| BackroundAIDS,also known as Acquired Immune Deficiency Syndrome(AIDS),is a highly lethal,chronic infectious disease caused by the Human Immunodeficiency Virus(HIV).After HIV infection,it usually does not occur immediately and requires a long incubation period,which makes a considerable number of HIV-infected people less likely to be detected in a short time.At present,the overall AIDS epidemic in China is at a low epidemic level,but due to the particularity of high-risk groups of AIDS such as men who have sex with men(MSM),female sex workers(FSW),males who have casual sex with women(MCSW),drug users(DU),seronegative partners among HIV serodiscordant couples(SNP),as well as the weak awareness of AIDS prevention and control,the AIDS epidemic in high-risk groups is still relatively serious.With the development of AIDS prevention and treatment,the awareness rate of AIDS knowledge among high-risk groups in China is increasing,but the HIV infection rate among high-risk groups remains high.One of the important reasons is the "separation between knowledge and action",that is,the knowledge of the transmission route,infection mode,and harm of unprotected sexual behavior is fully understood,but the behavior is contrary to cognition when sexual behavior occurs.Analyzing the influencing factors of the separation of knowledge and action in high-risk groups,exploring and innovating intervention models,and promoting the prevention of HIV before and after exposure are important measures to curb the spread of HIV among high-risk groups.ObjectivesThe purpose of this study was to conduct a questionnaire survey in MSM,FSW,MCSW,DU and SNP,to understand the knowledge of AIDS,sexual behavior and the separation between knowledge and action in condom use among the above five high-risk groups with correct cognition of condom use,to analyze the influencing factors leading to the separation between knowledge and action in condom use.Then,we will explore more targeted measures to prevent and control HIV/AIDS and reduce the level of separation between knowledge and action in condom use.MethodsCross-sectional surveys among MSM,FSW,MCSW,DU,and SNP were conducted in ten cities in China using a convenient sample,while electronic and paper questionnaires were used to collect information.After sorting out all questionnaires and eliminating invalid questionnaires,respondents who could correctly answer "Can correct condom use reduce AIDS" or "Can insisting on correct condom use reduce the risk of contracting and spreading AIDS?" were included in the study.SPSS 26.0 was used to analyze the demographic characteristics,AIDS knowledge,HIV-related service utilization,and behavioral information of the respondents.χ2 test was performed to analyze the demographic characteristics of five high-risk groups of HIV infection with correct cognition of condom use.Taking the separation between knowledge and action in condom use as the dependent variable,the Logistic regression model was used for analysis,and the factors P<0.1 in the univariate analysis were included in the multivariate Logistic regression,and the OR(95%CI)was calculated.The test level α=0.05.Results1.Demographic characteristics401 MSM were cognitively correct in the use of condoms,86.5%were under the age of 40,71.6%had lived locally for more than 2 years,87.5%had a high school education or above,and 40.6%had a monthly income of 3,000 yuan or less,of which 100(24.9%)were students.371 FSW were cognitively correct in the use of condoms,50.4%were over the age of 40,65.5%had lived locally for less than 2 years,77.9%had a junior high school education or below,and 69.5%had a monthly income of less than 3,000 yuan.346 MCSW were cognitively correct in the use of condoms,89.6%were under the age of 40,78.3%had lived locally for more than 2 years,87.0%had a high school education or above,and 43.4%had a monthly income of more than 5,000 yuan.319 cases of DU were cognitively correct in the use of condoms,63.8%were male,66.1%were under the age of 40,87.1%had lived locally for more than 2 years,79.2%had a high school education or above,57.1%had a monthly income of less than 3,000 yuan,of which 46(14.6%)were students.378 cases of SNP were cognitively correct in the use of condoms,64.0%were female,59.0%were over the age of 40,92.5%had lived locally for more than 2 years,51.2%had a junior high school education or below,and 71.7%had a monthly income of less than 3,000 yuan.2.AIDS knowledge and HIV-related servicesThe awareness rate of AIDS knowledge in the five high-risk groups of HIV infection with correct cognition of condom use was 87.4%.The awareness rate of AIDS knowledge among MSM,FSW,MCS W,DU,and SNP with correct cognition of condom use was 85.3%,88.4%,90.1%,72.7%,and 98.4%,respectively.The awareness rates of AIDS knowledge among different populations were different(χ2=107.952,P<0.001)。The acceptance rate of HIV-related services in the five high-risk groups of HIV infection with correct cognition of condom use was 81.2%.The acceptance rate of HIV-related services in MSM,FSW,MCSW,DU,and SNP with correct cognition of condom use was 80.5%,88.9%,62.6%,88.7,and 85.1%,respectively.The difference in HIV-related service acceptance rates among the five groups was statistically significant(χ2=108.535,P<0.001).3.Behavioral characteristics,alcohol consumption,sexually transmitted disease history and HIV testingAmong those who were cognitively correct in the use of condoms in the MSM population,63.3%had a homosexual sexual orientation,71.8%had anal sex with the same sex in the past 6 months,67.4%had less than 2 same-sex sexual partners in the past 6 months,and 75.7%had less than 2 times of anal sex in the most recent week.65.6%of them had been drinking less than twice in the past three months,20 persons(5.0%)had suffered from STDs in the past year,and 71.3%had been tested for HIV in the past year.Among those who were cognitively correct in the use of condoms in the FS W population,33.4%were engaged in this work for more than one year,and 66.8%received less than 7 guests per week,41.0%looked for guests in upscale establishments.73.4%of them drank less than twice in the past three months,18 persons(4.9%)were diagnosed with STDs in the past year,and 78.2%had been tested for HIV in the past year.Among the MCSW population with correct cognition of condom use,61.0%had both commercial and non-commercial temporary sexual partners in the past year,62.1%had less than 3 commercial partners in the past year,81.0%had less than 3 non-commercial temporary sexual partners in the past year and 52.3%had spent more than 301 yuan per commercial sexual activity in the past year.64.2%of them drank more than 1-3 times per month in the past year,68 persons(19.7%)were diagnosed with STDs in the past year,and 34.4%had been tested for HIV in the past year.Among those who were cognitively correct in the use of condoms in the DU population,71.4%used new drugs,85.3%used drugs in a non-injecting manner,52.1%had sex after using drugs in the past year,and 35.4%of them had sex with multiple persons after using drugs in the past year.58.0%of them drank less than twice in the past three months,25 persons(8.0%)had suffered from STDs in the past year,and 57.3%had been tested for HIV in the past year.Among those who were cognitively correct in the use of condoms in the SNP population,58.2%had sex with their HIV-infected spouses/partners,of which 48.2%had reduced the frequency of sexual activity,and 50.0%had sex with their spouses/partners in the past year less than 1 time per week.67.1%had not consumed alcohol in the past three months,and 83.7%had been tested for HIV in the past year.4.Analysis of factors influencing separation between knowledge and actionThe proportions of separation between knowledge and action in condom use among MSM,FSW,MCSW,DU,and SNP were 35.3%,50.8%,71.7%,80.5%,and 12.9%,respectively,and the difference was statistically significant(χ2=277.316,P<0.001).Multivariate logistic regression showed that among MSM,people with more than 2 samesex sexual partners in the past 6 months(OR:2.553,95%CI:1.404-4.646),people who currently had fixed sexual partners(OR:5.696,95%CI:3.005-10.800),and people who had heterosexual sex in the past 6 months(OR:6.132,95%CI:2.926-12.850)had a high probability of separation between knowledge and action in condom use.Among FSW,those whose household registration location was from another province or a foreign country(OR:0.098,95%CI:0.036-0.268)and who had received peer education(OR:0.352,95%CI:0.200-0.618)had a low probability of separation between knowledge and action.People with marital status of cohabitation/marriage(OR:3.955,95%CI:1.912-8.180),who had been engaged in this work for more than 1 year(OR:3.413,95%CI:1.753-6.643),and who had consumed alcohol at least once a week in the past three months(OR:4.325,95%CI:1.77210.553)had a high probability of separation between knowledge and action in condom use.Among MCSW,those whose marital status was cohabitation/marriage(OR:2.875,95%CI:1.510-5.474),whose commercial partners in the past year was more than 3(OR:3.169,95%CI:1.536-6.539),who drank alcohol more than once a week in the past year(OR:11.968,95%CI:3.590-39.903),who had been diagnosed with STD in the past year(OR:5.246,95%CI:1.65416.640)had a high probability of separation between knowledge and action in condom use.People who spent an average of more than 301 yuan per commercial sexual activity in the past year(OR:0.149,95%CI:0.036-0.625)had a low probability of separation between knowledge and action in condom use.Among DU,those registered in other cities in the province(OR:0.399,95%CI:0.1790.893)and drank 1 or 2 times in the past three months(OR:0.340,95%CI:0.124-0.933)had a low probability of separation between knowledge and action in condom use.For SNPs,those with the frequency of sex with their spouse/cohabitant in the past year more than once a week(OR:4.092,95%CI:1.313-12.751)had a high probability of separation between knowledge and action in condom use.Females(OR:0.252,95%CI:0.089-0.715),those who had local residence for more than 2 years(OR:0.103,95%CI:0.026-0.409),and those whose spouse/cohabitant took medication for more than 6 months(OR:0.260,95%CI:0.070-0.962)had a low probability of separation between knowledge and action in condom use.Conclusions and recommendations1.Among those who were cognitively correct in the use of condoms in MSM population,the frequency of condom use when they had sex with women was much lower than the frequency of condom use when they had sex with men.Therefore,we should pay more attention to the heterosexual behavior when promoting condom use among MSM.2.Those who were cognitively correct in the use of condoms in FSW and MCSW population were less likely to use condoms when they had sex with their spouse/boyfriend or girlfriend than they used condoms consistently when they had sex with their guest/casual partner.The study also found that the FSW and MCSW who were cohabiting/married were more likely to have separation between knowledge and action in condom use.Therefore,the dissemination and education of AIDS knowledge among FSW and MCSW should emphasize the risk of HIV transmission between partners,focus on improving their awareness of protecting their spouse/boyfriend/girlfriend,so as to increase the frequency of condom use.At the same time,considering that the FSW population is closely related to the MCSW population and most of them have temporary or regular sexual partners other than commercial sexual behavior,twoway interventions should be taken in FSW and MCSW to improve the intervention effect.3.Drinking frequency was related to the separation between knowledge and action in condom use among FSW,MCSW and DU population.Drinking behavior intervention should be combined with AIDS prevention to promote the correct use of condoms and reduce the separation between knowledge and action in condom use.4.Compared with FSW who were cognitively correct in the use of condoms,MCSW in this study were characterized by younger,higher education,higher income and lower mobility.However,this population had a low acceptance rate of HIV-related services and a high ratio of separation between knowledge and action in condom use,which may be a weak link in AIDS prevention and control.Therefore,it is more urgent to explore the publicity and education on AIDS knowledge and disease risk for the MCSW.For this group,AIDS prevention intervention measures can be taken based on hotels,bars,dance halls,clubs and other high-level entertainment venues.5.The proportions of separation between knowledge and action in condom use among five high-risk groups of HIV infection had statistical difference.We should take measures based on the influencing factors of the separation between knowledge and action in condom use among five high-risk groups of HIV infection,combining the demographic and behavioral characteristics of each group,to improve the popularization and pertinence of AIDS knowledge publicity and education and AIDS-related service,and highlight susceptible populations and key populations at risk of HIV infection.Furthermore,the Internet and mobile applications should be utilized to innovate the provision of HIV prevention and control services and promote condom use,so as to reduce the separation between knowledge and action in condom use. |
PDF Full Text Request