運用健康信念模式探討台灣年輕男性間性行為者至衛生所進行愛滋匿名篩檢之意圖

Abstract

背景：自1981在LA發現第一位HIV感染者至今已達39年，全球感染人數仍持續上升。近年來，台灣積極推廣愛滋匿名篩檢政策，但在新通報的男男間性行為者 (MSM) 僅有 42% 自述曾接受過篩檢，可見MSM 的篩檢率仍有提升空間。2005年起各縣市衛生局所開始免費HIV篩檢，儘管衛生所的護理人員可深入社區營造健康環境，提供台灣年輕男性間性行為者之健康促進服務，仍有許多不利台灣年輕男性間性行為者至衛生所進行愛滋匿名篩檢之障礙，惟缺乏相關實證研究，因此，有必要針對MSM對於至衛生所接受愛滋匿名篩檢之一項進行了解，以作為未來衛生所在推廣愛滋匿名篩檢政策之實證參考依據。 目的：以健康信念模式為基礎，透過量性問卷調查，探討臺灣年輕男性間性行為者至衛生所進行愛滋匿名篩檢之相關信念因素，首先了解MSM過去之愛滋匿名篩檢之相關健康信念，其次以過去愛滋篩檢經驗分層分析，了解不同愛滋篩檢經驗者未來至衛生所篩檢意圖及其相關之健康信念。 方法：本研究將依據文獻回顧之結果，以自擬之量性問卷作為研究工具，採取網路匿名自填形式，於 2020 年 3 月至5 月間採立意取樣之方式透過相關網路平台分享或轉發問卷連結進行招募，共計 1,156 位研究參與者納入最終統計分析。問卷依據 HBM 五大構念(自覺罹患性、自覺嚴重度、自覺利益、自覺障礙及行動線索)設計而成，透過探索性因素分析萃取出五個潛在因素，並先以過去 HIV 篩檢經驗為依變項，運用多變項之多類別羅吉斯迴歸(Multi-nominal Logistic Regression)進行分析，再以過去 HIV 篩檢經驗為分層依據，以多變項羅吉斯迴歸 (logistic regression analysis)，進一步探討影響臺灣年輕男性間性行為者主動至衛生所進行愛滋匿名篩檢之相關因子。 結果：(1)過去篩檢經驗與未來至衛生所篩檢意圖有顯著相關，有衛生所篩檢經驗者，未來至衛生所篩檢意圖越高。(2)自覺罹患性、自覺嚴重度、自覺情境障礙、自覺污名障礙以及行動線索分別與過去篩檢經驗有顯著相關；而自覺利益則與過去篩檢經驗無關。(3)依篩檢經驗分層後，與過去篩檢意圖相關之健康信念分別如下：(i)對無篩檢經驗者而言，自覺利益相對中度和相對高度之高篩檢意圖分別為相對低度的3.54倍 (AOR=3.54 ) 和6.62倍 (AOR=6.62)；自覺污名障礙相對中度與相對高度之高篩檢意圖則是較相對低度分別降低68 % (AOR=0.32)和68% (AOR=0.32)。(ii)對有衛生所篩檢經驗者而言，自覺罹患性相對中度之高篩檢意圖為相對低度的3.49倍 (AOR=3.49)；自覺利益相對中度和相對高度之高篩檢意圖分別為相對低度的2.77倍 (AOR=2.77 ) 和5.22倍 (AOR=5.22)；外在途徑相對高度之高篩檢意圖為相對低度的4.04倍 (AOR=4.04)。(iii)對有其他篩檢經驗者而言，自覺利益相對中度和相對高度之高篩檢意圖分別為相對低度的2.39倍 (AOR=2.39) 和6.3倍 (AOR=6.3)；自覺情境障礙相對高度之高篩檢意圖則是較相對低度降低41 % (AOR=0.59)；外在對象相對高度之高篩檢意圖為相對低度的1.95倍 (AOR=1.95) ；有得過性病者之高篩檢意圖為沒得過者的2.5倍 (AOR=2.5) 結論：本研究運用 HBM 為架構，發現發現自覺利益雖與過去之愛滋匿名篩檢經驗無關，卻是影響未來至衛生所篩檢意圖的重要健康信念。因此，未來可加強宣導至衛生所進行HIV 匿名篩檢之益處，發展可提高MSM對於到衛生所匿名篩檢之自覺利益的衛教介入計畫，進而提升至衛生所進行 HIV 篩檢意圖，順利達成「90-90-90」之目標。

Background: The first HIV infection was found in LA in 1981, and the HIV case continues to rise in the world. In recent years, Taiwan has actively promoted the AIDS anonymous testing policy, but only 42% of new case who have sex with men (MSM) report that they have been screened, which shows that there is still room for improvement in the testing rate of MSM. Since 2005, the public health center have offered the free HIV testing in Taiwan. Although the nurses can go to the community to create a healthy environment and provide health promotion services for young Taiwanese men who have sex with men, who still have many obstacles to do HIV testing test in health public center, but there is a lack of relevant empirical research. Therefore, it is necessary to explore the factors related to use HIV voluntary testing services in a Public Health Center among young men who have sex with men in Taiwan, and the empirical findings could inform future health promotion programs for testing policy. Objective: In view of the above situation, this study uses the Health Belief Model to explore the HBM factors related to use HIV voluntary counseling and testing services in a Public Health Center among young men who have sex with men in Taiwan. First, understand the HBM of MSM’s testing experience, and then this study stratified the analysis by the testing experience and explore HBM of going to the health center for HIV testing intention among the different testing experience men in the future. Methods: The quantitative questionnaire will be developed according to the Health Belief Model and the literature review. Data will be collected through an anonymous survey on the internet or forward the questionnaire links through relevant online platforms for recruitment on the Internet and adopts sampling methods to share between March and May 2020. A total of 1,156 participants were included in the final statistical analysis. The questionnaire was designed according to the five main constructs of the HBM (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action). Five latent factors were extracted through exploratory factor analysis (EFA). First take the HIV testing experience as a dependent variable and use Multi-nominal Logistic Regression. Then, this study stratified the analysis by the testing experience and explore the factors associated with actively go to the health center for HIV testing among Taiwan young men who have sex with men. Result: (1) The HIV testing experience had significant correlation to the willing of going to public health center for HIV testing. People who had testing experience in public health center, they will go to the health center for HIV testing. (2) The perceived susceptibility, perceived severity, perceived barriers, and cues to action had significant correlation with the testing experience; however, the testing experience not correlate to perceived benefits. (3) According to the HBM had correlation with the testing experience, this study stratified the analysis by the screening experience. (i) Among no testing experience adults, those who perceived: intermediate (AOR=3.54) and high benefits (AOR=6.62), were significantly more likely to have high HIV testing intention. By contrast, no testing experience adults who perceived: intermediate (AOR=0.32) and high perceived barriers with stigma (AOR=0.32) were significantly less likely to have high HIV testing intention. (ii) Among the public health center testing experience adults, those who perceived intermediate susceptibility (AOR=3.49), intermediate (AOR=2.77) and high overall benefits (AOR=5.22), and cues to action with approach (AOR=4.04) were significantly more likely to have high HIV testing intention. (iii) Among the other testing experience adults, those who perceived intermediate (AOR=2.39) and high overall benefits (AOR=6.3), cues to action with people (AOR=1.95), and cues to action with sexually transmitted disease (AOR=2.5) were significantly more likely to have high HIV testing intention. By contrast, the other testing experience adults who perceived: perceived barriers with environment (AOR=0.59) were significantly less likely to have high HIV testing intention. Conclusions: Based on the HBM, framework the benefits of anonymous HIV testing at public health center are incorrelated to the past experience of anonymous HIV testing, but it does affect to the willing of MSM. Therefore, with the promotion of anonymous HIV testing in the Public Health Center, anticipate reaching the goal of “90-90-90” by developing the healthy teaching project with regards of increasing the benefits to the MSM , followed by improving their willing of going to the Public Health Center for anonymous testing.