自愿医学男性割礼与马拉维姆祖祖活跃性割礼男性性行为：一项横断面研究。
Voluntary medical male circumcision and sexual practices among sexually active circumcised men in Mzuzu, Malawi: a cross-sectional study.
机构信息
College of Medicine, Public Health Department, P/Bag 360, Chichiri, Blantyre 3, Malawi.
Malawi Defence Force, Malawi Military Health Services, Moyale Barracks, P.O Box 23, Mzuzu, Malawi.
出版信息
BMC Public Health. 2020 Feb 11;20(1):211. doi: 10.1186/s12889-020-8309-5.
BACKGROUND
Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices.
METHOD
A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18-49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson's chi square test and logistic regression.
RESULTS
Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7-38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n = 187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p < 0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex.
CONCLUSION
Risky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.
背景
自愿男性包皮环切术（VMMC）是预防异性性传播 HIV 的策略之一。已有 14 个高 HIV 流行率和低割礼率的国家采用了这种策略。VMMC 的 60.0%的保护效果在马拉维的一些社会中存在误解，因此 VMMC 客户可能会因为其被认为的保护效果而选择危险的性行为。这项研究估计了接受 VMMC 后进行危险性行为的割礼男性比例，评估了对 VMMC 保护效果的认识，并确定了与危险性行为相关的社会人口学因素。
方法
在姆祖祖市的两个地点进行了一项横断面研究。采用系统随机抽样方法选择了 322 名年龄在 18-49 岁之间、接受过 VMMC 的参与者。自变量包括年龄、地点、职业、宗教、婚姻状况和教育程度。因变量包括不使用安全套、有多个性伴侣和从事性交易。问卷数据使用 Pearson's chi square 检验和逻辑回归进行分析。
结果
在 322 名受访者中，84.8%（273 人）理解 VMMC 在 HIV 预防中的部分保护作用。96%的参与者报告在 VMMC 后继续使用安全套。总体而言，23.7-38.3%的参与者报告在 VMMC 后进行了危险的性行为，23.7%（76 人）有多个性伴侣；29.2%（94 人）付钱发生性行为，而 39.9%（n=187 人）没有使用安全套。居住在高密度地区与不使用安全套有关（p=0.043）。单身（p<0.001）和居住在低密度地区（p=0.004）与从事性交易有关。
结论
接受过 VMMC 的参与者中存在危险的性行为。需要向客户强调更安全的性行为信息和 VMMC 的局限性，特别是未婚或单身以及居住在低密度地区的客户。
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