Analysis On HIV High-risk Sexual Behaviors And Related Factors Among Male Students Who Have Sex With Men In Qingdao

Background and Objective: Men who have sex with men(MSM)are at high risk of human immunodeficiency virus(HIV)infection,preventing the spread of HIV in this group has become a global challenge.In the past few years,HIV infection cases increased significantly in the young students in our country,which has caused wide social concern and become a new feature of acquired immune deficiency syndrome(AIDS)in our country.In the undergraduates infected with HIV,more than 80% were infected through male sex,which has become the main path of HIV spread and infection among the young students.Therefore,as a special subgroup of MSM,male students who have sex with men have become the key population in the AIDS control in our country.Having unprotected anal intercourse(UAI)with male is considered to be the primary high-risk sexual behavior of MSM that spreads HIV in our country,and having multiple sexual partners can increase the speed and possibility of sexual transmission of HIV and is considered to be an important one.Research showed that high HIV infection rate developed along with high incidence of high-risk sexual behaviors in the MSM among the college students.In consideration of the age characteristic of the male students who have sex with men and the rapid spread of HIV among them,we seriously need to discuss the risk factors associated with the high-risk sexual behaviors in this special population.So we carried out this research among male students who have sex with men in Qingdao city,to describe the current situation of UAI and multiple sexual partners of the male students who have sex with men,to study their characteristics related with social demography,sexual behaviors,substance use,HIV prevention service and self-esteem,to explore the factors that may affect the development of HIV high-risk sexual behaviors.On this basis,we can better know the present situation of this young group,provide reference to targeted publicity,education and behavior intervention in future HIV prevention,and then,prevent the further spread of HIV in the college efficiently.Methods: From May 2021 to April 2022,we recruited male students who have sex with men in Qingdao city,and collected their information on social-demographic,sexual behaviors,substance use in the past 6 months(P6M),HIV prevention service and selfesteem.The plan was carried out through convenience sampling and snowball sampling,and in the way of anonymous electronic questionnaire.We got help from Qingdao Center for Disease Control and Prevention and Qingtong Anti-AIDS Volunteer Service Center,a local MSM social organization.SPSS22.0 and Stata15.0 software were used to conduct statistical analysis.Chi-square tests were used to compare the differences between male students who have sex with men with UAI and multiple sexual partners to those without,univariate and multivariate Log-binomial regression models were conducted to value the influencing factors of UAI and multiple sexual partners of male students who have sex with men.The decision tree models based on CART were built up to rank the influencing factors according to their importance.Results: In this research,we recruited 350 students MSM,got 341 valid response questionnaire copies with a valid rate of 97.4%.The age of participants ranged from 15 to30 years old,the median age was 22 years old(inter-quartile range: 20-23 years old),most of them were 20-25 years old,accounting for 75.7%,48.4% of them domiciled in Qingdao city,30.2% in other cities of Shandong province,and 21.4% in other places out of Shandong province.51.3% of them had lived in Qingdao for more than 3 years,82.4% were unmarried and lived alone,6.7% had an educational background of senior high school or specialized secondary school,38.7% junior college,48.1% college and 6.5% graduate.83.0% of them were homosexual,11.7% were bisexual and 5.3% were heterosexual or uncertain.29.6%of them had the first anal intercourse when they were under age,26.1% had it with a nonstudent mate,19.6% had it without a condom.3.5% of the participants had commercial sexual behavior in the P6 M,29.6% had 10 or more years older sexual partners.18.8% drank before sex,39.6% used recreational drugs in the P6 M,83.6% had used HIV self-testing kits before,95.0% had received outside HIV testing.27.0% received peer education in the past year,3.5% were diagnosed with HIV infection in the past year,42.8% had a low self-esteem level.The prevalence of UAI in the P6 M among the participants was 40.5%,and the prevalence of multiple sexual partners in the P6 M was 62.2%.According to the results of Chi-square tests,participants who had the first anal intercourse under 18 years old,had it without a condom,drank before sex,used recreational drugs,did not receive peer education in the past year and had a low self-esteem level had higher incidence rate of UAI in the P6M(P<0.05).The participants who had the first anal intercourse under 18 years old,had it with a student-mate,had sexual partners 10 or more years older,used recreational drugs and HIV self-testing kits had higher incidence rate of multiple sexual partners in the P6M(P<0.05).Univariate Log-binomial regression model showed that student MSM who had the first anal intercourse under 18 years old,had it without a condom,drank before sex in the P6 M,took recreational drugs in the P6 M and had a low self-esteem level had higher incidence rate of UAI in the P6M(P<0.05).The student MSM who were not sure whether their parents were aware of their sexual orientation and never used HIV self-testing kits had lower incidence of multiple sexual partners in the P6M(P<0.05),the student MSM who had the first anal intercourse under 18 years old,had sexual partners 10 or more years older than them,drank before sex in the P6 M and used recreational drugs had higher incidence of multiple sexual partners in the P6M(P<0.05).Multivariate Log-binomial regression model showed that the use of condom in the first anal intercourse,drinking before sex in the P6 M and self-esteem level were associated with UAI among male students who have sex with men in the P6 M.Student MSM who did not use condom during the first anal intercourse had a 1.753(95%CI: 1.356-2.250)times higher risk of UAI in the P6 M than those used condom during the first anal intercourse,student MSM who drank before sex in the P6 M had a 1.286(95%CI: 1.017-1.647)times higher risk of UAI in the P6 M than those did not drink,student MSM who had low selfesteem level had a 1.345(95%CI: 1.081-1.692)times higher risk of UAI in the P6 M than those had high self-esteem level.The age of the first anal intercourse and the use of recreational drugs in the P6 M were found to be associated with multiple sexual partners among male students who have sex with men in the P6 M.Student MSM who had the first anal intercourse under the age of 18 years had a 1.159(95%CI: 1.016-1.346)times higher risk of multiple sexual partners in the P6 M than those had the first anal intercourse when their age were not less than 18 years,student MSM who took recreational drugs in the P6 M had a 1.454(95%CI: 1.241-1.720)times higher risk of multiple sexual partners in the P6 M than those did not take.The decision tree model ranked the influencing factors of UAI among male students who have sex with men in the P6 M.Listed in descend order by importance,these factors were,the use of condom in the first anal intercourse,drinking before sex in the P6 M,selfesteem level,the age of the first anal intercourse and the use of recreational drugs in the P6 M.The most important factor was the use of condom in the first anal intercourse.The influencing factors of multiple sexual partners among male students who have sex with men in the P6 M were also ranked,listed in descend order by importance,they were the use of recreational drugs in the P6 M,the age of the first anal intercourse,having sexual partners10 or more years older,awareness of sexual orientation by parents,the use of HIV selftesting kits and drinking before sex in the P6 M.The most important factor was the use of recreational drugs.Conclusion: The incidence of HIV high-risk sexual behaviors(UAI and multiple sexual partners)in the P6 M among male students who have sex with men in Qingdao was high.Faced with the high risk of HIV infection and spread,we must pay great attention to this public health issue.To male students who have sex with men that had the first anal intercourse without condom,drank before sex and had low self-esteem level,the incidence of UAI will increase.To male students who have sex with men that had the first anal intercourse under age and used recreational drugs,the incidence of multiple sexual partners will increase.For this reason,targeted prevention and intervention measures should be carried out,such as developing early sex education,promoting safe sex,implementing screening and control of alcohol use,issuing warnings about the harm of recreational drugs.At the same time,we should also pay close attention to the mental health situation of male students who have sex with men,build up a friendly and inclusive environment for them to reduce the occurrence of unhealthy social psychological problems,lower the incidence of high-risk sexual behaviors in this special young population,thus efficiently contain the spread of AIDS in the campus.