| BackgroundAs a chronic infectious disease,AIDS is mainly transmitted by sexual means Among them,the proportion of homosexual transmission is increasing.In the long-term follow-up of the patients,some heterosexual male cases were found to be homosexual.As a result of external discrimination and their own physical conditions and long-term medication and other factors,AIDS patients have different degrees of depression and anxiety.The purpose of this study was to review self-reported heterosexual cases and to identify the real infection situation.Based on the people who were surveyed,the psychological influencing factors of male HIV/AIDS patients in Shandong province were explored.Objective1.To understand the true proportion of heterosexual and homosexual transmission among male patients who had self-reported heterosexual infection,and to provide a basis for the formulation,adjustment of policies and financial investment on AIDS epidemic in Shandong province;2.To understand the depression and anxiety level of HIV/AIDS patients,and analyze the influencing factors,providing the basis for patients individualized psychological counseling3.To understand the social demography,behavioral characteristics,infection status and knowledge of AIDS in the heterosexual infection group,the homosexual infection group and the self-reported homosexual infection group after the review of reorted heterosexual infection,so as to provide clues and basis for AIDS prevention and treatment intervention.MethodsFrom September to December 2019,four cities including Jinan,Qingdao,Weifang and Linyi were selected as survey sites to recruit research subjects through a cross-sectional survey.According to the different ways of self-reported infection,it was divided into two groups:self-reported heterosexual infection group and self-reported homosexual infection group.The self-reported heterosexual infection group was re-checked through interviews and divided into the actual heterosexual infection group and the compound actual homosexual infection group.The three groups were compared.The questionnaires included general demographic characteristics,AIDS knowledge,sexual behavior characteristics before and after HIV infection,and condition information.Psychological investigation includes depression and anxiety and the psychological scale includes fluid-modulated depression scale and anxiety self-rating scale.Epidata was used to establish a database for epidemiological data,and data entry was performed.SPSS24.0 software was used for statistical analysis of the data,and characteristic differences among different groups of people were analyzed.The single factors detected in depression and anxiety ofthe study subjects were tested by ?2 test.Factors with P<0.05 were included in multivariate logistic regression analysis.Results1.Review of male cases of self-reported heterosexualinfectionIn this survey,a total of 373 male HIV cases were reported from heterosexual infection,among which 148 cases were actually homosexual infection after review,accounting for 39.7%(148/373).There were 225 cases of heterosexual infection,accounting for 60.3%(225/373).The review rates of Jinan,Qingdao,Weifang and Linyi were 61.1%(33/54),35.7%(61/171),48.2%(27/56)and 29.3%(27/92),respectively.A total of 147 cases of self-reported homosexual infection were survryed.There were 39 cases in Jinan,63 in Qingdao,28 in Weifang and 17 in Linyi,accounting for 26.5%,42.9%,19.0%and 11.6%respectively.2.Basicinformation of the research objectThe subjects were between 19 and 89 years old,with an average age of 40.25 years old.The age group between 26 and 35 years old accounted for the highest proportion of 33.3%(173/520).Among them,the heterosexual group,the post-review homosexual group and the self-reported homosexual group all accounted for the highest proportion of 26-35 years old(32.0%,33.8%and 34.7%),while the proportion of>55 years old was 15.1%,10.1%and 4.8%,respectively(?2=15.601,P=0.048).Marital status is given priority to with in marriage/cohabitation is 49.7%,unmarried accounted for 33.1%(170/513),divorced or widowed accounted for 17.2%(88/513),with the heterosexualgroup is given priority to with in marriage/cohabitation,accounted for 65.3%,unmarried accounted for 20.3%,gay groups after review in the marriage/live together accounted for 42.5%,unmarried accounted for 37.0%,the self-reported homosexual group marriage is given priority to with unmarried,49.0%,33.1%in marriage/cohabitation,the difference was statistically significant(?2=45.171,P<0.001);The registered permanent residence is mainly in this province,accounting for 86.2%;In the heterosexual group,Jinan accounted for 9.3%,Qingdao(48.9%),Weifang(12.9%),Linyi accounted for 28.9%.In thegay group after review,Jinan accounted for 22.3%,Qingdao(41.2%),Weifang(18.2%),Linyi accounted for 18.2%.In the self-reported homosexual group,Jinan accounted for 26.5%,Qingdao(42.9%),Weifang(19.0%),Linyi accounted for 11.6%,the difference was statistically significant(?2=34.439,P<0.001);The proportion of college education or above was 39.1%(198/506),and the primary education was 6.7%(34/506).Among them,the proportion of the heterosexual group with primary school or below is 11.3%,and the proportion with college degree or above is 32.4%.In the homosexual group after review,5.4%hadprimary schoolor below,42.6%had college education or above.In the self-reported homosexual group,1.4%hadprimary schoolor below,45.5%had college education or above,the difference was statistically significant(?2=18.823,P=0.004).65.4%had permanent jobs;Monthly income with 3000?5000 yuan accounted for the highest proportion.Before HIV positive diagnosis,28.7%had been tested,20.7%had been tested in the heterosexual group,28.0%had been tested in the homosexual group after review,and 42.3%had been tested in the self-reported homosexual group(?2=19.398,P<0.001).77.3%felt in good physical condition.The AIDS knowledge awareness rate was 80.7%.The heterosexual group was72.9%,the homosexual group after review 80.4%,and 90.4%in the self-reported homosexual group,the difference was statistically significant(?2=12.395,P=0.002).In terms of the first epidemiological survey,37.2%of patients in the heterosexual group were in the hospital,62.8%in the CDC.35.6%of homosexual groupafter review wasin the hospital,64.4%in the CDC.12.3%of the self-reported homosexual group wasin the hospital,87.7%in the CDC,the difference was statistically significant(?2=14.258,P=0.001).The overall detection rate of depression was 47.0%in the study subjects,among which 48.9%in the heterosexual group,55.8%in the homosexual group after review and 35.4%in the self-reported homosexual group,the differences were statistically significant(?2=12.850,P=0.002).The rate of anxiety was 25.1%,three groups were 24.4%,31.5%and 19.7%,respectively,with no significant difference(?2=5.496,P=0.064).3.Behavioral characteristics of the study subjectsBefore HIV infection,55%of heterosexual group,9.6%of homosexual group after review and 2.1%of self-reported homosexual group had commercial heterosexual sex.0%of heterosexual group,1.4%of homosexual group after review,2.1%of self-reported homosexual group had commercial homosexual sex(?2=171.985,P<0.001).Non-marital non-commercial heterosexual sex accounted for 37.6%in the heterosexual group,11.0%in the homosexual group after review,and 14.5%in the self-reported homosexual group(?2=43.700,P<0.001).The number of homosexual partners>2 in the homosexual group after review accounted for 59.9%,the number of homosexual partners>2 in the self-reported homosexual group accounted for 43.9%(?2=6.822,P=0.009).In the homosexual group after review,9.4%of the patients' first homosexual sex were aged less than 18 years,60.1%were aged between 19 and 30 years,30.4%were aged more than 30 years.6.9%were aged less than 18 years,79.4%were aged between 19 and 30 years,and 13.7%were aged more than 30 years in the homosexual group.The differences were statistically significant(?2=12.512,P=0.002).After HIV infection,heterosexual group,after the review of gay group and the report gay group only with heterosexual sex ratio was 49.3%,17.1%and 7.5%respectively.Only gay sex ratio was 0.9%,30.8%and 44.5%respectively.heterosexual and homosexual sex ratio accounted for 1.8%,8.9%and 3.4%.The differences were statistically significant(?2=157.582,P<0.001).4.HIV infection information and AIDS awareness68.3%(352/515)of the subjects informed infection to others.Among them,74.4%of the heterosexual group,70.5%of the homosexual group after review and 56.8%of the self-reported homosexual group reported their illness to others,the difference was statistically significant(?2=13.075,P=0.001).30.8%of subjects who didnot know anything about AIDS,knowing HIV/AIDS,but don't know their behavior would be infected with the AIDS virus was 37.0%,knowing that their behavior would be infected with HIV,but for a stroke of luck accounted for 25.9%,believing their actions do not be infected with the AIDS virus was 6.2%,statistically significant difference between different groups(?2=63.248,P<0.001).5.Analysis of mental health factors of depression and anxietyThe depression level of divorced/widowed(OR=0.472,95%CI:0.247-0.901)was lower than that of unmarried.Compared with Jinan Weifang(OR=2.102,95%CI:1.118-3.951)and Linyi(OR=2.341,95%CI:1.281-4.277)had higher depression detection rates.Unemployment/retirement(OR=1.966,95%CI:1.081-3.575)was associated with a higher rate of depression than permanent employment(OR=1.966,95%CI:1.081-3.575).Compared with Jinan,Weifang(OR=4.531,95%CI:1.514-13.558)had a high rate of anxiety detection.Compared with those who knew nothing about AIDS,those who knew about AIDS but did not know their behaviors would infect AIDS(OR=0.277,95%CI:0.115-0.0.665)and those who knew their behaviors would infect AIDS but had fluke(OR=0.375,95%CI:0.144-0.976)had lower detection rates of anxiety.Compared with being in good physical condition,being general(OR=4.066,95%CI:1.773-9.328),anxiety was detected higher.In the homosexual group after review,the depression detection rate was higher with jobs but not fixed(OR=6.658,95%CI:1.246-35.572)than with fixed jobs.The preoperatie/blood donation detection(OR=11.054,95%CI:1.127-108.450)was associated with a higher detection rate of depression than those who went to a medical institution after high-risk behaviors.Compared with those without knowledge of AIDS,those with knowledge of AIDS(OR=0.179,95%CI:0.034-0.953)had a lower detection rate of anxiety.Condoms were used every time,compared with a decrease in the number of sexual encounters,and the detection rate of anxiety was lower than that of unaltered anxiety before infection.Conclusion1.The ratio of sexual transmission of AIDS epidemic in Shandong province is obviously deviated from the actual situation,and the ratio of homosexual transmission is actually higher.Therefore,it is necessary to improve the quality of follow-up and reduce the error in the investigation and determination of the epidemic;2.The research subjects not only lack AIDS knowledge,but also have the phenomenon of "separation between knowledge and action",and the fluke mentality is serious.Itneeds to take corresponding preventive measures;3.There are high-risk behaviors such as multiple partners and intersex before and after infection.The proportion of accidental behavior was higher in reported heterosexual infected persons.Continuous follow-up intervention should be conducted to reduce transmission:4.AIDS patients have a low level of information about their spouse or sexual partner,so they should strengthen the mobilization work of spouse or sexual partner information and detection,and explore effective means to promote spouse or sexual partner detection;5.Male HIV patients in Shandong province have severe symptoms of depression and anxiety,the self-reported heterosexual approach was actually homosexual more than the other two groups,which need to be paid attention to.It is suggested to carry out psychological counseling and mental health education regularly. |
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