STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China.
Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
BMC Public Health. 2022 Apr 29;22(1):858. doi: 10.1186/s12889-022-13264-z.
Although men who have sex with men (MSM) and male sex workers (MSWs) both represent the high-risk groups for the transmission of HIV/AIDS and syphilis, the comparison between them have not yet been well studied in China. We aimed to evaluate the prevalence of HIV among MSM and MSW, and then identify the difference of risk factors of HIV infection.
A snowball sampling was employed to recruit patrons attending the Tianjin bathhouse from March 2011 to October 2018. A questionnaire covering sociodemographic characteristics, sexual behaviors, HIV-related and HIV awareness was completed by 5166 patrons from all parts of China. Bivariate analyses were done using the Chi-square test to investigate the association between factors and HIV infection among MSM and MSWs. Subsequently, we studied the different impact of risk factors on HIV infections among the two groups using multiple logistic regression with the adjusted odds ratio (aOR) being derived.
From 2011 to 2018, 235 MSWs and 4931 MSM were included into our study. HIV prevalence among the MSWs was 17.8% (95%CI: 13.2% ~ 23.4%) while 6.5% (95%CI: 5.8% ~ 7.2%) for MSM (P < 0.01). MSWs tends to be younger (26.50% in MSWs vs. 8.64% in MSM, P < 0.05), live alone (84.68% in MSWs vs. 47.98 in MSM, P < 0.05), get poor education (41.28% in MSWs vs. 28.45 in MSM, P < 0.05), use drug (8.09% in MSWs vs. 0.89% in MSM, P < 0.05), have more proportion of always use condom during anal sex (56.50% in MSWs vs. 41.95% in MSM, P < 0.05) but less proportion during commercial sex (81.28% in MSWs vs. 98.48% in MSM, P < 0.05), access HIV-related health services (65.96% in MSWs vs. 47.80% in MSM, P < 0.05) and have a HIV test last year(60.85% in MSWs vs. 41.27% in MSM, P < 0.05). The significant associations between risk factors with HIV infection in MSM were not observed in MSWs and vice versa.
High HIV prevalence needs urgent intervention targeting MSWs as a higher susceptible to HIV in comparison to MSM owing to their unique characteristics. The discrepancies of profiles and risk factors between MSM and MSWs should be consider in design and development of strategies.
男男性行为者（MSM）和男性性工作者（MSW）均为 HIV/AIDS 和梅毒传播的高危人群，但目前中国尚未对两者进行全面比较。本研究旨在评估 MSM 和 MSW 中 HIV 的流行率，并确定 HIV 感染风险因素的差异。
2011 年 3 月至 2018 年 10 月，采用滚雪球抽样法招募来自全国各地的天津浴场顾客。共招募了 5166 名顾客，完成了一份涵盖社会人口统计学特征、性行为、HIV 相关知识和 HIV 知晓率的问卷。采用卡方检验对不同因素与 MSM 和 MSW 中 HIV 感染的相关性进行了双变量分析。随后，我们采用多因素 logistic 回归分析了不同风险因素对两组人群 HIV 感染的影响，并得出校正比值比（aOR）。
2011 年至 2018 年，共纳入 235 名 MSW 和 4931 名 MSM。MSW 中的 HIV 流行率为 17.8%（95%CI：13.2%23.4%），而 MSM 中的 HIV 流行率为 6.5%（95%CI：5.8%7.2%）（P<0.01）。MSW 往往更年轻（MSW 中 26.50%，MSM 中 8.64%，P<0.05），独居（MSW 中 84.68%，MSM 中 47.98%，P<0.05），受教育程度低（MSW 中 41.28%，MSM 中 28.45%，P<0.05），吸毒（MSW 中 8.09%，MSM 中 0.89%，P<0.05），肛交时始终使用安全套的比例较高（MSW 中 56.50%，MSM 中 41.95%，P<0.05），但商业性性行为中始终使用安全套的比例较低（MSW 中 81.28%，MSM 中 98.48%，P<0.05），获得 HIV 相关健康服务的比例较低（MSW 中 65.96%，MSM 中 47.80%，P<0.05），最近一年进行 HIV 检测的比例也较低（MSW 中 60.85%，MSM 中 41.27%，P<0.05）。MSM 中与 HIV 感染相关的风险因素在 MSW 中并不显著，反之亦然。
与 MSM 相比，MSW 作为 HIV 的易感人群，其 HIV 流行率较高，需要紧急采取干预措施。在制定和实施策略时，应考虑 MSM 和 MSW 之间的特征和风险因素差异。
