Study On Cognition About AIDS, Behavior And Effect Of The Intervention Among Men Who Have Sex With Men In Chongqing

1. BackgroudUnprotect sexual behavior of man who have sex with men(MSM) has beenthe major transmission route of HIV in the worldwide. MSM has been the risk population of HIV infection in China. The data of national sentinel surveillance reflected that HIV infection rate of MSM was above 1.3%. The result of the survey in some cities indicated that HIV infection rate increased gradually. HIV prevalence was 2% to 10.4%. These risk factors such as multiple sexual partners,low rate of condom use, unprotected sexual behavior will promote HIV spread among MSMs. There are large population of MSM in Chongqing and several gay venues. And MSM are more active with the tolerant social environment than other cities. The result of the survey reflected that HIV prevalence was higher than it in the other city. The intervention has been conducted since 2006 supported by Global Fund Round Five. To understand HIV prevalence and its associated factors and evaluate the effect before and after the intervention is to provide the scientific evidence for adjusting the strategy of AIDS prevention and control targeting MSM.2. ObjectiveTo conduct the cross-sectional survey to understand the status of AIDS cognition,sexual behavior, HIV and Syphilis prevalence and its associated factors and evaluate the effect of the intervention is to provide the scientific evidence for adjusting the strategy for AIDS prevention and control targeting MSM.3. MethodsThe surveillance was conducted in 2009 and 2010. The participants were recruit through snowballing. The particiant was over 18 years old and over 6 months living in Chongqing. The site of the surveillance was STD clinic of Chongqing center for disease prevention and control. The participant was investigated by face-toface with formal consent. All staffs of STD clinic were trained. The questionnaire included demographic characteristic, AIDS cognition, status of sexual behavior, receiving HIV intervention, drug use and STD infection. The blood sample was taken to test HIV and Syphilis anti-body. HIV test was screened by ELISA and confirmed by WB. Syphilis was screened by RPR and confirmed by TPPA. All data were entered with software EPI DATA3.0 and analyzed by software SPSS12.0. The effect of the inetrevntion was compared by Chi-square test. The influencing factor was identified by multivariate logistic regression analysis.4. ResultsA total of 600 MSM and 436 MSM were recruited in 2009 and 2010 respectively. Their average age wa(s26.9±8.1) and (26.6±6.3)years old respectively. 56.3% and 71.6% of them was 20-29 years old.most of them was single, which accounted 82.7% and 90.1% respectively in 2009 and 2010. 55.8% and 68.8% of them received high school education level respectively. The profession distributed student, servant and company staff.The rate of AIDS cognition was 89.8% and 92.4% in 2009 and 2010 respectively. The major route of getting AIDS knowledge was internet, which accounted for 70.7% and 78.2% respectively. The following was friend and TV. The discrimination about AIDS was good. If your friend infected HIV, 60.5% and 62.4% of them selected that they would like to make a friend in 2009 and 2010.69.0% and 75.5% of them self-identified homosexual orientation in 2009 and 2010. The major place of seeking sexual partner was internet, which accounted for 61.5% and 70.6%. 71.8% and 77.8% of them had first sex with male sexual partner. The average age of having first sex with man was 20 years old (Median). The first sex with man was mutual voluntary, which accounted for 80.5% and 84.6% in 2009 and 2010 respectively. The number of sexual partners was 2 in the past six months in 2009 and 2010. The proportion of having anal sex with man in the past six months was 91.2% and 93.3% respectively. And the rate of condom use in the past six months and last time during anal sex with man was 34.7% , 65.8% in 2009 and 41.5%, 69.8% in 2010.In the past six months, 84.7% and 87.2% of them had oral sex with man in 2009 and 2010 respectively. The rate of condom use during oral sex with man in the past six months and last time was 13.5%, 24.3% in 2009 and 12.2%, 23.7% in 2010. 4.8% and 5.0% of them had group sex with men in 2009 and 2010 respectively. In the past six months, 8 MSMs bought sex in 2009 and 2010. 18 MSMs and 5 MSMs sold sex in the past six months in 2009 and 2010. 14.2% and 7.3% of them had sex with woman in the past six months in 2009 and 2010 respectively. The rate of condom use during sex with woman in the past six months and last time was 47.1%, 32.9% in 2009 and 37.5%, 21.9% in 2010. 16 sexual partners having sex with MSM participated in the surveillance was HIV infection in 2009 and 2010. More than 50% of them didn't kow HIV infection status of their sexual partners. If HIV infection of their sexual partners was unclear, 47.0% and 61.2% of them discussed HIV test and 63.5% and 71.6% of them discussed condom use in 2009 and 2010 respectively.10 MSMs and 3 MSMs had the history of drug use in 2009 and 2010 respectively.Only 1 MSM had the history of injecting drug, but he never shared needle with others. The history of STD in the past year self-reported accounted for 16.3% and 10.1% in 2009 and 2010 respectively. 36.7% and 80.3% of them received HIV test in 2009 and 2010 respectively. The proportion of receiving the intervention increased from 74.7% in 2009 and 89.7% in 2010. MSM selected important service including STD/ AIDS counseling service, psychological counseling service, which accounted for 77.3%, 56.7% in 2009 and 79.4%, 64.7% in 2010. HIV prevalence decreased from 19.2% in 2009 to 9.4% in 2010. Syphilis prevalence decreased from 5.2% in 2009 and 2.1% in 2010.The result of multivariate logistic regression analysis indicated that age (OR=3.1,95%CI:1.6-6.0), number of anal sexual partner in the past six months(OR=4.0 ,95%CI:1.3-12.4) and Syphilis infection were independent factors of HIV prevalence. And HIV infection (OR=5.3,95%CI:1.2-23.2) was independent factor of Syphilis prevalence.5. Conclusion5.1 The prevalence of HIV and Syphilis among MSMs was high in Chongqing and the prevalence increased year by year. HIV epidemic was serious.5.2 The effect of comprehensive intervention targeting MSM in Chongqing was displayed. The rate of AIDS cognition, receiving behavior intervention in the past year, receiving HIV test in the past year and condom use during anal sex with man in the past six months increased in 2010 compared it in 2009. And the proportion of self-reported infected STD decreased in 2010 compared it in 2009.5.3 These factors including low rate of condom use, multiple sexual partners, high proportion of unprotected sex with woman, poor awareness of HIV risk and low proportion of HIV test and counseling will accelerate HIV transmission among MSM and promote HIV spread from MSM to general population.5.4 Although a lot of interventions have been conducted in the past in Chongqing, the coverage of HIV counseling and test will be expanded and the awareness of receiving HIV test actively will be raised further. It is important task to provide post-test counseling service and positive intervention for MSM.