Suppr
超能文献

男男性行为者的性行为变化和 HIV 感染：来自中国一个开放队列的证据。

Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China.

机构信息

School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China.

STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, China.

出版信息

BMJ Open. 2022 Sep 28;12(9):e055046. doi: 10.1136/bmjopen-2021-055046.

DOI:10.1136/bmjopen-2021-055046

PMID:36171031

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9528664/

Abstract

BACKGROUND

The HIV epidemic in key populations such as men who have sex with men (MSM) is a public health issue of worldwide concern. China has seen an increase in newly diagnosed HIV infections through male-male sexual contact in the past decade. In a long-term cohort, how the complex behaviour pattern of MSM changed and the association with the HIV risk are unclear at present.

METHODS

This study was conducted from October 2011 to December 2019 in Tianjin. MSM were recruited by snowball sampling through online and offline ways. Demographic and sexual behavioural data were collected for analysis. Three indicators (condom use in last anal sex, frequency of condom use during anal sex and the number of sexual partners) were used to define the behaviour change. Participants with zero, one, and two or three risk indicators were categorised into behaviour types of 'protective', 'moderate', and 'fragile', respectively. Change in behaviour type between baseline and each visit was considered. Time-varying Cox models were performed to evaluate HIV infection risk.

RESULTS

Of 2029 MSM included in the study, 127 were new HIV diagnoses. The overall incidence rate was 3.36 per 100 person-years. The percentage of 'protective' and 'moderate' behaviour types had a conspicuous growth trend as the follow-up. Furthermore, the HIV incidence rate in each visit among different behaviour transition types showed a general downward trend as the number of total follow-up times increased. Individuals who remained in 'fragile' (adjusted HR (aHR): 25.86, 95% CI: 6.92 to 96.57) or changed from 'protective' to 'moderate' (aHR: 4.79, 95% CI: 1.18 to 19.47), 'protective' to 'fragile' (aHR: 23.03, 95% CI: 6.02 to 88.13), and 'moderate' to 'fragile' (aHR: 25.48, 95% CI: 6.79 to 95.40) between baseline and the last follow-up had a higher HIV risk. Gained risk indicators were associated with the increase of HIV risk (gained one indicator, aHR: 2.67, 95% CI: 1.68 to 4.24; gained two or three indicators, aHR: 4.99, 95% CI: 3.00 to 8.31) while losing just one risk indicator could halve the risk (aHR: 0.43, 95% CI: 0.21 to 0.90).

CONCLUSIONS

Among MSM in Tianjin, it is necessary to get timely behaviour change for those with high-incidence behaviour patterns while sustaining for those with low-incidence patterns.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trials Registry (ChiCTR2000039500).

摘要

背景

男男性行为者（MSM）等关键人群中的艾滋病毒流行是一个全球关注的公共卫生问题。在过去的十年中，中国新诊断出的艾滋病毒感染病例通过男男性接触有所增加。在一个长期队列中，目前尚不清楚 MSM 的复杂行为模式如何变化以及与艾滋病毒风险的关联。

方法

本研究于 2011 年 10 月至 2019 年 12 月在天津进行。通过在线和线下方式通过滚雪球抽样招募 MSM。收集人口统计学和性行为数据进行分析。使用三个指标（最近一次性交时使用安全套、性交时安全套使用频率和性伴侣数量）来定义行为变化。将零、一和两个或三个风险指标的参与者分别归类为“保护”、“中度”和“脆弱”行为类型。将基线和每次随访之间的行为类型变化视为一种行为类型变化。采用时变 Cox 模型评估艾滋病毒感染风险。

结果

在纳入研究的 2029 名 MSM 中，有 127 人新诊断出艾滋病毒感染。总发病率为每 100 人年 3.36 例。随着随访的进行，“保护”和“中度”行为类型的比例呈明显增长趋势。此外，随着总随访次数的增加，不同行为转变类型在每次随访中的艾滋病毒发病率呈总体下降趋势。仍处于“脆弱”状态的个体（调整后的 HR（aHR）：25.86，95%CI：6.92 至 96.57）或从“保护”变为“中度”（aHR：4.79，95%CI：1.18 至 19.47），“保护”变为“脆弱”（aHR：23.03，95%CI：6.02 至 88.13）和“中度”变为“脆弱”（aHR：25.48，95%CI：6.79 至 95.40）之间的个体在基线和最后一次随访时具有更高的艾滋病毒风险。获得风险指标与艾滋病毒风险增加相关（获得一个指标，aHR：2.67，95%CI：1.68 至 4.24；获得两个或三个指标，aHR：4.99，95%CI：3.00 至 8.31），而仅失去一个风险指标可将风险降低一半（aHR：0.43，95%CI：0.21 至 0.90）。