Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China.
Department of HIV/AIDS and STDs Control and Prevention, Ningbo Center for Disease Control and Prevention, Ningbo, People's Republic of China.
BMC Public Health. 2023 Apr 21;23(1):734. doi: 10.1186/s12889-023-15672-1.
BACKGROUND: Men who have sex with men and women (MSMW) are the most important bridge population for HIV transmission. Condom use plays an important role for HIV infection. However the predictors for condom ues with females are not well characterized. METHODS: This was a cross-sectional study. Participants were enrolled by four community-based organizations (CBOs) by offline (bathrooms, bars), and online (gay applications, chat room) from April to December 2019. Electronic questionnare was fulfilled after a face-to-face training led by CBOs. We identified predictors of inconsistent condom use with females by creating a risk score based on regression coefficients. We externally validated this score via an independent cross-sectional survey conducted in Zhejiang Province in 2021. A total of 917, 615 MSMW were included in analysis in 2019 and 2021, seperately. RESULTS: Among 917 MSMW, 73.2% reported heterosexual behavior in the prior 6 months and 38.3% reported inconsistent condom use with females (ICUF) over that time. Compared with heterosexual/unsure MSMW, bisexual MSMW reported more male and female sex partners, higher proportion of inconsistent condom use with males, less commercial sex with males (p < 0.05). Four risky predictors of ICUF were identified: Duration of local residence ≦6 months; more than one male partner in the prior 6 months; inconsistent condom use with males in the prior 6 months; and never heard post-exposure prophylaxis (PEP). The proportions of respondents indicating ICUF in the low- (0), medium- (2-4) and high-risk (6-20) groups (according to our risk scoring system) were 11.7% (14/120), 26.9% (96/357), and 78.1% (125/160), respectively (P < 0.001). In the validation survey, the respective proportions of those reporting ICUF were 13.4% (15/112), 17.8% (24/185) and 87.3% (96/110) (P < 0.001). CONCLUSIONS: We developed and validated a predictive risk score for ICUF among MSMW; four factors were identified, of which inconsistent condom use with men was the most important. Risk reduction intervention programs should focus on MSM who report inconsistent condom use with males, never heard PEP, having multiple partners and living in local less than 6 months.
背景：男男性行为者和女性（MSMW）是 HIV 传播最重要的桥梁人群。安全套的使用对 HIV 感染起着重要作用。然而，女性安全套使用的预测因素尚未得到很好的描述。
方法：这是一项横断面研究。参与者通过线下（浴室、酒吧）和线上（同性恋应用程序、聊天室），由四个社区组织（CBO）招募，时间为 2019 年 4 月至 12 月。在 CBO 领导的面对面培训后，填写电子问卷。我们根据回归系数创建了一个风险评分，以确定与女性发生不安全套性行为的预测因素。我们通过 2021 年在浙江省进行的独立横断面调查对该评分进行了外部验证。2019 年和 2021 年分别有 917 名和 615 名 MSMW 纳入分析。
结果：在 917 名 MSMW 中，73.2%的人在过去 6 个月内有异性性行为，38.3%的人在过去 6 个月内与女性发生过不安全套性行为（ICUF）。与异性/不确定 MSMW 相比，双性恋 MSMW 报告了更多的男性和女性性伴侣、更高的男性与女性发生不安全套性行为的比例、更少的男性商业性性行为（p<0.05）。确定了与女性发生不安全套性行为的四个危险预测因素：当地居住时间≦6 个月；过去 6 个月有超过一个男性性伴侣；过去 6 个月与男性发生过不安全套性行为；从未听说过暴露后预防（PEP）。在低风险（0）、中风险（2-4）和高风险（6-20）组中，根据我们的风险评分系统，报告发生 ICPUF 的受访者比例分别为 11.7%（14/120）、26.9%（96/357）和 78.1%（125/160）（p<0.001）。在验证调查中，报告发生 ICPUF 的比例分别为 13.4%（15/112）、17.8%（24/185）和 87.3%（96/110）（p<0.001）。
结论：我们开发并验证了 MSMW 中与女性发生不安全套性行为的预测风险评分；确定了四个因素，其中与男性发生不安全套性行为是最重要的。减少风险的干预计划应侧重于报告与男性发生不安全套性行为、从未听说过 PEP、有多个伴侣和在当地居住时间少于 6 个月的 MSMW。
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