使用不当的肛门灌肠工具与男男性行为者中 HIV 感染的增加有关：中国沈阳的一项横断面研究。

The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China.

机构信息

NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning Province, China.

Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.

出版信息

BMC Public Health. 2021 Jan 28;21(1):235. doi: 10.1186/s12889-021-10276-z.

DOI:10.1186/s12889-021-10276-z

PMID:33509136

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7844917/

Abstract

BACKGROUND

Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is associated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex.

METHODS

Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection.

RESULTS

A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%, 25/307) before sex. The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD, practicing RD before sex, the interaction between RD and CRAI using a shower hose for RD and other risk factors, practicing RD after sex, CRAI, using nitrite inhalants, main sexual role with males as bottom and syphilis infection.

CONCLUSIONS

RD is popular among Chinese MSM. Improper noncommercial RD tools use (such as shower hose), the interaction effect between RD and CRAI associated with HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM. We recommend that further studies should be conducted to understand the detailed mechanism between RD and increased HIV prevalence.

摘要

背景

直肠灌洗（RD）在男男性行为者（MSM）中广泛流行，与 HIV 感染风险增加有关。然而，RD 如何增加 HIV 感染风险的机制尚不清楚，而且在中国，进行肛交的 MSM 中关于 RD 行为的数据有限。我们研究了 MSM 进行 RD 的目的、与肛交相关的时间、使用的 RD 产品类型以及报告肛交的性行为风险。

方法

2017 年 8 月至 2018 年 12 月，在中国沈阳对成年 MSM 进行了一项横断面研究。通过访谈者面对面问卷收集最近一次性行为的人口统计学、性行为和 RD 数据。采集血样检测 HIV 和梅毒抗体。多变量逻辑回归模型用于评估与 HIV 感染相关的风险因素。

结果

共有 515 名符合条件的 MSM 参与了这项调查（中位年龄：31 岁）。在最近一次肛交中，28.3%（146/515）有套肛交，21.4%（110/515）进行了血清学筛选，超过一半（61.6%，317/515）报告在肛交前后进行了 RD。在进行 RD 的人群中，96.8%（307/317）在性交前进行 RD，而 62.5%（198/317）在性交后进行 RD。使用的冲洗装置主要是淋浴软管（85.3%，262/307），很少有 MSM 在性交前使用商业 RD 产品（8.1%，25/307）。HIV-1 和梅毒的流行率分别为 11.7%和 13.2%。HIV 感染与 RD、性交前 RD、使用淋浴软管进行 RD 与 CRAI 之间的交互作用以及其他风险因素、性交后 RD、CRAI、使用亚硝酸盐吸入剂、男性作为肛交接受者的主要性角色和梅毒感染呈正相关。

结论

RD 在我国 MSM 中很流行。不恰当地使用非商业 RD 工具（如淋浴软管）以及 RD 与 CRAI 之间的相互作用与 HIV 感染有关。公共卫生工作者和 MSM 社区应宣传与 MSM 的 RD 和 HIV 传播相关的科学知识和预防方法。我们建议进一步研究以了解 RD 与 HIV 感染率增加之间的详细机制。