| ObjectiveTo describe the current situation of civil society organizations conducting health management with MSM populations and analyze the changes in the risk of the MSM population during the health management and analyze the factors affecting the HIV infection in MSM population and the rate of new HIV infections managed by civil society organizations in 17 municipalities of 6 provinces.MethodsCross-sectional study:The first part of the questionnaire was used to select civil society organizations that conducted MSM population health interventions in Shijiazhuang,Qingdao,Jinan,Xuzhou,Zhenjiang,Wuxi,Ningbo,Jiaxing,Xiamen,Zhuhai,Baoding,Kunshan,Yancheng,Changzhou,Jinhua,Fuzhou and Foshan.The questionnaire consisted of two parts,one was for information about the organization,which was filled out by the head of the organization,mainly including basic information about the organization,financial information,work situation and external support,as well as the problems that the head of the organization thought existed at present and suggestions for better participation of the organization in the future.The other part is the information of core members of civil society organization,which is filled in by full-time and part-time staff of civil society organization.Since the definition of part-time staff is not consistent among civil society organization,the definition of part-time staff is unified,and full-time staff of civil society organization are defined as those who have specific work in the society and are only involved in HIV prevention and treatment as a sideline.They are responsible for fixed work in the civil society organization,obey the management of the social organization and are paid by the civil society organization for their labor.The main content includes the sociodemographic information of the core members,their work information and participation in training.The overall situation of the civil society organization and the core members were described,and a chi-square test was used to compare the financial situation and work situation of the civil society organization over the past three years.Cohort study:A cohort study design was used to select MSM populations who were tested at the civil society organization from February 2019 to June 2021 and met the inclusion criteria to be included in the study,and only MSM populations who were repeatedly tested at the civil society organization were included in the cohort,and personal sociodemographic information and sexual behavior information were collected from MSM each time they were tested for HIV infection,and the number of times collected was equal to the number of times they were repeatedly tested during the observation time,risk scores were used to demonstrate the risk status of the MSM population during observation,logistic regression model was used to explore the factors influencing the risk of HIV infection in MSM population managed by civil society organization,and Cox regression model was used to analyze the factors influencing the risk of new HIV infections in MSM population managed by civil society organization.ResultsPart Ⅰ:A total of 20 civil society organizations involved in HIV prevention and treatment for MSM in 17 cities in 6 provinces were surveyed,of which 14(70%)civil society organizations have been registered with the industry and commerce or civil affairs departments.2019-2021,the average annual application funding for civil society organizations increased year by year,respectively,to RMB 282,936.85,RMB 337,412.55 and RMB 407,403.15,and the average annual number of testing visits were 2164,2576 and 3066 respectively.The average annual number of people tested was 2164,2576 and3066,and the proportion of online appointment testing increased year by year(p<0.001),and by 2021,online appointment testing already accounted for 58.8% of the total number of tests,while the initial screening positive rate decreased year by year,from 3.13% in2019 to 2.22% in 2021(p<0.001).The problems faced by social organization leaders are mainly related to lack of funding,lack of core staff capacity,and the current unhealthy competition encountered in institutional development.Part Ⅱ:Study subjects with repeat HIV testing appointments at civil society organizations were included in the cohort,which included a total of 6749 study subjects with a mean age of 30.71 9.83 years,including 207 positive conversions,a total observation time of5658.09 person-years,and an incidence density of 3.66/100 person-years.There were differences between the positively transferred and negative subjects in education level,sexual orientation,whether there was a male HIV-positive partner,whether condom was used during sex,sexual role in sex life,whether there was commercial sex,whether there was a diagnosis of STD or symptoms of STD infection,whether addictive substances were used when sex occurred,whether there was drunken sex,number of sexual partners,time segment of infection and HIV testing,and the differences were statistically significant(P<0.05).The results of multivariate Cox regression analysis showed that years of education 9(HR=1.98,95% CI:1.3-3.02),unknown sexual partner’s infection status(HR=1.88,95% CI:1.38-2.56)and not first tested in the current year(HR=1.62,95%CI:1.15-2.28)were a risk factor for new HIV infection in MSM population,while age 35-44 years(HR=0.63,95%CI:0.41-0.98),sex role only 1(HR=0.34,95%CI:0.22-0.51)and0,1 both(HR=0.61,95%CI:0.44-0.86)have a low risk of new HIV infection in MSM.Part Ⅲ:A total of 6,749 study subjects were enrolled in the study and their risk of HIV infection was assessed at the time of inclusion in the study cohort and at each subsequent HIV test.The t-test for baseline and endline risk scores showed that:risk scores for the number of men who had anal and oral sex decreased from 1.72 at baseline to 1.67 at end.risk scores for the presence of positive sexual partners decreased from1.6 at baseline to 1.53 at end.risk scores for the presence of male-to-male group sex decreased from 1.14 at baseline to 1.12 at end.risk scores for the presence of same-sex commercial sex decreased from 1.27 at baseline to 1.24 at end.The overall risk score also decreased from 11.5 at baseline to 11.3 at the end of the study,and the differences were statistically significant(P<0.05).ConclutionsCivil society organizations in China have taken shape and are better able to complete HIV prevention and control work and meet the demand for prevention and treatment.They have played a significant role in health interventions for the MSM population,and the implemented health management measures can effectively reduce the risk of HIV infection in MSM. |
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