男男性行为者艾滋病暴露前预防用药性行为去抑制化情况  

Sexual risk compensation in HIV pre-exposure prophylaxis clinical trial among men who have sex with men

作　　者：李洮庭 付春静[1] 钟晓妮[1] 彭斌[1] 张燕[1] 叶孟良[1] 孔翠娥 曾馨[1] 荆少华 幸箐筠 林倚伊 黄爱龙[2] 

机构地区：[1]重庆医科大学公共卫生与管理学院卫生统计与信息管理教研室,重庆400016 [2]重庆医科大学感染性疾病分子生物学教育部重点实验室,重庆400016

出　　处：《重庆医科大学学报》2015年第6期828-833,共6页Journal of Chongqing Medical University

基　　金：国家科技重大专项资助项目(编号:2012ZX10001-007)

摘　　要：目的:了解男男性行为者(men who have sex with men,MSM)在参加暴露前预防用药(pre-exposure prophylaxis,Pr EP)临床试验中是否存在性行为去抑制化现象及其影响因素。方法:采用非概率抽样法招募并筛选出108名MSM,随机分为77名服用药物组和31名空白对照组,第12、24、36、48周进行临床随访和问卷调查,问卷调查主要包括社会人口学特征,艾滋病相关知识、态度和行为等相关情况。采用单因素和多因素的广义估计方程分析MSM在参与Pr EP中是否存在性行为去抑制化现象及其影响因素。结果:药物服用组MSM在参与Pr EP的第12、24、36、48周的性伴个数中位数分别为1(0,6)、1(0,6)、1(0,10)、1(0,3)、1(0,3),高危性行为次数中位数分别为1(0,26)、1.5(0,8)、1(0,12)、1(0,9)、2(0,30);空白对照组性伴个数中位数分别为1(0,21)、1(0,2)、1(0,3)、1(0,3)、1(0,3),高危性行为次数中位数分别为1(0,9)、1(0,6)、0.5(0,15)、0(0,10)、1(0,10);多因素广义估计方程分析发现MSM在参与Pr EP过程中性伴个数及高危性行为次数均没有发生改变(Z=-0.24,P=0.811;Z=0.93,P=0.355),性行为方式为"1"和"0.5"的较性行为方式为"0"的拥有更多的性伴(Z=2.47,P=0.014;Z=2.24,P=0.025);发生过商业性行为的MSM较没有发生过的拥有较少的性伴和高危性行为(Z=-2.82,P=0.005;Z=-2.28,P=0.023);已婚较离异MSM发生较少的高危性行为次数(Z=-2.34,P=0.019)。结论:本研究中暂未发现Pr EP中存在性行为去抑制化现象,性行为方式为"1"和"0.5"的MSM拥有较多性伴,是后期随访中的重点管理人群。还需进一步加强对艾滋病相关知识的科普。Objective：To explore whether exist sexual risk compensation in the HIV pre-exposure prophylaxis clinical trial among men who have sex with men（MSM）. Methods：Totally 108 MSM were recruited with non-probability sampling method,and randomly divided into treatment group（n=77）and blank control group（n=31）. Clinical follow-up and questionnaire were carried at 12 th,24th,36 th,48th week;the socio-demographic characteristics and the HIV/AIDS-related knowledge and behavior were collected according to the questionnaire. Univariate and multivariate generalized estimating equations were used to analyze the sexual risk compensation in the Pr EP and the associated factors. Results：During MSM participated in the Pr EP clinical trial,the median number of sexual partners of the treatment group at the 12 th,24th,36 th,48th week was 1（0,6）,1（0,6）,1（0,10）,1（0,3）,1（0,3）,respectively,and the median number of high-risk sexual behavior was 1（0,26）,1.5（0,8）,1（0,12）,1（0,9）,2（0,30）,respectively. On the other hand,the median number of sexual partners of blank control group was 1（0,21）,1（0,2）,1（0,3）,1（0,3）,1（0,3）,respectively,and the median number of high-risk sexual behavior was 1（0,9）,1（0,6）,0.5（0,15）,0（0,10）,1（0,10）,respectively. Multiariable analysis found that the number of the sexual partners and the number of highrisk sexual behavior were not changed in the Pr EP trial（Z=-0.24,P=0.811;Z=0.28,P=0.779）;＂1＂and ＂0.5＂style sexual behavior MSM had more sex partners compared with that of ＂0＂type MSM（Z=2.47,P=0.014;Z=2.24,P=0.025）. MSM who ever had a commercial sexual behavior had fewer sexual partner and fewer high-risk sexual behavior（Z=2.82,P=0.005;Z=2.28,P=0.023）. Conclusion：There is no evidence of the sexual risk compensation in the Pr EP clinical trial among MSM. ＂1＂style and ＂0.5＂style MSM seem to have more sexual partners,who may be the important population during the late follow-up management. We need to

关 键 词：男男性行为者 艾滋病 暴露前预防用药 性行为去抑制化 

分 类 号：R186.4[医药卫生—流行病学]