男同性恋艾滋病危险感知影响因素结构方程模型分析
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摘要
目的:了解天津市男同性恋人群AIDS认知水平及危险性行为现况;利用结构方程模型阐明AIDS认知水平、性行为与AIDS危险感知的关系,并探索AIDS危险感知对自愿参与HIV检测、上网寻找性伴的影响,说明各因素间彼此相互作用,为该人群中开展AIDS防治工作提供理论依据。
方法:由调查员在天津市某同性恋网站发布招募信息,有意参与者可到指定的调查网站填写电子问卷,提交后可得到检测号码,凭检测号码到指定医院进行免费HIV、梅毒检测。数据分析:首先对天津市男同性恋AIDS认知及危险性行为现况进行描述,并依据因子分析建立初始测量模型,进而对AIDS危险感知影响因素进行结构方程模型拟合。
结果:829名被调查年龄较低,18.35岁者占86.4%,具有大专及以上文化程度者占72.6%,自认为同性恋者占65.7%。近6个月内的性伴数较多,安全套使用率低。对资料进一步采用结构方程模型分析,结果显示:AIDS危险感知的危险因素依次为性伴数、社会地位、高危性方式(口交、肛交)、低危性方式(手淫、吻肛、股间摩擦),其效应系数分别为:0.271、0.126、0.119、0.063;保护因素为危险途径知识、安全途径知识,效应系数分别为:-0.104、-0.025。同时这些因素又对HIV自愿检测产生直接或间接影响,其中社会地位作用最大,效应系数为0.328。上网寻找性伴除受到性伴数、高危性方式影响外,与AIDS危险感知、HIV自愿检测没有关联。2006年4月至2007年10月间,参与免费检测者共98人,HIV阳性率为2.0%(2/98),梅毒阳性率为11.8%(11/98)。
结论:天津市男同性恋人群多为文化程度较高的年轻人,对AIDS传播途径知识知晓率较高,但普遍存在利于AIDS、STD传播的高危性行为。本次研究表明,AIDS认知水平直接影响着AIDS危险感知,同时AIDS认知水平还通过性伴数、性方式对其产生间接影响,说明男同性恋者AIDS相关防治知识的掌握程度影响着自身的行为方式以及对自身感染AIDS可能的评价。而AIDS危险感知又进一步影响着男同性恋者参与HIV检测的意愿。另外,上网寻找性伴受到性伴数、高危性方式的影响,提示上网找寻性伴者发生危险性行为可能性更大。因此,在未来干预中可将网络作为干预平台,在系统传播AIDS预防知识的同时,提高同性恋者AIDS危险感知能力,使其准确地评价自身行为的危险性以促使其采取HIV检测等保护性措施。
Objective To investigate the situation of AIDS perception and risk sex behaviors among men who have sex with men(MSM)in Tianjin;Use structural equation model to:Explain the relation between AIDS perception,sex behaviors and AIDS risk assessment;Explore the relation between AIDS risk assessment,voluntary HIV test and finding sex partner through Internet and their interactive effects for preventing AIDS among MSM.
Method Investigator spread recruit information at a gay website in Tianjin.The responders completed questionnaires at our survey website and got a test number and can get a free test of HIV and syphilis.Data analyze:At first,we made descriptive statistics of AIDS risk assessment and risk sex behaviors.Then we built the measurement model with factor analysis and explained the influencing factors of AIDS risk assessment with structural equation model.
Result Our responders were relative young.Percent of MSM aged from 18 to 35 was 86.4%.72.6%of them were graduate education and self identified gay was 66.7%. Most of them had multi-sex partners with low condom using.Under structural equation modeling,the risk factors of AIDS risk assessment were:sex partner number, social status,high risk sex behaviors,and low risk sex behaviors.Their effect indexes of these factors were:0.271,0.126,0.119,and 0.063 respectively.The protective factors were knowledge of AIDS transmitted way with the effect index -0.104 and -0.025.Meanwhile these factors affected voluntary HIV test.The strongest factor of them was social status with the effect index 0.328.Finding sex partner through Internet was affected by number of sex partners and high risk sex behavior.There was no relation between finding sex partner through Internet and AIDS risk assessment, voluntary HIV test.98 persons got free test.The positive rate of HIV and syphilis were 2.0%(2/98)and 11.8%(11/98)respectively.
Conclusion Most of MSM in Tianjin were young with high level of education and knowledge of AIDS transmitted way but the risk sex behaviors were common.Our research show that AIDS risk assessment was affected by AIDS knowledge perception directly and AIDS knowledge perception affected AIDS risk assessment through number of sex partners and sex behaviors at the same time.It meant that the knowledge level of AIDS prevention among MSM affected their sex behavior and assessment of infecting AIDS risk.Then AIDS risk assessment affected voluntary HIV test.Finding sex partners online was affected by the number of sex partners and high risk sex behavior.In the future intervention we should spread knowledge of AIDS and improve the ability of risk assessment of MSM to make them evaluate the risk level of their behaviors precisely and take protective method behavior such as HIV test.
方法:由调查员在天津市某同性恋网站发布招募信息,有意参与者可到指定的调查网站填写电子问卷,提交后可得到检测号码,凭检测号码到指定医院进行免费HIV、梅毒检测。数据分析:首先对天津市男同性恋AIDS认知及危险性行为现况进行描述,并依据因子分析建立初始测量模型,进而对AIDS危险感知影响因素进行结构方程模型拟合。
结果:829名被调查年龄较低,18.35岁者占86.4%,具有大专及以上文化程度者占72.6%,自认为同性恋者占65.7%。近6个月内的性伴数较多,安全套使用率低。对资料进一步采用结构方程模型分析,结果显示:AIDS危险感知的危险因素依次为性伴数、社会地位、高危性方式(口交、肛交)、低危性方式(手淫、吻肛、股间摩擦),其效应系数分别为:0.271、0.126、0.119、0.063;保护因素为危险途径知识、安全途径知识,效应系数分别为:-0.104、-0.025。同时这些因素又对HIV自愿检测产生直接或间接影响,其中社会地位作用最大,效应系数为0.328。上网寻找性伴除受到性伴数、高危性方式影响外,与AIDS危险感知、HIV自愿检测没有关联。2006年4月至2007年10月间,参与免费检测者共98人,HIV阳性率为2.0%(2/98),梅毒阳性率为11.8%(11/98)。
结论:天津市男同性恋人群多为文化程度较高的年轻人,对AIDS传播途径知识知晓率较高,但普遍存在利于AIDS、STD传播的高危性行为。本次研究表明,AIDS认知水平直接影响着AIDS危险感知,同时AIDS认知水平还通过性伴数、性方式对其产生间接影响,说明男同性恋者AIDS相关防治知识的掌握程度影响着自身的行为方式以及对自身感染AIDS可能的评价。而AIDS危险感知又进一步影响着男同性恋者参与HIV检测的意愿。另外,上网寻找性伴受到性伴数、高危性方式的影响,提示上网找寻性伴者发生危险性行为可能性更大。因此,在未来干预中可将网络作为干预平台,在系统传播AIDS预防知识的同时,提高同性恋者AIDS危险感知能力,使其准确地评价自身行为的危险性以促使其采取HIV检测等保护性措施。
Objective To investigate the situation of AIDS perception and risk sex behaviors among men who have sex with men(MSM)in Tianjin;Use structural equation model to:Explain the relation between AIDS perception,sex behaviors and AIDS risk assessment;Explore the relation between AIDS risk assessment,voluntary HIV test and finding sex partner through Internet and their interactive effects for preventing AIDS among MSM.
Method Investigator spread recruit information at a gay website in Tianjin.The responders completed questionnaires at our survey website and got a test number and can get a free test of HIV and syphilis.Data analyze:At first,we made descriptive statistics of AIDS risk assessment and risk sex behaviors.Then we built the measurement model with factor analysis and explained the influencing factors of AIDS risk assessment with structural equation model.
Result Our responders were relative young.Percent of MSM aged from 18 to 35 was 86.4%.72.6%of them were graduate education and self identified gay was 66.7%. Most of them had multi-sex partners with low condom using.Under structural equation modeling,the risk factors of AIDS risk assessment were:sex partner number, social status,high risk sex behaviors,and low risk sex behaviors.Their effect indexes of these factors were:0.271,0.126,0.119,and 0.063 respectively.The protective factors were knowledge of AIDS transmitted way with the effect index -0.104 and -0.025.Meanwhile these factors affected voluntary HIV test.The strongest factor of them was social status with the effect index 0.328.Finding sex partner through Internet was affected by number of sex partners and high risk sex behavior.There was no relation between finding sex partner through Internet and AIDS risk assessment, voluntary HIV test.98 persons got free test.The positive rate of HIV and syphilis were 2.0%(2/98)and 11.8%(11/98)respectively.
Conclusion Most of MSM in Tianjin were young with high level of education and knowledge of AIDS transmitted way but the risk sex behaviors were common.Our research show that AIDS risk assessment was affected by AIDS knowledge perception directly and AIDS knowledge perception affected AIDS risk assessment through number of sex partners and sex behaviors at the same time.It meant that the knowledge level of AIDS prevention among MSM affected their sex behavior and assessment of infecting AIDS risk.Then AIDS risk assessment affected voluntary HIV test.Finding sex partners online was affected by the number of sex partners and high risk sex behavior.In the future intervention we should spread knowledge of AIDS and improve the ability of risk assessment of MSM to make them evaluate the risk level of their behaviors precisely and take protective method behavior such as HIV test.
引文
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[83]Parsons,J.T.,J.A.Koken,and D.S.Bimbi,Looking beyond HIV:eliciting individual and community needs of male internet escorts[J].J Homosex,2007.53(1-2):219-40.
[84]Rhodes,S.D.,L.J.Yee,and K.C.Hergenrather,A community-based rapid assessment of HIV behavioural risk disparities within a large sample of gay men in southeastern USA:a comparison of African American,Latino and white men[J].AIDS Care,2006.18(8):1018-24.
[85]Rhodes,S.D.,et al.,Comparing MSM in the southeastern United States who participated in an HIV prevention chat room-based outreach intervention and those who did not:how different are the baseline HIV-risk profiles?[J].Health Educ Res,2008.23(1):180-90.
[86]Rhodes,S.D.,et al.,Characteristics of a sample of men who have sex with men, recruited from gay bars and Internet chat rooms,who report methamphetamine use[J].AIDS Patient Care STDS,2007.21(8):575-83.
[87]Rhodes,S.D.,et al.,Condom acquisition and preferences within a sample of sexually active gay and bisexual men in the southern United States[J].AIDS Patient Care STDS,2007.21(11):861-70.
[88]Essien,E.J.,et al.,Reported condom use and condom use difficulties in street outreach samples of men of four racial and ethnic backgrounds[J].Int J STD AIDS,2005.16(11):739-43.
[89]Gullette,D.L.and J.G.Turner,Stages of change and condom use among an Internet sample of gay and bisexual men[J].J Assoc Nurses AIDS Care,2004.15(2):27-37.
[90]曹宁校,在MSM人群中开展性病知识的同伴教育效果研究[J].中国艾滋病性病,2005.11(6):431-435.
[91]Hilliard,N.,et al.,Informal knowledge transfer in the period before formal health education programmes:case studies of mass media coverage of HIV and SIDS in England and Wales[J].BMC Public Health,2007.7(14.7):293.
[1]Scott D.Rhodes.Risk among men who have sex with men in the United States:A comparison of an Internet sample and a conventional outreach sample[J].AIDS education and prevention.2002,14:41-50.
[2]Robin M.Methodological rigor with Internet samples:New ways to reach underrepresented populations[J].Cyber Psychology & Behavior.2002,5:253-266.
[3]Giusseppe riva.The use of the Internet in psychological research:Comparison of online and offline questionnaires[J].Cyber Psychology & Behaviour.2003(6).
[4]Sean Esteban.McCabe.Comparison of web and mail surveys in collecting illicit drug use data:A randomized experiment[J].Drug education.2004(1):61-72.
[5]Houston JD.Online medical surveys:Using the Internet as a research tool[J].MD Comput. 1998,15:116-20.
[6]Quanyi Wang. Differences between char room and e-mail sampling approaches in Chinese men who have sex with men[J].AIDS Education and Prevention .2002, (5):361-366.
[7]Scott D.Rhodes. Correlates of hepatitis B vaccination in a high -risk population: an Internet sample[J]. The American Journal of medicine.2001(110):628-632.
[8]Rhodes.S.D, Collecting behavioral data using the World-Wide-Web: Considerations for researchers[J].Journal of Epidemiology and community health .2003,57:68-73.
[9]Eric G Benotsch .Men who have sex partners via the internet: Prevalence. predictors, and implications for HIV prevention[J]. Archives of sexual behavior.2002 ,31:177.
[10]Mary McFarlane. The Internet as a newly emerging risk environment for sexually transmitted diseases[J].Journal of the American Medical Association.2000,284 (4):443-446.
[1 l]Cornelis A Rietmeijer. Risk and benefits of the Internet for populations at risk for sexually transmitted infections(STIs) Result of an STI clinic survey[J].2003. (30):15-19.
[12]Graham Bolding. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? [J]. AIDS 2005, (19).9:961-968.
[13]Harm J.Hospers. A new meeting place: chatting on the Internet e-dating and sexual risk behavior among Dutch men who have sex with men[J]. AIDS,2005,Voll9,No.10:1097-1101
[14]Michael W Ross. Characteristics of Latino men who have sex with men on the Internet who complete and drop out of an Internet-based sexual behavior survey [J]. AIDS education and prevention .2004,16,6,Health & Medical Complete:526.
[15]J.D.Klausner. Internet-based site-specific interventions for syphilis prevention among gay and bisexual men[J].AIDS Care. 2004,Nov,Vol(16),No.8:964-970.
[16]Scott D.Rhodes .Factors associated with testing for hepatitis C in an Internet recruited sample of men who have sex with men[J].Sexually transmitted diseases.2001 ,Sep,Vol(28),No.9:515-520.
[17]Bailey RD. Human sexual behavior: a comparison of college and internet surveys. In Birabaum,ed. Psychological experiments on the Internet .San Diego,CA Academic Press.2000:141-68.
[18]Scott D. Rhodes. Hookups or health promotion? An exploratory study of a chat room-based HIV prevention intervention for men who have sex with men[J]. AIDS Education and Prevention.2004, 16:315-327.
[19]Reips UD.The web experiment method: advantages, disadvantages ,and solutions.In:Birhaum MH, ed. Psychological experiments on the Internet. San Diego,CAAcdemic Press.2000:89-117.
[20]C K Kent. Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men - San Francisco, California, 1999-2003. MMWR. Morbidity and Mortality Weekly Report.Atlanta:Dec 19, 2003.52:1226-1229
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[22] Ross F. Conner. The solar HIV prevention program for Gay and bisexual Latino men: using social marketing to build capacity for service provision and evaluation[J].AIDS Education and prevention.2005,(17):361-374.
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[1]Scott D.Rhodes.Risk among men who have sex with men in the United States:A comparison of an Internet sample and a conventional outreach sample[J].AIDS education and prevention.2002,14:41-50.
[2]Robin M.Methodological rigor with Internet samples:New ways to reach underrepresented populations[J].Cyber Psychology & Behavior.2002,5:253-266.
[3]Giusseppe riva.The use of the Internet in psychological research:Comparison of online and offline questionnaires[J].Cyber Psychology & Behaviour.2003(6).
[4]Sean Esteban.McCabe.Comparison of web and mail surveys in collecting illicit drug use data:A randomized experiment[J].Drug education.2004(1):61-72.
[5]Houston JD.Online medical surveys:Using the Internet as a research tool[J].MD Comput. 1998,15:116-20.
[6]Quanyi Wang. Differences between char room and e-mail sampling approaches in Chinese men who have sex with men[J].AIDS Education and Prevention .2002, (5):361-366.
[7]Scott D.Rhodes. Correlates of hepatitis B vaccination in a high -risk population: an Internet sample[J]. The American Journal of medicine.2001(110):628-632.
[8]Rhodes.S.D, Collecting behavioral data using the World-Wide-Web: Considerations for researchers[J].Journal of Epidemiology and community health .2003,57:68-73.
[9]Eric G Benotsch .Men who have sex partners via the internet: Prevalence. predictors, and implications for HIV prevention[J]. Archives of sexual behavior.2002 ,31:177.
[10]Mary McFarlane. The Internet as a newly emerging risk environment for sexually transmitted diseases[J].Journal of the American Medical Association.2000,284 (4):443-446.
[1 l]Cornelis A Rietmeijer. Risk and benefits of the Internet for populations at risk for sexually transmitted infections(STIs) Result of an STI clinic survey[J].2003. (30):15-19.
[12]Graham Bolding. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? [J]. AIDS 2005, (19).9:961-968.
[13]Harm J.Hospers. A new meeting place: chatting on the Internet e-dating and sexual risk behavior among Dutch men who have sex with men[J]. AIDS,2005,Voll9,No.10:1097-1101
[14]Michael W Ross. Characteristics of Latino men who have sex with men on the Internet who complete and drop out of an Internet-based sexual behavior survey [J]. AIDS education and prevention .2004,16,6,Health & Medical Complete:526.
[15]J.D.Klausner. Internet-based site-specific interventions for syphilis prevention among gay and bisexual men[J].AIDS Care. 2004,Nov,Vol(16),No.8:964-970.
[16]Scott D.Rhodes .Factors associated with testing for hepatitis C in an Internet recruited sample of men who have sex with men[J].Sexually transmitted diseases.2001 ,Sep,Vol(28),No.9:515-520.
[17]Bailey RD. Human sexual behavior: a comparison of college and internet surveys. In Birabaum,ed. Psychological experiments on the Internet .San Diego,CA Academic Press.2000:141-68.
[18]Scott D. Rhodes. Hookups or health promotion? An exploratory study of a chat room-based HIV prevention intervention for men who have sex with men[J]. AIDS Education and Prevention.2004, 16:315-327.
[19]Reips UD.The web experiment method: advantages, disadvantages ,and solutions.In:Birhaum MH, ed. Psychological experiments on the Internet. San Diego,CAAcdemic Press.2000:89-117.
[20]C K Kent. Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men - San Francisco, California, 1999-2003. MMWR. Morbidity and Mortality Weekly Report.Atlanta:Dec 19, 2003.52:1226-1229
[21]Best .S.J. An assessment of the generalizability of Internet surveys .Social Science Computer Review.2001,19:131-145.
[22] Ross F. Conner. The solar HIV prevention program for Gay and bisexual Latino men: using social marketing to build capacity for service provision and evaluation[J].AIDS Education and prevention.2005,(17):361-374.