男男性行为者在参加男同性恋桑拿浴室时的 HIV 风险、风险认知以及接受 HIV 检测和咨询的情况。
HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna.
机构信息
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Thammasat University Hospital, Pathumthani, Thailand.
出版信息
AIDS Res Ther. 2019 Jun 12;16(1):13. doi: 10.1186/s12981-019-0229-z.
BACKGROUND
Men who have sex with men (MSM) are amongst populations at-risk for HIV acquisition in Thailand. In youth MSM (aged 15-24 years), the incidence of HIV infection has substantially increased. However, data on HIV risk, risk perception and HIV testing and counseling (HTC) uptake among youth MSM in hotspots are limited.
METHODS
A subanalysis of a prospective study among Thai MSM attending a gay sauna was conducted. HIV risk and risk perception were assessed by an anonymous survey. The MSM were categorized as having actual "low-risk", "moderate-risk" and "high-risk" for HIV acquisition based on the validated study risk categorization tool. HTC was provided on-site with result notification within 1 h. HIV care establishment appointment was arranged by the counselors for HIV-infected participants. Care engagement within 1 year of diagnosis was subsequently assessed.
RESULTS
There were 358 MSM participants; 87 (24%) were youth MSM. Comparing to other MSM, youth MSM had significantly higher median number of lifetime sexual partners [2 (IQR 1-9) vs. 1 (IQR 0-1); P < 0.001), were more-likely to ever exchange sex for money (44% vs. 9%; P < 0.001) and have sexual partner who exchanged sex for money (8% vs. 1%; P < 0.001). Rates of consistent condom use in the past 3 months for anal, oral and vaginal sexes were low and not significantly different between youth and other MSM (51% vs. 61%, 26% vs. 35% and 72% vs. 61%, respectively). By using the study risk categorization tool, there were 68 youth MSM with moderate or high-risk for HIV acquisition, of which 43 (63%) had false perception of low HIV risk. Youth MSM were more likely than other MSM to accept HTC [68% vs. 33%, P < 0.001)] and to be first-time testers (42% vs. 28%, P = 0.07). By HTC, the rates of HIV infection tended to be higher among youth MSM comparing to other MSM [14/59 (24%) vs. 11/89 (12%); P = 0.07]. Among the 14 youth MSM newly-diagnosed with HIV infection, only 6 (43%) showed-up for continuity care after 1-year follow-up.
CONCLUSIONS
Youth MSM had substantial high HIV risk, false perception of low HIV risk and low rate of care engagement but demonstrated considerable rate of HTC uptake. Strategies to improve access to HTC, risk perception and linkage to care are needed for HIV prevention and management among the youth MSM.
背景
男男性行为者（MSM）是泰国艾滋病毒感染高危人群之一。在青年 MSM（15-24 岁）中，艾滋病毒感染的发病率显著增加。然而，有关青年 MSM 在热点地区的艾滋病毒风险、风险认知以及艾滋病毒检测和咨询（HTC）的接受程度的数据有限。
方法
对泰国 MSM 参加男同性恋桑拿浴室的前瞻性研究进行了子分析。通过匿名调查评估艾滋病毒风险和风险认知。根据经过验证的研究风险分类工具，将 MSM 分为实际“低风险”、“中风险”和“高风险”HIV 获得风险类别。现场提供 HTC，并在 1 小时内通知结果。咨询员为 HIV 感染参与者安排 HIV 护理机构预约。随后在诊断后 1 年内评估护理参与情况。
结果
共有 358 名 MSM 参与者，其中 87 名（24%）为青年 MSM。与其他 MSM 相比，青年 MSM 的终生性伴侣中位数明显更高[2（IQR 1-9）与 1（IQR 0-1）；P<0.001]，更有可能曾用钱换取性[44%与 9%；P<0.001]，以及性伴侣用钱换取性[8%与 1%；P<0.001]。过去 3 个月内进行肛交、口交和阴道性交时坚持使用安全套的比例较低，且青年 MSM 与其他 MSM 之间无显著差异（分别为 51%与 61%、26%与 35%和 72%与 61%）。根据研究风险分类工具，有 68 名青年 MSM 具有中度或高度 HIV 获得风险，其中 43 名（63%）对低 HIV 风险存在错误认知。青年 MSM 比其他 MSM 更有可能接受 HTC[68%与 33%，P<0.001)]和首次接受检测（42%与 28%，P=0.07）。通过 HTC，青年 MSM 的 HIV 感染率似乎高于其他 MSM[14/59（24%）与 11/89（12%）；P=0.07]。在 14 名新诊断为 HIV 感染的青年 MSM 中，只有 6 名（43%）在 1 年随访后前来继续护理。
结论
青年 MSM 具有较高的 HIV 风险、错误的低 HIV 风险认知以及较低的护理参与率，但接受 HTC 的比例相当高。需要采取措施改善青年 MSM 获得 HTC 的机会、风险认知和与护理的联系，以预防和管理他们的 HIV 感染。
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