基于人际依赖理论的男男性接触者伴侣艾滋病高危性行为研究

Men who have sex with men (MSM) bear a disproportionate burden of HIV in China and continue to acquire a distressingly high number and proportion of new infections. An estimated major proportion of HIV infections among MSM are acquired from primary sexual partners, suggesting that work with MSM as couples could be an important contributor to prevention. However, few epidemiologic data are available to examine the interdependence contexts of sexual risk among MSM couples in China. This proposed research is to qualitatively and quantitatively identify the collective roles of interdependent factors in relationships and social network factors out of relationships on engagement of sexual risk for HIV among MSM couples. The objective will be addressed through a range of qualitative methods and a community-based survey targeting same-sex male couples, aimed to quantify the interdependent factors based on the Interdependence Theory as well as social network components. Finally, the central hypothesis of the direct actor/partner effects of interdependent factors and the mediation actor/partner effects of social network factors on risk behaviors will be quantitatively tested using Actor-partner interdependence model (APIM). The expected finding will have an important positive impact on adapting MSM couples to the current couple-based biomedical interventions, and will also provide thoughts on developing effective and tailored intervention for MSM couples at risk for HIV in China.

目前我国艾滋病通过男男性行为传播的比例上升明显，而男性固定性伴侣是男男性接触者（men who have sex with men, MSM）感染艾滋病的主要传播来源之一。了解MSM成对伴侣的高危性行为特征及其影响因素，对预防和控制艾滋病在MSM人群中传播有至关重要的作用。本研究拟采用定性和定量研究相结合的方法，调查MSM伴侣双方，了解MSM成对伴侣的艾滋病感染状况和高危性行为特征；运用人际依赖理论阐明伴侣间依赖模式的因素（依赖水平、依赖方式、有效沟通等）；同时，分析伴侣外社会网络的因素；最后，综合以上因素，应用基于成对数据的主客体互依模型，构建MSM成对伴侣的高危性行为风险预测模型，找出其高危性行为的主要影响因素和干预路径。本研究目标的实现将为针对MSM伴侣的生物预防干预和行为干预研究奠定基础，为基于MSM伴侣模式的艾滋病防治措施的制定提供科学依据。

目前我国艾滋病通过男男性行为传播的比例上升明显，而男性固定性伴侣是男男性接触者（men who have sex with men, MSM）感染艾滋病的主要传播来源之一。了解MSM成对伴侣的高危性行为特征及其影响因素，对预防和控制艾滋病在MSM人群中传播有至关重要的作用。研究采用了定性和定量研究相结合的方法，调查MSM伴侣双方，了解MSM成对伴侣的艾滋病感染状况和高危性行为特征；运用人际依赖理论阐明伴侣间依赖模式的因素（依赖水平、依赖方式、有效沟通等）；同时，分析伴侣外社会网络的因素；综合以上因素，应用基于成对数据的主客体互依模型，构建了MSM成对伴侣的高危性行为风险预测模型。研究发现MSM成对伴侣中有着较高的HIV和梅毒感染率，且HIV相关的高危性行为高发。伴侣关系特征和各自的社会网络对HIV感染及高危性行为有影响，而且这种影响在不同的性角色不同。正向的社会规范(坚持使用安全套)与MSM的高危性行为负向相关，负向的社会规范与MSM的高危性行为正向相关。因此，在基于成对MSM伴侣的HIV干预措施中，有必要将干预重点放在具有特定关系特征和社会网络特征的特定性角色的MSM上。