以計劃行為理論為基礎探討台灣年輕男性間性行為者藥愛之意圖及相關因素

Abstract

背景：根據台灣疾病管制署近三年 (2016–2019) 愛滋病統計資料顯示：每年皆有1000多位HIV新發個案，約有90% 感染者由不安全性行為所造成，而其中有近90% 為男性間性行為者。此外，在台灣HIV感染者主要以年輕族群為主，其年齡層多落在15–34歲。近年來有研究指出，年輕男同志次文化中，普遍可觀察到在性行為前或性行為中使用精神活性物質，此行為一般稱為「藥愛」。因為藥愛會降低對於風險之評估、用藥後自制力下降、感官加強、性愛時間較為持久，恐增加愛滋傳染之風險，有必要進一步了解藥愛的相關因素，然而，過去使用行為理論來研究藥愛意圖與行為的研究十分有限。 目的：本研究運用計劃行為理論 (theory of planned behavior，TPB)，探討台灣男性間性行為者之藥愛意圖及其相關因素。 方法：本研究依據計劃行為理論以及文獻回顧之結果研擬問卷，透過網路招募年輕 (15-39歲) 男性間性行為者，並使用自填式網路匿名問卷進行資料收集。使用羅吉斯迴歸來分析TPB構念與未來藥愛意圖的關聯性。 結果：共有1,070位研究參與者的資料納入分析。在控制社會人口學變項以及過去藥愛經驗與物質使用經驗後，TPB構念直接測量之正向行為態度和自覺行為控制與相對高藥愛意圖有正相關；間接測量的四個因素與相對高藥愛意圖有關，分別為正向行為結果評價、負向行為結果評價、主觀規範，與有利情境之自覺行為控制。直接測量的主觀規範與間接測量的阻礙情境之自覺行為控制則未與藥愛意圖有關。 討論：計劃行為理論中的構念可能預測台灣年輕男性間性行為者的藥愛意圖，此結果可為減少藥愛行為之健康傳播與促進之介入的參考。 關鍵字：藥愛意圖、計劃行為理論、男性間性行為者、台灣、愛滋防治

Abstract Background: According to the Taiwan Centers for Disease Control AIDS statistics, there were more than 1,000 new HIV cases each year over the past three years (2016–2019) in Taiwan; approximately 90% of infections were caused by unsafe sex, and nearly 90% of infected individuals were men who have sex with men (MSM). In addition, HIV-infected individuals in Taiwan are mainly young people aged 15–34 years. In recent years, studies have indicated that in gay subcultures, there is an increasing trend of using psychoactive substances before or during sex, namely ”Chemsex.' Chemsex would increase the risk of HIV infection by reducing the ability of personal risk assessment and self-control, sensory strengthening, and prolonged sexual intercourse time, indicating a need to better understand factors associated with Chemsex. However, there are few previous studies of the intention and behavoir of Chemsex based on behavioral theories. Objectives: This study applied the theory of planned behavior (TPB) to explore the chemsex intention and associated factors in MSM in Taiwan. Methods: A questionnaire on Chemsex and associated factors was developed based on the theory of planned behavior and previous literature. Young MSM aged 15-39 years were recruited through the Internet, and a self-administered online anonymous questionnaire was used for data collection. Logistic regression was used to investigate the association between TPB constructs and Chemsex intention. Results: Data for 1070 participants were included in the analysis. After adjusting socio-demographic characteristics and past history of Chemsex and substance use, directly measured attitude toward behavior and perceive belief control were associated with Chemsex intention. The following four indirectly measured TPB contructs were associated with Chemsex intention: attitude toward the behavior about positive outcomes, attitude toward the behavior about negative outcomes, subjective norm, and perceived behavioral control under facilitating conditions. Discussion: The constructs of theory of planned behavior may predict Chemsex intention. The finding may inform the design of health communication and promotion interventions to reduce Chemsex. Keywords: Chemsex intention, Theory of Planned Behavior, men who have sex with men (MSM), Taiwan, HIV prevention