中国成都农村地区 HIV 阴性老年男性的终身商业异性性行为：一种修正的知识-态度-实践观点。
Lifetime commercial heterosexual behavior among HIV negative elderly men from rural Chengdu, China: a modified knowledge-attitude-practice perspective.
机构信息
Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China.
Department of Urology, Chengdu Second Peoples' Hospital, 10 Qingyunnan Road, Chengdu, 610017, China.
出版信息
BMC Public Health. 2021 Nov 15;21(1):2095. doi: 10.1186/s12889-021-12139-z.
BACKGROUND
China is facing big challenges to achieve the "90-90-90 targets". The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China.
METHODS
The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective.
RESULTS
129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02-5.91), age(≥60 vs. 50-59, OR = 0.41, 95% CI = 0.19-0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16-0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0-0.52), and undecided (AOR =0.02, 95%CI = 0.01-0.09) and objection (AOR =0.04, 95%CI = 0.01-0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior.
CONCLUSIONS
High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50-59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.
背景
中国在实现“90-90-90 目标”方面面临巨大挑战。中国老年（≥50 岁）男性的艾滋病毒流行率一直在稳步上升，主要通过性传播途径，但对他们的性行为知之甚少。2019 年，中国四川省老年男性占艾滋病病毒/艾滋病病例的 59.2%。
方法
本研究设计为横断面研究。对来自四川省省会成都农村地区的 795 名艾滋病毒阴性老年男性进行面对面访谈。采用二项和多变量逻辑回归模型，从改良的知识-态度-实践（KAP）角度探讨与商业异性性行为相关的因素。
结果
129 名（16.23%）受访者承认存在高危性行为，包括 11.07%的商业异性性行为、6.16%的婚外性行为、2.89%的随意性行为和 0.25%的同性恋行为，且没有人始终使用安全套。427 名（68.43%）曾接受过与艾滋病毒相关的健康教育（HRHE），主要通过大众媒体（70.49%）。艾滋病毒相关知识知晓率仅为 31.41%。有迁移史（AOR=2.46，95%CI=1.02-5.91）、年龄（≥60 岁与 50-59 岁相比，OR=0.41，95%CI=0.19-0.91）、从大众媒体获得 HRHE（OR=0.37，95%CI=0.16-0.85）、婚姻状况（已婚与从未结婚相比，OR=0.04，95%CI=0-0.52）、未决定（AOR=0.02，95%CI=0.01-0.09）和反对（AOR=0.04，95%CI=0.01-0.1）对商业性的态度与一生中的商业异性性行为有关。
结论
来自成都农村地区的老年男性存在高危性行为。从大众媒体获得 HRHE 以及对商业性行为的未决定和反对态度可以防止老年人参与商业异性性行为。根据研究结果，卫生机构应继续进行系统干预，更加关注 50-59 岁年龄段的人群。需要在公众场合谈论性和安全套的使用。与大众媒体合作，卫生机构不仅要对老年男性进行艾滋病病毒/艾滋病知识教育，还要进行安全套使用知识和技能教育。
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