臺灣年輕男性間性行為者之健康信念與愛滋病毒暴露前預防性投藥使用意圖

Abstract

背景 至2015年7月底止，台灣的愛滋感染者已經達到三萬人，雖然性行為時使用保險套，是一直以來的衛生教育重點，但年輕男男間性行為者仍是受到愛滋疫情的很大影響。愛滋病毒暴露前預防性投藥是一個新的預防方式，它可以有效降低愛滋感染的風險。 研究目的 健康信念模式是一種健康行為改變理論，它可以解釋跟預測健康相關的行為，本研究即是以健康信念模式為基礎，來探討台灣男男間性行為者的預防投藥使用意圖與相關的因子。 方法 本研究就利用線上匿名網路問卷，在2016年3月15至4月15進行調查，調查15至39歲的男男間性行為者，其預防投藥使用意圖、基本人口學特徵、性相關行為、健康信念模式構念，統計分析利用羅吉斯回歸來檢視與預防性投藥使用意圖相關的因子。 結果 共1329位受訪者列入分析，其中僅488位 (36.7%)是對於預防性投藥具有高使用意圖，高與低使用意圖者在年紀、教育程度、性傾向、性別氣質和性角色上的分佈，是沒有統計上的差別，而學生和全職工作者、高月收入者、單身者、有性經驗者中，高使用意圖者所佔比例是較高的。 羅吉斯回歸顯示，大學學歷 (AOR=0.65)、無業或兼職工作 (AOR=0.40)、非單身 (AOR=0.60)，是與低使用預防投藥意圖相關的，而有肛交經驗 (AOR=1.70)則是與高使用預防投藥意圖相關。 結論 本研究為少數首幾個針對台灣男男間性行為者，運用健康信念模式為研究架構的預防性投藥使用意圖研究，結果顯示約五分之二的男男間性行為者是有高使用意圖的，研究也發現一些障礙和與預防性投藥意圖相關的因子，這些發現可以作為未來在提升預防性投藥意圖規劃上的重要參考。

Background The number of HIV-infected people in Taiwan reached 30 thousands in July, 2015. Young men who have sex with men (MSM) were the most affected population, despite the promotion of condom use during sex. Pre-exposure prophylaxis (PrEP) is a new prevention strategy in preventing HIV transmission. It could reduce the risk of getting HIV significantly. Objectives The Health Belief Model (HBM) is a health behavior change theory that can explain and predict behaviors related to health. Based on the HBM, this study evaluated PrEP use intention and associated factors among MSM in Taiwan. Methods An anonymous online survey was conducted from 15th March to 15th April, 2016 among 15-39 years old MSM via various channels. Information was collected regarding PrEP use intention, demographic characteristics, sex-related characteristics, and HBM constructs of MSM. We performed logistic regression to examine the factors associated with PrEP use intention. Results A total of 1,329 responses were included for analysis. Nearly 80% lived in the six major metropolitans most affected by HIV. The high PrEP use intention group consisted of 488 (36.7%) MSM and the low intention group 841 (63.3%). The high and low intention groups did not differ significantly by age, education level, sexual orientation, gender characteristic, and sexual role. The high PrEP use intention group had more students and full-time workers, higher monthly income, more singles, and more anal sex experience, compared with the low PrEP use intention group. Logistic regression showed that MSM with college degree (AOR=0.65) had lower PrEP use intention than those with less education. Those unemployed or with a part-time job (AOR=0.40) had lower PrEP use intention than full-time workers. Non-single status (AOR=0.60) was associated with lower PrEP use intention. MSM with anal sex experience (AOR=1.70) had higher PrEP use intention than those without anal sex experience. MSM perceiving high (AOR=2.16) and moderate (AOR=1.95) risk of HIV infection had higher PrEP use intention than MSM with low perceived risk. High (AOR=2.24) and moderate (AOR=1.99) perceived benefits, high (AOR=4.10) and moderate (AOR=3.12) self-efficacy were associated with higher PrEP use intention. MSM with high perceived barriers had lower PrEP use intention (AOR=0.62) than those with low perceived barriers, but moderate perceived barriers were not significantly associated with PrEP use intention. MSM with relatively more cues to action had higher PrEP use intention (AOR=1.52) than those with relatively fewer cues. However, those with some cues to action did not have significantly higher PrEP use intention. In addition, the effect of demographic characteristics, sex-related characteristics, and HBM constructs to PrEP intention varied by sexual role. Conclusions This study was among the first to examine PrEP use intention among MSM in Taiwan using the HBM as a theoretical framework. Only nearly two in five MSM had high PrEP use intention. Several barriers and factors associated with PrEP use intention were identified in this study. These findings could inform future intervention efforts to increase the uptake of PrEP among MSM in Taiwan.