had anal sex with men in the past 6 months;68.17% had at least one-time sex behavior in the past week;the proportion of condom use in homosexual anal in the last 6months was 36.00%~68.86 %;the proportion of condom use in the last anal sex was 74.70%~96.90%.A total of 1.80% MSM in the past 5 years hadsame-sex commercial sexual behavior in the past 6 months;the proportion of condom use was among 60% to 100%;the ratio of condom use in the last same-sex commercial sex was 100 %.5.00% MSM had sex with female in the last 6 months;47.60% used condoms every time when they had heterosexual behavior;86.20% MSM used condoms for the most recent heterosexual behavior.4 Participation in AIDS-related intervention services and testingIn 2013-2017,95.12%(1189)received MSM intervention services,of which more than 65.60% received condom distribution/AIDS counseling and testing,and the proportion of peer education services ranged from51.20% to 76.80%.The proportion who have received any intervention services during 5 yearswas above 93.20%.The proportion of MSM tested for HIV in the past year was 39.44%.5 Sexually transmitted diseases5.52%(69)MSM diagnosed sexually transmitted diseases in the last year,including 16 gonorrhea,17 syphilis,8 genital chlamydia trachomatis infection,26 genital warts,and 7 genital herpes.Six people diagnosed with STDs in the past year detected HIV infection and four were infected with syphilis.6 HIV infection and new infectionsIn 2013-2017,130 HIV-infected patients were found in MSM sentinel surveillance.The positive rate of total HIV antibody detection in 5 years was 10.40%,which were 10.40%,10.40%,10.40%,10.80% and 10.00% in each year.Recent infections were detected in patients except MSM who was known infections(8)and lack samples(6).Among them,new infections accounted for 27.59%(32/116),and long-term infections accounted for 72.41%(84/116).According to the formula,the 5-year new infection rate is 7.98%(90% CI: 4.95%~11.01%),which were 10.78%,12.18%,5.65%,1.84% and 6.93%,respectively.The new infection rate in2015-2017 has decreased compared with 2013-2014.HIV-infected individuals and previous/long-term infected MSM had homosexual or heterosexual behavior in the past 6 months,while condoms are not used in large numbers.There had been no use condoms in last sex behavior.A few of them had twice sex behavior in the previous week before HIV tested.7 Influencing factors of new HIV infectionOne-way chi-square analysis of the relevant factors affecting HIV infection showed that the source of the sample,age group,education level,frequency of homosexual condom use in the last 6 months,HIV antibody screening in the last year related tonew HIV infection(P<0.05).Multivariate logistic regression analysis showed that age group,sample source,and knowledge awareness were the influencing factors of condom use.Multivariate logistic regression analysis showed that the use of condoms in the last 6 months homosexual and the involvement of HIV antibody screening in the recent year were the influencing factors of new HIV infection.MSM who did not participate in HIV testing(OR=3.589,95% CI: 1.210~10.645)and didn't consistently use condom in homosexual anal intercourse in the past 6 months(OR=9.098,95% CI: 3.116~26.569)were risk factors related with HIV recent infection.8 Condom use related factorsOne-way chi-square analysis of the relevant influencing factors of condom use showed that sample source,age group,marital status,education level,knowledge of AIDS,and participation in intervention services were related to the use of condoms(P<0.05).Multivariate logistic regression analysis showed that age group,sample source,and knowledge awareness were the influencing factors of condom use.The probability of MSM not adhering to condoms use in the 21~30 age group was 1.533 timesthan that of MSM under 20 years old(95% CI=1.099~2.139);the probability of MSM from bath/sauna/pedicure/massage does not adhere to condoms use was 6.143 times(95% CI=2.591~14.565)than that the bar/song hall/tea room/club MSM,the probability of MSM not using the condom from the online recruitment was 1.533 times(95%CI=1.017~2.311)than that bar/song hall/tea room/club MSM;the probability of MSM who did not knew AIDS knowledge did not insist on using condoms was 6.098 times(95% CI=3.407~10.914)than that knew MSM.Conclusion: 1.In this area,the HIV infection rate of MSM in2013-2017 is around 10%.There was no obvious rising or falling trend,which is a high level.The new infection rate has decreased in 2015-2017 than 2013-2014,indicating that the HIV intervention has certain effect,but still bad.2.Failure to adhere to condoms use is an infulence factor in new HIV infection of HIV.We should continue to increase the publicity of condom use in various interventions,as well as intervene and protect education for MSM who have sex with female and partners.3.The HIV detection rate of this study was low,did not participate in HIV test is an infulence factor in new HIV infetion.The proportion of long-term infection among infected people was high,suggesting that more newly discovered HIV-infected people have been infected for a long time,and should continue to carry out HIV testing in MSM population,and find positive as soon as possible.Due to discrimination,MSM and HIV-infected people had less HIV test,so timely intervention is imminent.4.For factors related to HIV new infection,attention should be paid to the network,age,knowledge promotion and sex education,psychosocial factors,and targeted interventions should be explored to reduce theoccurrence of risky behaviors.5.The next step should be to conduct in-depth interviews,propose and explore possible research directions.