An Epidemiological Study Of Anxiety,Depression And Stress States Of Homosexual AIDS Men Who Have Heterosexual Marriage

Background Acquired immunodeficiency syndrome?AIDS?,caused by human immunodeficiency virus?HIV?,is a serious infectious disease.According to CDC,there are 958,278 patients living with HIV/AIDS and 307,288 deaths in China by the end of October 2019.A total of 130,553 new HIV infections were reported from January to October 2019^[1].Moreover,sexual transmission has been the primary route of transmission in those who are newly diagnosed in China.The number of HIV infected men who have sex with Men?MSM?is increasing.73.7%newly-diagnosed HIV/AIDS patients were transmitted through heterosexual behavior from January to October 2019.23.0%newly-diagnosed HIV/AIDS patients were transmitted through homosexual bwhavior from January to October 2019.MSM is defined as men who have or have had sex with men.Under the background of traditional Chinese culture,MSM living with HIV/AIDS who suffer the discrimination of"HIV infection"and"homosexual orientation"have to undertake the responsibility of reproduction,thus forming the social phenomenon of MSM coexisting with their wives.MSM's wives is defined as women whose husbands have or had sex with men.Researchers generally pay more attention to the infection and psychological problems of MSM's wives due to its sexual transmission.However,the relationship between MSM and their wives have not been regarded as a factor to observe its impact on MSM population in previous studies.Under the guidance of"treatment is equal to prevention",this research combines qualitative and quantitative research to explore the methods of developing correct ethics of MSM population and to help them deal with family relationship.It can not only improve the quality of life,medication adherence,and the situation of their wives,but also reduce the transmission rate of HIV/AIDS from the perspective of treatment,care and psychology,in order to provide basis and reference for clinical multidisciplinary diagnosis and treatment.Objective To understand the current situation of stress,anxiety and depression among men who have sex with men with HIV infection,and to explore the correlation between treatment duration,the family relationship of MSM's wives and the above factors,so as to provide guidance for HIV/AIDS clinical diagnosis and HIV/AIDS case management.Methods The study has been approved by the ethics committee of Shanghai Public Health Clinical Center.We combined quantitative study with qualitative study.We selected patients followed up in the Shanghai Public Health Clinical Center from May to September in 2017 in the qualitative study.Samples were selected continuously according to the inclusion criteria and exclusion criteria of this reseach.We collected the data through semi-structured interview and used Colaizzi's phenomenological analysis method to analyze the data.The sample size of the study was based on the standard of data saturation.In the quantitative study,homosexual-married people living with HIV/AIDS in the VCT clinics,from Shanghai Public Health Clinical Center,Wuxi Fifth People's Hospital in Jiangsu Province and Hangzhou Xixi Hospital in Zhejiang Province,participated in the study after informed consent from January to August 2018.We use PSS-10,SAS,SDS,and self-reported questionnaire to investigate the correlation between stress,anxiety,depression,treatment duration,and the relationship with their wives of MSM.Data analysis methods included descriptive statistical analysis,t-test,Spearman correlation analysis and multiple linear regression analysis.ResultsQualitative resultsSix theme were summarized through qualitative interviews with 10 homosexual AIDS men who have heterosexual marriage:?1?MSM were under the pressure of HIV infection and suffering self-discrimination;?2?MSM were anxiety about HIV status of their wives;?3?Marriage provided hope and pressure to MSM;?4?MSM had the hope for active treatment and healthy offspring;?5?MSM were depressed because they do not know how to get along with their wives;?6?MSM were uncertain about the outcome of treatment.Quantitative results1.Demographic survey results:We finally obtained 267 valid questionnaires with an effective response rate of 92.07%.the data of 267 cases of demography showed that the age of 15?45 was 43.82%,the nationality of Han was 80.52%,the education background of middle school was 52.43%,the occupation status of full-time was 58.80%,the monthly income of 4000 RMB and above accounted for 67.04%;the treatment time of more than 6 months accounted for 89.14%,the wives did not know their sexual orientations accounted for 61.42%;the wives did not know the HIV status of MSM accounted for 44.94%.2.The incidence rates of stress,anxiety and depression of this population were68.07%,57.58%and 92.50%respectively,of which 35.50%was severe depression.3.According to the t-test,the passible factors that may affect depression in people living with HIV were duration of treatment and the relationship between MSM and MSM's wives.4.Stress was positively correlated with the awareness of MSM's wives?r=0.40,P<0.05?.Anxiety was negatively correlated with the education of MSM's wives?r=-0.354,P<0.05?.Depression was negatively correlated with the education background of MSM's wives?r=-0.45,P<0.05?.5.Linear regression analysis showed the length of treatment and education of MSM,the education of MSM's wives and the wife's awareness were the influencing factors of anxiety score?P<0.05?;the length of treatment and the education of MSM's wives were the influencing factors of depression score?P<0.05?;the ethnic group,the monthly income,the wives'awareness,the condom use,pressure during the sexual behaviors,the diagnosis and treatment,the worry about the wives'discovery and the frequency of sexual behavior were the influencing factors of stress score?P<0.05?.Conclusion1.MSM living with AIDS are under the pressure of unacceptable sexual orientations and HIV infection.2.MSM are suffering from pressure,anxiety,depression and other psychological emotions due to marriage and fertility problems,which are also related to some factors such as family relationship and the effectiveness of their treatment.