| Objectives To investigate the knowledge, self-efficacy, risk sexual behavior among MSM in Luzhou and Yibin and to explore the relationship of MSM in variety peer-groups with HIV infection. Based on survey above, to develop an intervention on HIV-risk sexual behavior targeted MSM, China via peer network and to determine the feasibility and effectiveness of the intervention in reducing risky sexual behavior.Methods A cross-sectional survey was conducted in Yibin and Luzhou,two cities of Sichuan province. Fifteen key MSM who were in good relationship among MSM were chosen as cores to recruit the partners by Limiting the recruited partners in each city, finally 405 MSM (30 groups) were investigated with an questionnaire which contained social characteristics, knowledge about HIV/AIDS, self-efficacy of condom use, high risk sexual behavior with different partners in the last 2 months. Additionally, 5 ml blood specimen of each participants was then all tested for HIV and syphilis antibody. EpiData3.0 software was used to established a data-base. SPSS13.0 was used for statistical analysis.Based on survey above,we chose the MSM who were already recruited in Luzhou as the participants, a total of 219 MSM were recruited to participate in the intervention study by 15 key person of MSM community and the peer group, as an intervention unit, consisted of the key MSM and his peers on his referral chain. The key MSM led his peer-network intervention based on his peer group during intervention of six months. The intervention was composed of four theme interventions including (1) identifying the risk of HIV epidemic in his peer network, (2) Avoiding the risk of acquiring and transmitting HIV by peer-network, (3) The skill of communication effectively in peer education, and (4) Sharing experience in advocating safe sexual behavior via peer network. After intervention, 183 MSM participated in assessment survey and the overall the rate of follow up was 83.56%. We evaluated effectiveness of intervention by comparing the scores of knowledge related HIV/AIDS and self-efficacy of condom use, the numbers of variety of sexual partners and HIV-risk sexual behaviors among participants between pre-and post-intervention.Results The cross-sectional study showed that the prevalence of HIV infection among participants was 7.7%. HIV infection in participants with high school education or below and with College or more were 10.4% and 4.3% respectively and in groups of being married and unmarried were13.5% and 6.3% respectively and in groups of having a job and no job were 9.7% and 3.6%,while the rate of HIV infection in groups of homosexuality,bisexual and the others were 5.3%,13.3%,9.5% respectively, Chi Square Test showed significant differences (P<0.05). The median of?knowledge score related HIV/AIDS and self-efficacy of condom use were 10 and 8. In HIV positive group and HIV negative group,the percentage of participants having risk sexual behavior with female sexual partners in the last intercourse were 25.8% and 10.2% respectively (P<0.05). In the peers directedly and indirectedly related to HIV-positive participants in the recruitment chain, the percentage of having male commercial homosexual partners were 24.8% and 14.5% respectively. The percentages of having risk sexual behavior with female sexual partner last time were 16.8% and 9.5%. The percentage of having risk sexual behavior with male commercial homosexual partners in the last intercourse were 17.8% and 5.6%, all Chi Square Test showed significant differences(P<0.05).Comparing the peer groups with two or more HIV-positive to peer groups with non HIV-positive, the percentage of having female sexual partners were 23.3% and 13.9%. The rates of having male commercial homosexual partners were 25.8% and 13.9%. The percentages of having risk sexual behavior with male commercial homosexual partners in last 2 months were 20.0% and 11.1%. The percentage of having risk sexual behavior with female sexual partner last time were 17.5% and 8.9%; the percentage of having risk sexual behavior with male commercial homosexual partners last time were 15.0% and 6.1%, all Chi Square Test showed significant differences(P<0.05). Comparing the peer groups with three or more HIV-positive to the peer groups with non HIV-positive, the percentage of having female sexual partners were 26.7% and 13.9%. The rates of having male commercial homosexual partners were 31.1% and 13.9%. The percentage of having risk sexual behavior with male commercial homosexual partners in last 2 months were 28.9% and 11.1%;The percentages of having risk sexual behavior with female sexual partner last time were 22.2% and 8.9%. The percentage of having risk sexual behavior with male commercial homosexual partners last time were 24.4% and 6.1%, all Chi Square Test showed significant differences(P<0.05).The intervention study showed that the scores of knowledge related HIV/AIDS and self-efficacy of condom use were higher in post-intervention than in pre-intervention. The numbers of female sexual partners and male commercial sexual partners were decrease in post-intervention comparing with pre-intervention,Wilcoxon paired test suggest they were all significant(P<0.05). The high-risk sexual behaviors of participants with female sexual partners, male commercial sexual partners, male main sexual partners and male occasional sexual partners in last 2 months in post-intervention decreased significantly than in pre-intervention and odds ratio accordingly were 0.167, 0.424, 0.475, 0.533. In the last intercourse, comparing to pre-intervention, the participants also had less high-risk sexual behavior significantly with female sexual partners, male commercial sexual partners, male main sexual partners and male occasional sexual partners in post-intervention and the odds ratio were 0.087, 0.259, 0.188, 0.173 respectively.Conclusions Not only prevalence of HIV infection among MSM is at high level, but also the HIV-risky behaviors among MSM are common and MSM could be bridge of HIV transmission to female.The intervention was designed for HIV-risk behavioral intervention among MSM via peer-network in China. The study showed that the intervention can improve knowledge related HIV/AIDS and self-efficacy of condom use, decrease HIV-risk sexual behavior with variety of partners, and as well as reduce the numbers of female sexual partners and commercial sexual partners. |
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