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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 丁志音 | |
dc.contributor.author | Yi-Hsin Chang | en |
dc.contributor.author | 張怡馨 | zh_TW |
dc.date.accessioned | 2021-06-15T01:14:14Z | - |
dc.date.available | 2013-10-03 | |
dc.date.copyright | 2011-10-03 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-08-16 | |
dc.identifier.citation | 1. 曾毓珊, 楊靖慧. 台灣梅毒流行病學現況. 愛之關懷季刊 2010,72:5-13.
2. Lee HC, Ko NY, Lee NY, Chang CM, Liu SY, Ko WC. Trends in sexually transmitted diseases and risky behaviors among HIV-infected patients at an outpatient clinic in southern Taiwan. Sex Transm Dis 2010,37:86-93. 3. Ko NY, Liu HY, Lee HC, Lai YY, Chang CM, Lee NY, et al. One-Year Follow-Up of Relapse to Risky Behaviors and Incidence of Syphilis Among Patients Enrolled in the HIV Case Management Program. AIDS Behav 2010. 4. 衛生署疾病管制局. 防疫專區疾病介紹. In: 衛生署疾病管制局防疫專區資料,取自http://www.cdc.gov.tw; 2010. 5. Phipps W, Kent CK, Kohn R, Klausner JD. Risk factors for repeat syphilis in men who have sex with men, San Francisco. Sex Transm Dis 2009,36:331-335. 6. 洪健清, 吳岫, 劉玟君, 巫沛瑩. 愛滋病毒感染者之梅毒感染的臨床病徵與診斷. 愛之關懷季刊 2010,72:14-25. 7. Cohen MS, Hellmann N, Levy JA, DeCock K, Lange J. The spread, treatment, and prevention of HIV-1: evolution of a global pandemic. J Clin Invest 2008,118:1244-1254. 8. Hasse B, Ledergerber B, Hirschel B, Vernazza P, Glass TR, Jeannin A, et al. Frequency and Determinants of Unprotected Sex among HIV-Infected Persons: The Swiss HIV Cohort Study. Clin Infect Dis 2010,51:1314-1322. 9. Burt RD, Thiede H. Variations in Patterns of Sexual Risk Behavior among Seattle-Area MSM Based on their HIV Status, the HIV Status of their Partner and Partner Type. AIDS Behav 2011. 10. Elford J. Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy. Curr Opin Infect Dis 2006,19:26-32. 11. Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet 2001,357:432-435. 12. Cox J, Beauchemin J, Allard R. HIV status of sexual partners is more important than antiretroviral treatment related perceptions for risk taking by HIV positive MSM in Montreal, Canada. Sex Transm Infect 2004,80:518-523. 13. Van Kesteren NM, Hospers HJ, Kok G. Sexual risk behavior among HIV-positive men who have sex with men: a literature review. Patient Educ Couns 2007,65:5-20. 14. Mansergh G, Marks G, Colfax G, Guzman R, Rader M, Buchbinder S. 'Barebacking'in a diverse sample of men who have sex with men. AIDS 2002,16:653. 15. Thurnheer MC, Weber R, Toutous-Trellu L, Cavassini M, Elzi L, Schmid P, et al. Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study. AIDS 2010,24:1907-1916. 16. Wolitski RJ, Parsons JT, Gomez CA. Prevention with HIV-seropositive men who have sex with men: lessons from the Seropositive Urban Men's Study (SUMS) and the Seropositive Urban Men's Intervention Trial (SUMIT). J Acquir Immune Defic Syndr 2004,37 Suppl 2:S101-109. 17. Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS 2009,23:243-252. 18. Dosekun O, Fox J. An overview of the relative risks of different sexual behaviours on HIV transmission. Curr Opin HIV AIDS 2010,5:291-297. 19. Kalichman SC, Rompa D, Cage M. Sexually transmitted infections among HIV seropositive men and women. Sex Transm Infect 2000,76:350-354. 20. van de Laar TJ, Matthews GV, Prins M, Danta M. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS 2010,24:1799-1812. 21. Stall R, Wei C, Raymond HF, McFarland W. Do rates of unprotected anal intercourse among HIV-positive MSM present a risk for hepatitis C transmission? Sex Transm Infect 2011. 22. Urbanus AT, van de Laar TJ, Stolte IG, Schinkel J, Heijman T, Coutinho RA, et al. Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic. AIDS 2009,23:F1-7. 23. van de Laar TJ, van der Bij AK, Prins M, Bruisten SM, Brinkman K, Ruys TA, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis 2007,196:230-238. 24. Schmidt AJ, Rockstroh JK, Vogel M, An der Heiden M, Baillot A, Krznaric I, et al. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study. PLoS One 2011,6:e17781. 25. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological review 1977,84:191. 26. 林燕卿, 朱元祥. 運用跨理論模式分析青少年保險套使用情形. 性學研究 2010,1:67-85. 27. Boer H, Mashamba MT. Psychosocial correlates of HIV protection motivation among black adolescents in Venda, South Africa. AIDS Educ Prev 2005,17:590-602. 28. 莊小玲, 郭青萍, 劉恩琪, 葉昭幸. 以理性行為論探討影響愛滋病毒感染高危險群保險套使用的相關因素. 台灣醫學 2006,10:10-19. 29. Yeh CY. Predictors of Condom Use Intention in the Prevention of HIV/AIDS among Taiwanese Junior College Students. Nursing Research 1998,6:264-278. 30. Ko NY, Lee HC, Hung CC, Tseng FC, Chang JL, Lee NY, et al. Trends of HIV and Sexually Transmitted Infections, Estimated HIV Incidence, and Risky Sexual Behaviors Among Gay Bathhouse Attendees in Taiwan: 2004-2008. AIDS Behav 2010. 31. Kauth MR, St Lawrence JS, Kelly JA. Reliability of retrospective assessments of sexual HIV risk behavior: a comparison of biweekly, three-month, and twelve-month self-reports. AIDS Educ Prev 1991,3:207-214. 32. DiFranceisco W, McAuliffe TL, Sikkema KJ. Influences of survey instrument format and social desirability on the reliability of self-reported high risk sexual behavior. AIDS and Behavior 1998,2:329-337. 33. Weinhardt LS, Forsyth AD, Carey MP, Jaworski BC, Durant LE. Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice. Arch Sex Behav 1998,27:155-180. 34. Curran-Everett D, Benos DJ. Guidelines for reporting statistics in journals published by the American Physiological Society. Adv Physiol Educ 2004,28:85-87. 35. Hidaka Y, Ichikawa S, Koyano J, Urao M, Yasuo T, Kimura H, et al. Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan. BMC Public Health 2006,6:239. 36. 李欣純, 柯乃熒, 張家銘, 柯文謙. 男同性性行為者合併感染HIV/HCV的流行病學現況. 愛之關懷季刊 2008,64:6-11. 37. Morin SF, Steward WT, Charlebois ED, Remien RH, Pinkerton SD, Johnson MO, et al. Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project. J Acquir Immune Defic Syndr 2005,40:226-235. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/42465 | - |
dc.description.abstract | 目的
我們並不清楚台灣本土愛滋病毒感染者,特別是男男間性行為者(men who have sex with men,以下簡稱MSM),在高效能抗病毒藥物 ( highly active antiretroviral therapy,以下簡稱HAART ) 廣泛運用於愛滋病毒感染治療的時代,在性行為模式上是否有改變、是否正在從事危險性行為,使自己暴露在性病感染的風險中。因此,本研究希望能夠調查MSM之愛滋病毒感染者梅毒感染相關因子,以及娛樂性藥物與助性劑的使用和危險性行為的關聯性。 方法 本研究於2011年3月至2011年5月期間,以自填式問卷的方式,邀請規則在門診就醫之MSM愛滋病毒感染者參與本研究調查。所設計的結構式問卷,內容包含基本人口學資料、感染愛滋病毒後服藥與健康狀況及有無梅毒感染、性伴侶及性行為模式和娛樂性藥物使用概況。 結果 在這段研究期間,一共有200位個案自願參與本研究及提供有效問卷填答。在邏輯斯迴歸分析中,調整年齡、教育程度、職業、有無使用HAART、CD4數及病毒量之作用後,與梅毒感染相關的變項包括:固定性伴侶是愛滋病毒感染者、有不固定性伴侶者、全程及正確使用保險套頻率低者、肛交及口交戴套頻率低者、不戴套體外射精頻率高者、與愛滋病毒感染者發生性行為不戴套頻率低者,以及過去有娛樂性藥物及助性劑使用經驗者。針對有使用HAART的個案當中,進行複邏輯斯迴歸分析,最後結果為CD4數(odds ratio [OR], 1.0; 90% confidence interval [CI], 1.00-1.00; p=0.018)、主要性伴侶「是」及「有的是有的不是」愛滋病毒感染者(OR, 5.42; 90% CI, 2.17-13.52; p=0.002)、有不固定性伴侶(OR, 2.41; 90% CI, 1.30-4.47; p=0.019)等為感染梅毒的相關因子。本研究未能確立娛樂性藥物與助性劑使用和梅毒感染之間的相關性,僅能呈現娛樂性藥物或助性劑的使用,的確與保險套使用頻率低之危險性行為和教育程度有關。 結論 本研究顯示,與性伴侶關係固定與否以及性伴侶的愛滋病毒感染身份,是MSM愛滋病毒感染者感染梅毒的重要相關因素。娛樂性藥物的使用和危險性行為之間的相關性,甚至兩者之間可能的協同作用,更是愛滋病防疫的一大挑戰,也顯現相關行為介入的措施有其必要性與急迫性。未來針對這群易感族群、性行為活躍之MSM愛滋病毒感染者,除了被動篩檢有無性病感染之外,應積極加強行為介入衛教宣導等次級預防工作。 | zh_TW |
dc.description.abstract | Background & Purpose: Little is known about factors contributing to syphilis among HIV-infected patients in Taiwan, especially among men who have sex with men (MSM) , in the era of highly active antiretroviral therapy (HAART).
Methods: From March to May 2011, HIV-infected MSM patients who regularly attended an HIV/AIDS outpatient clinic of a medical center were invited to participate in the study. Quantitative data were collected through a self-administered survey. The structured questionnaire for this study included questions regarding socio-demographic characteristics, HIV infection history, health status, sexual partners and patterns of sexual behavior, and use of recreational drugs. Results: During the study period, a total of 200 HIV-infected MSM were voluntarily enrolled and provided valid responses to the questionnaire. In the first stage analysis where association between each sexual or drug related factor and syphilis after diagnosis of HIV infection was examined while adjusting the effect of age, education, occupation, receiving HAART or not, CD4 counts, and plasma HIV RNA load (log10). We demonstrated the following factors that were associated with syphilis: having main sexual partner(s) who were also sero-positive, having casual sexual partner(s), condom use while having anal and oral sex, practice of withdrawal before ejaculation, having sex with sero-positive partner(s) without condom, and use of recreational drugs. Further stepwise multiple logistic regression analysis focusing on patients who were on HAART indicated that CD4 counts (OR, 1.0; 90% CI, 1.00-1.00; p=0.018), having had sero-positive main partners before or some of the main sexual partners being HIV-positive (OR, 5.42; 90% CI, 2.17-13.52; p=0.002), and having had casual sexual partner(s) (OR, 2.41; 90% CI, 1.30-4.47; p=0.019) were statistically significant contributors for syphilis infection experience. This study failed to present a significant relationship between recreational drug use and syphilis. However, it did display an association between recreational drug use and education and risky sexual behaviors in the past 6 months. Conclusion: Findings of this study demonstrate the critical role the identity of sexual partners (sero-status) and the nature of relationship with sexual partners (steadiness or casualness) play in relation to syphilis. Moreover, association between risky sexual behaviors and recreational drug use and possible synergetic effect of both explicate the emerging challenge to HIV/AIDS control. It suggests the urgency to implement interventions targeting HIV-infected persons in general and HIV-infected MSM in particular. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T01:14:14Z (GMT). No. of bitstreams: 1 ntu-100-R98847005-1.pdf: 793404 bytes, checksum: 9b4f3e23295b54642b3d0b562ea60493 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 摘要 ii
Abstract iv 第一章 緒論 1 第一節 研究動機 1 第二節 研究目的 2 第三節 實習單位簡介 3 第二章 文獻探討 4 第一節 梅毒感染 4 第二節 愛滋病毒感染者、危險性行為與娛樂性藥物使用之關係 5 第三節 自我效能與保險套使用關係 8 第四節 MSM、愛滋病毒感染者性病感染與危險性行為之研究整理 8 第五節 小結 10 第三章 研究方法 11 第一節 研究架構 11 第二節 研究設計 12 第三節 資料處理與統計分析 17 第四章 研究結果 18 第一節 個人特質、健康狀況與服藥行為 18 第二節 性行為模式 21 第三節 娛樂性藥物及助性劑使用 29 第四節 MSM之愛滋病毒感染者梅毒感染相關因子分析 35 第五節 C型肝炎傳染途徑知識、自覺罹病風險及自我效能 38 第五章 討論 40 第一節 MSM之愛滋病毒感染者梅毒感染因素剖析 40 第二節 防治介入策略 45 第三節 研究限制 46 第六章 結論 47 參考文獻 48 附件一 愛滋病患者梅毒感染危險因素調查問卷 51 附件二 臺大醫院研究倫理委員會核可文件 57 | |
dc.language.iso | zh-TW | |
dc.title | 男男間性行為愛滋病毒感染者之梅毒感染相關因素 | zh_TW |
dc.title | Factors Associated with Syphilis among HIV-infected Men Who Have Sex with Men | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 洪健清 | |
dc.contributor.oralexamcommittee | 楊靖慧 | |
dc.subject.keyword | 梅毒,愛滋病毒感染,危險性行為,男男間性行為者, | zh_TW |
dc.subject.keyword | syphilis,HIV,risky sexual behavior,men who have sex with men, | en |
dc.relation.page | 57 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-08-16 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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