Wang Ying, Wang Zezhou, Jia Mengmeng, Liang Ajuan, Yuan Dong, Sun Zhe, Gan Feng, Wang Yichen, Cai Yong, Zhang Zhiruo
School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
Renji Hospital, affiliated with School of Medicine Shanghai Jiao Tong University, Shanghai, 200127, China.
BMC Infect Dis. 2017 Jan 7;17(1):46. doi: 10.1186/s12879-016-2132-8.
Previous studies have discussed the overlapping and reinforcing effects (defined as a syndemic) of psychosocial problems on high-risk sexual behaviors among men who have sex with men (MSM). The present study aimed to apply the syndemic theory to verify the reinforcing effects of psychosocial problems on unprotected anal intercourse (UAI) among MSM in Shanghai, and determine if other important psychosocial factors fit into the syndemic theory.
Data were collected from 547 MSM in Shanghai, China, through face-to-face interviews. The measures for psychosocial problems included the Rosenberg Self-Esteem Scale; the Generalized Anxiety Disorder-7; the Center for Epidemiological Studies Depression Scale; the University of California, Los Angeles Loneliness Scale; and the Sexual Compulsivity Scale. We used multivariate analysis and binary logistic regression to investigate the associations between psychosocial problems and high-risk sexual behaviors.
The prevalence of UAI among MSM in the past 6 months was 54.5%. Education (graduate from college vs. high school) served as a protective factor against UAI (OR 0.59, 95% CI: 0.38-0.94). There was a high prevalence of psychosocial problems, and at least one-third of participants reported experiencing more than two psychosocial symptoms. Of these psychosocial factors that we investigated, lower self-esteem was associated with UAI in both univariate and multivariate regression model (P = 0.009). Result suggests that overlapping and reinforcing effects of psychosocial problems may increase high risk sexual behaviors among MSM in Shanghai, China (OR 1.65, 95% CI: 1.09-2.50; P = 0.018).
We found further evidence for a syndemic of psychosocial problems among MSM in Shanghai, China. This syndemic may also increase high risk sexual behaviors among MSM. Most HIV prevention interventions are focused on behavior change and only have moderate effects; our findings suggest that a shift from behavior-focused interventions to a more comprehensive strategy that addresses psychosocial factors may be necessary.
以往研究探讨了心理社会问题对男男性行为者（MSM）高危性行为的重叠和强化效应（定义为共病综合征）。本研究旨在应用共病综合征理论，验证心理社会问题对上海男男性行为者无保护肛交（UAI）的强化效应，并确定其他重要的心理社会因素是否符合共病综合征理论。
通过面对面访谈，收集了来自中国上海547名男男性行为者的数据。心理社会问题的测量指标包括罗森伯格自尊量表、广泛性焦虑障碍-7量表、流行病学研究中心抑郁量表、加利福尼亚大学洛杉矶分校孤独感量表和性强迫量表。我们使用多变量分析和二元逻辑回归来研究心理社会问题与高危性行为之间的关联。
在过去6个月中，男男性行为者中无保护肛交的患病率为54.5%。教育程度（大学毕业与高中毕业）是无保护肛交的保护因素（比值比0.59，95%置信区间：0.38-0.94）。心理社会问题的患病率很高，至少三分之一的参与者报告经历了两种以上的心理社会症状。在我们调查的这些心理社会因素中，自尊水平较低在单变量和多变量回归模型中均与无保护肛交有关（P = 0.009）。结果表明，心理社会问题的重叠和强化效应可能会增加中国上海男男性行为者的高危性行为（比值比1.65，95%置信区间：1.09-2.50；P = 0.018）。
我们发现了中国上海男男性行为者存在心理社会问题共病综合征的进一步证据。这种共病综合征也可能会增加男男性行为者的高危性行为。大多数艾滋病毒预防干预措施都侧重于行为改变，效果一般；我们的研究结果表明可能有必要从以行为为重点的干预措施转向更全面的、解决心理社会因素的策略。
