| 摘要 | 【目的】 本研究旨在了解某市青年男男性行为（Men who have sex with men, MSM）的艾滋病知识掌握情况、艾滋病相关行为现状、接受预防艾滋病教育的现况和需求；了解青年MSM，尤其是青年艾滋病病毒感染者的心理健康状况；探究影响青年MSM心理的可能因素，为政策制定者做出干预决策提供依据。【方法】本研究采用滚雪球法和受试者推荐的混合招募方法，于黑龙江省某市招募青年MSM人群，采用定量问卷和定性访谈结合的方法进行调查。通过大众人群艾滋病基本知识（“国八条”）和青年学生艾滋病核心知识（“青八条”）了解青年MSM人群的艾滋病知识知晓情况；通过艾滋病知识来源、受教育学段、知识技能等需求了解青年MSM对预防艾滋病教育的需求；通过最近3个月/确诊前3个月的性行为情况了解青年MSM的HIV相关行为；通过抑郁自评量表了解青年MSM人群的抑郁状况；通过事件影响量表、创伤后成长量表、反刍沉思问卷、积极/消极注意偏向量表了解青年HIV感染者的心理状况，并通过路径分析构建HIV感染者心理状况模型，探究抑郁等心理影响因素对青年HIV感染者创伤后成长的影响，青年HIV感染者以及反刍沉思、事件影响、积极/消极注意偏向发挥的中介作用。研究共调查204人，回收有效问卷201份，问卷有效率98.5%。在上述研究的基础上，采用志愿者征集法对自愿接受访谈的HIV感染者进行访谈，共访谈100名青年HIV感染者，深入了解青年HIV感染者的性取向、性行为等心理以及可能的影响因素。【结果】研究表明，青年MSM的“国八条”知晓率为87.9%，“青八条”知晓率为82.3%。青年MSM获取艾滋病知识的主要途径为网络媒体，有18.0%的青年MSM从未接受过预防艾滋病教育。有31.5%的青年MSM从高中开始接受预防艾滋病教育，43.2%的青年MSM建议从初中开始接受预防艾滋病教育，不同人群对艾滋病相关知识和技能的需求有差异。HIV阳性青年MSM和HIV阴性青年MSM开始接受和建议开始接受预防艾滋病教育的学段不同（P＜0.01）。有12.0%的青年MSM在18岁前发生了性行为，26.0%的青年MSM上大学前多性伴，71.5%的青年MSM上大学后多性伴，69.5%的青年MSM确诊前3个 月/最近3个月多性伴，38.9%的青年MSM确诊前3个月/最近3个月未持续使用安全套，还有23.4%的青年MSM在最近3个月发生性行为之前使用过Rush，19.4%在发生性行为前饮用过酒精。有78.6%的青年MSM主要通过社交网站寻找性伴，常有的社交软件有Blued、微信、QQ、Aloha等。有53.7%的青年MSM出现了抑郁症状，有45.3%的青年MSM希望得到来自家人的心里支持。HIV感染（aOR=5.87,95%CI:2.89-11.91,P<0.01）、独居状态（aOR=2.65,95%CI:1.18-5.99,P<0.05）和18岁前发生首次性行为（aOR=5.34,95%CI:1.49-19.18,P<0.05）是青年MSM抑郁的危险因素，掌握艾滋病知识是青年MSM抑郁的保护因素（aOR=0.16,95%CI:0.04-0.66,P<0.05）。有34.5%的青年HIV感染者受到“HIV感染事件”的中度影响，37.9%重度影响，有54.7%的青年HIV感染者表示在感染HIV后有成长。其中，抑郁、事件影响、侵入性反刍沉思和消极注意偏向与创伤后成长存在负相关（P＜0.05），积极注意偏向与创伤后成长存在正相关（P＜0.01）。【结论】青年MSM人群艾滋病知识知晓率尚未达到国家要求，高危性行为发生率较高，心理健康状况亟待提高，青年HIV感染者心理状况复杂，但创伤后有成长。未来应加强中小学性教育及预防艾滋病教育，提高学生对自身的认识和预防艾滋病能力，确保其发生首次性行为前能够做出负责任的决定；关注青年MSM的心理健康状况，让他们得到来自社会、家庭、学校的支持；采取措施，帮助HIV感染者的创伤后成长，从积极、正面的注意偏向入手，对青年HIV感染者进行引导，减少青年HIV感染者的负性情绪，使其尽快从创伤中恢复，并得到成长。 |
| 其他摘要 | 【Objective】 We aim to understand the HIV related knowledge, behaviors, and the need of HIV education of young men who have sex with men (MSM) in Harbin. To investigate the mental health status of young MSM, especially in young HIV-infective MSM, to explore the possible factors that affected the mental health of young MSM, and to provide basis for policy makers to make intervention decisions.【Methods】 We used a mixed recruitment method of snowball sampling and respondent driven sampling to recruit HIV-infected young MSM in a city, using the method of quantitative questionnaire and qualitative interview. Through the basic knowledge of “Guo Ba Tiao” and “Qing Ba Tiao” to understand the knowledge of HIV among young MSM, through the source of HIV knowledge, education section, knowledge and skills needs to understand the needs of young MSM for HIV prevention education; through the sexual behavior in the three months before diagnosis/last three months to understand the HIV related behaviors of young MSM; to understand the depression status of young MSM through SDS, PTG, ERRI, APNI, and to build a mental status model of HIV infected people through path analysis, to explore the influence of depression and other psychological factors on post-traumatic growth. A total of 204 young MSM were recruited, and the effective rate was 98.5%.On the basis of the above research, we used the method of volunteer solicitation to interview 100 young HIV infected people to understand their sexual orientation, sexual behavior and other psychological factors.【Results】 In this survey, the awareness rate of “Guo Ba Tiao” of MSM was 87.9%, the awareness rate of the “Qing Ba Tiao” of MSM was 82.3%. Network media is the main way for young MSM to acquire HIV knowledge (45.3%). 18.0% of young MSM have never receive HIV prevention education, 31.5% began to receive HIV prevention from high school, 43.2% suggested that they start to receive HIV prevention education from junior high school, and different groups have different needs for HIV related knowledge and skills. The stages of HIV positive MSM and HIV negative MSM receiving HIV prevention education were different (P<0.01). 12.0% of young MSM had sex before the age of 18, 26.0% of young MSM had multiple sexual partners before going to university, 71.5% of young MSM had multiple sexual partners after going to university, 69.5% of young MSM had multiple sexual partners 3 months before diagnosis last 3 months, 38.9% of young MSM did not use condoms continuously 3 months before diagnosis/last 3 months, and 23.4% of young MSM had used Rush before having sex in the last 3 months, 19.4% drinking alcohol before having sex. 78.6% of young MSM mainly search for sexual partners through social networking sites, and some social software include Blued, Wechat, QQ, Aloha, etc.53.7% of young MSM had depression symptoms, and 45.3% of young MSM hoped to get psychological support from their families. HIV infection (aOR = 5.87,95% CI: 2.89-11.91, P < 0.01), living alone (aOR = 2.65,95% CI: 1.18-5.99, P < 0.05), and having sex for the first time before the age of 18 (aOR = 5.34,95% CI: 1.49-19.18, P < 0.05) were the risk factors of MSM depression in young people. Mastering AIDS knowledge was the protective factor of MSM depression in young people (aOR = 0.16,95% CI: 0.04-0.66, P < 0.05).34.5% of young HIV infected people were moderately affected by the "HIV infection event", 37.9% were severely affected, and 54.7% of young HIV infected people said they had grown up after HIV infection. Among them, depression, event influence, invasive ruminant meditation and negative attention bias were negatively correlated with post-traumatic growth (P<0.05), while positive attention bias was positively correlated with posttraumatic growth (P <0.01).【Conclusion】 The awareness rate of AIDS knowledge of young MSM has not reached the national requirements, the incidence of high-risk sexual behavior is high, the mental health needs to be improved, the mental state of young HIV infected people is complex, but they grow up after HIV infected. In the future, we should promote the education of sex education and HIV prevention in primary and secondary schools based on the extensive education of HIV prevention in universities, so that young people can have early access to relevant knowledge and help them make responsible decisions, we also need to pay attention to the mental health of young MSM, and let them get the support from society, families and schools, and take measures to help the post-traumatic growth of HIV infected people from a positive and positive perspective, guide the young people infected with HIV, reduce the negative emotions of young people infected with HIV, make them recover from the trauma as soon as possible, and begin to grow up. |
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