Study On The Growth Trajectory And Influencing Factors Of Anticipated HIV Stigma Among Men Who Have Sex With Men Based On Trajectory Model

Background:AIDS is a chronic infectious disease with a high mortality rate caused by the human immunodeficiency virus(HIV).The number of reported AIDS deaths in 2021 ranked first in China in all notifiable infectious diseases.Currently,sexual transmission has become the main route of HIV transmission in China,with men who have sex with men(MSM)playing an important role in same-sex sexual transmission and being one of the key populations in controlling AIDS epidemic.China’s AIDS intervention guidelines encourage MSM to receive HIV testing every 3-6 months,but the overall HIV testing rate in China is still suboptimal.Only 56.4%of MSM had been tested for HIV and knew the status of infection in 2019.Studies have shown that HIV-related stigma and discrimination may reduce HIV testing rates and thus hinder the process of ending the AIDS epidemic.Identifying the subgroups of study factor’s trend through trajectory analysis helps to understand the dynamic change process.Therefore,by applying the latent growth curve model(LGCM),latent growth curve model(LCGA)and growth mixture model(GMM)to identify potential categories of anticipated HIV stigma trends among MSM and to explore its influencing factors,we can suggest innovative HIV testing interventions from the perspective of anticipated HIV stigma,so as to promote the development of HIV prevention and control in China.Objectives:To describe the growth trajectories of anticipated HIV stigma among MSM under the online multi-level intervention model,to explore the potential categories of the growth trajectories,and to explore the relationship between different potential categories and HIV testing,so as to evaluate the effect of online multi-level intervention model to promote HIV testing among MSM,and finally put forward innovative opinions and suggestions on HIV testing intervention from the perspective of anticipated HIV stigma.Methods:The participants of 6 cities in Shandong Province were recruited through Blued and Community-based Organizations(CBOs)of MSM,and then followed up for one year.The questionnaire included socio-demographic characteristics,anticipated HIV stigma scale and HIV testing information.Descriptive analysis was conducted on basic information of participants.The LGCM,LCGA and GMM were estimated by linear estimation,second estimation and free estimation to explore the growth trajectories of anticipated HIV stigma,the best fitting model and the number of latent classes.Then the factors affecting the classification of latent categories were explored.The factors influencing the trajectory categories were also explored.Kruskal-Wallis H test was used to compare the difference of items in anticipated HIV stigma scale between the fourth follow-up and the first follow-up in different trajectory categories.Generalized estimation equation was used to compare HIV testing in different follow-up periods.A logistic regression model was used to compare HIV-testing differences between all trajectory categories at the 4th follow-up.Results:1.A total of 304 MSM were included in the study.2.The results of LGCM,LCGA and GMM showed that LCGA of 3 latent classes estimated by free estimation had the smaller AIC,BIC and aBIC,the larger Entropy(0.708)and LMR and BLRT test were all less than 0.05.So,it was the best latent class and the best fitting model.The LCGA model divided MSM into three groups.The high-level-stigma-stable group included 109(35.86%)participants,and the initial anticipated HIV stigma level was the highest in this group.The anticipated HIV stigma level decreased slightly after the first follow-up,and then remained stable.The moderate-level-stigma-slow-decline group included 148(48.68%)participants,and the anticipated HIV stigma in this group was higher at first,decreased slowly after the first follow-up,and then remained stable.The low-level-stigma-rapid-decline group included 47(15.46%)participants.In this group,the initial anticipated HIV stigma level was the lowest,decreased rapidly after the first follow-up,and then slowly decreased to stable.3.Compared with the first follow-up,the scores of "if I am infected with HIV,I will be worried that others will discriminate against me","if I am infected with HIV,no one will fall in love or date with me" and "if I am infected with HIV,no one will want to have sex with me" in the anticipated HIV stigma scale among the moderate-level-stigma-slow-decline group decreased by 2 points at the fourth follow-up(P<0.001),and the degree of decline was higher than the other two groups(all 0 points).The score of "if I am infected with HIV,I will feel inferior" among the high-level-stigma-stable group decreased by 1 point(P<0.005),higher than the 0 point among the low-level-stigma group(P<0.05).The scores of "I will never be ashamed of being infected with HIV" in three groups decreased by 0,0 and 2 points respectively(P<0.001),and there was significant difference with each other(P<0.001).4.MSM with children were more likely to be classified in the moderate-level-stigma-slow-decline group(AOR=4.450,95%CI:1.185-16.704),MSM with high school and below(including technical secondary school)(AOR=4.254,95%CI:1.475-12.271)and college(AOR=5.045,95%CI:1.894-13.433)are more likely to be classified in the low-level-stigma-rapid-decline group.5.After adjusting city,age,household registration,residence time,occupation,marital status,having children,education,income,sexual orientation and disclosure of sexual orientation,HIV testing rate of the second follow-up was lower than the fourth follow-up(AOR=0.709,95%CI:0.530-0.948),and HIV testing rate of the third follow-up was higher than that of the fourth follow-up(AOR=1.451,95%CI:1.074-1.959).6.HIV testing rates in the last follow-up of the moderate-level-stigma-slow-decline group and the low-level-stigma-rapid-decline group were 67.97%(OR=1.776,95%CI:1.018-3.098)and 11.6%(OR=2.510,95%CI:1.098-5.841),which were higher than 54.44%of the high-level-stigma-stable group.Conclusions:1.There exists group heterogeneity in the growth trajectories of anticipated HIV stigma among MSM under the multi-level intervention model.MSM can be divided into high-level-stigma-stable group,moderate-level-stigma-slow-decline group and low-level-stigma-rapid-decline group.2.The influencing factors of potential categories of anticipated HIV stigma were whether they have children and education level.In the future,new measures which are more in line with the social and cultural background of China should be taken against MSM who do not respond obviously to the existing intervention measures.3.At the end of the intervention follow-up,the scores of some items of anticipated HIV stigma scale decreased differently among three categories,which suggests that we need to seek more effective intervention measures for the above non-responsive items and the stable group with less intervention effect,so as to improve the level of anticipated HIV stigma,and achieve more effective HIV prevention.4.The final HIV testing rates of the moderate-level-stigma-slow-decline group and low-level-stigma-rapid-decline group were higher than the high-level-stigma-stable group,and HIV testing rate of the low-level-stigma-rapid-decline group was higher than the moderate-level-stigma-slow-decline group,that is,the higher the anticipated HIV stigma score,the lower the HIV testing rate.