運用計劃行為理論探討台灣年輕男性間性行為者使用愛滋唾液快速自我篩檢之意圖

Abstract

背景：根據台灣疾病管制署統計，台灣愛滋感染現況有逐年攀升之趨勢，其中感染者有較高之比例為年輕男性間性行為者 (young men who have sex with men, YMSM)，再者，目前於台灣知道自身HIV感染狀態之感染者僅有74%，與UNAIDS所設定之「90-90-90」目標仍存有差距。近年新型態之「愛滋唾液快速自我篩檢」(oral rapid self-testing for HIV, HIV ORST) 有增加隱私性與突破時空限制等特質，可為潛在使用者（如：YMSM）之選擇。然而，台灣目前對於YMSM使用HIV ORST之意圖，以及影響其使用HIV ORST之相關因素，仍缺乏具理論基礎之調查與討論。 目的：透過以計劃行為理論 (Theory of Planned Behavior, TPB) 作為架構之問卷調查，了解台灣YMSM使用HIV ORST之意圖，及其使用HIV ORST之相關影響因素，並以HIV篩檢經驗進行分層分析，以供未來發展適性衛教或介入策略之實證參考依據。 方法：本研究係於2017年12月至2018年03月間，透過網路匿名自填式問卷，針對台灣15–39歲之YMSM進行招募，共計有2,063位HIV陰性之YMSM參與並納入最終統計分析。問卷題項主要依據TPB三大構念（行為態度、主觀規範與自覺行為控制）設計而成，透過探索性因素分析萃取出六個潛在因素，並運用多變項邏輯斯迴歸，以HIV篩檢經驗分層，分別探討影響YMSM使用HIV ORST意圖之相關因素。 結果：若過去無HIV篩檢經驗之YMSM具以下特質時，其未來具高使用HIV ORST意圖之勝算比皆顯著上升：具相對中立 (AOR=1.54) 與相對正向 (AOR=1.64) 之正向行為結果評價、具相對支持之主觀規範 (AOR=1.68)、在與HIV ORST相關之有利情境下具相對中度之自覺行為控制 (AOR=1.69)，以及在與性伴侶相關之有利情境下具相對中度 (AOR=1.96) 與相對高度 (AOR=3.46) 之自覺行為控制；而過去有HIV篩檢經驗之YMSM則是具有以下特質時，其未來具高使用HIV ORST意圖之勝算比會顯著上升：具相對中立 (AOR=1.57) 與相對正向 (AOR=2.80) 之正向行為結果評價、具相對支持之主觀規範 (AOR=1.43)、在與HIV ORST相關之有利情境下具相對高度之自覺行為控制 (AOR=1.59)，以及在與性伴侶相關之有利情境下具相對中度 (AOR=1.72) 與相對高度 (AOR=1.61) 之自覺行為控制。 結論：此研究運用TPB為架構，探討台灣YMSM使用HIV ORST之意圖，並以有無HIV篩檢之經驗進行分層分析。結果顯示「正向行為結果評價」及「與性伴侶相關之有利情境下之自覺行為控制」，分別為有、無篩檢經驗者，對於使用HIV ORST意圖之重要相關因子。此研究之結果，可作為發展適性之HIV/AIDS預防措施之實證參考依據。

Background: According to statistics of the Taiwan Centers for Disease Control (CDC), young men who have sex with men (YMSM) are at disproportionately higher risk for HIV infection. Introduced by Taiwan CDC, oral rapid self-testing (ORST) for HIV has recently become available in Taiwan on a limited scale. Prior research has also found that previous HIV testing experience had moderating effects on future intention to uptake HIV testing. However, little is known about whether and how YMSM with different HIV testing experiences differed in their HIV ORST intention and associated factors. Objectives: This study aimed to examine the factors related to HIV ORST intention among YMSM in Taiwan using the Theory of Planned Behavior (TPB), separately by their HIV testing experience. Methods: An anonymous online survey was conducted between December 2017 and April 2018 among YMSM in Taiwan. Responses from 2,063 HIV-negative participants were included in the multivariate logistic regression analyses. Data were stratified by HIV testing experience to explore the TPB-based factors linked to higher intention to use HIV ORST. Items derived from the TPB constructs—Attitude Toward the Behavior (ATB), Subjective Norm (SN), and Perceived Behavioral Control (PBC)—were factor-analyzed to form 6 factor-based subscales, whose scores were trichotomized. Results: Among YMSM with HIV testing experience, those who perceived: (1) neutral (AOR=1.54) and positive (AOR=1.64) ATB about positive outcomes, (2) neutral (AOR=1.68) SN, (3) intermediate (AOR=1.69) PBC under facilitating conditions related to HIV ORST, and (4) intermediate (AOR=1.96) and high (AOR=3.46) PBC under facilitating conditions related to sex partners, were more likely to have higher intention to use HIV ORST. By contrast, among YMSM without HIV testing experience, they were more inclined to use HIV ORST when they perceived: (1) neutral (AOR=1.84) and positive (AOR=1.84) ATB about positive outcomes, (2) supportive (AOR=1.57) SN, (3) high (AOR=2.80) PBC under facilitating conditions related to HIV ORST, (4) and intermediate (AOR=1.43) and high (AOR=1.59) PBC under facilitating conditions related to sex partners. Conclusions: For YMSM with different HIV testing experiences, TPB-based factors were differentially associated with HIV ORST intention and had important implications for future practice—e.g., among ever-tested YMSM, we should increase their positive outcome expectations regarding ORST, but among never-tested YMSM, we should increase their sex partner related self-efficacy to use ORST. These findings can inform future HIV/AIDS prevention initiatives tailored according to HIV testing experience to optimize the program effectiveness.