台灣年輕男性間性行為者之身體意象與危險性行為：以性刺激尋求傾向分層之比較分析

Abstract

背景：前人針對男性間性行為者之身體意象與危險性行為關聯之討論，並無明確一致之結論，另有國外學者指出，對自身身體意象不滿意可能與性行為時之低保險套使用有關，此外，我國亦鮮少有研究探討上述之變項與性刺激尋求傾向之關聯。 目的：希望藉由本研究，了解台灣年輕男同志族群之身體意象分布，及其與不同類型性伴侶之危險性行為狀況，並檢視台灣年輕男同志之身體意象與危險性行為之關聯性，是否因性刺激尋求傾向之不同而有所差異。 方法：本研究針對全台灣15至39歲年輕男同志，使用網路匿名問卷為研究工具，進行資料蒐集。最終共計682位研究參與者納入分析，使用多變項羅吉斯迴歸模型，並以性刺激尋求傾向之高低分層 (以中位數為切點)，檢視台灣年輕男同志族群之身體意象，及其與三種不同類型之性伴侶 (固定、非固定、透過網路軟體認識) 發生無套肛交之危險性行為的關聯性。 結果：研究參與者中，有87.2%的研究參與者自陳為同性戀，12.8%自陳為雙性戀，絕大多數有性經驗 (90.2%)，過半數 (61.1%) 的參與者為單身，且大多數非獨居而有同住的室友或家人 (74.0%)，近九成 (87.9%) 年齡介於20至39歲，其餘則為15至19歲。以性刺激尋求傾向之高低分層後，於低刺激尋求傾向者中，與固定伴侶方面，具中度身體部位滿意度者，有2.26倍之危險性行為風險；在與非固定伴侶方面，低刺激尋求傾向者中，年紀大於25歲者，相較於20歲以下者，有較高之危險性行為風險 (AOR=2.68)，而有情感伴侶者則減低了近八成的危險性行為風險 (AOR=0.24)。於高刺激尋求傾向者中，與非固定伴侶方面，具高過重執著者相較於低過重執著者，有2.10倍之危險性行為風險，然而具有中度與高度外表重視程度者，均有較低之危險性行為風險 (AOR分別為0.42與0.50)。最後，與透過網路軟體認識的伴侶，低刺激尋求傾向者且有情感伴侶者，降低了近一半 (AOR=0.51) 的性行為風險，然而低刺激尋求傾向且有中度過重執著者，有1.92倍之不安全性行為風險，有中度與高度身體部位滿意度者，則均有較高之危險性行為風險 (AOR分別為2.59與2.58)。 結論：本研究發現，於控制背景變項後，身體部位滿意度、過重執著度與外表重視程度，均與和不同類型性伴侶發生危險性行為之風險具顯著關聯性。然而，高、低性刺激尋求傾向之年輕男性間性行為者有不同的危險性行為模式。是故，針對年輕男性間性行為者提倡健康身體意象時，應同時宣導安全性行為之重要，並依此族群之需要，設計適性之身體意象相關的性健康促進方案。

Background: The results of previous studies remain inconclusive regarding the associations between body image and sexual risk behaviors among young men who have sex with men (YMSM). Prior research has identified body dissatisfaction to be a risk factor of less frequent condom use. In Taiwan, few studies had examined such associations and the role of sexual sensation seeking (SSS) tendency. Objectives: This study aimed to examine body image and its associations with unsafe anal sex behavior with three different types of sex partners, stratified by SSS tendency. Methods: Data were collected from YMSM aged 15–39 years in Taiwan using an anonymous online survey. A total of 682 participants were included in the final analysis. Multivariate logistic regression was used, stratified by low vs. high SSS tendency (using the median as the cutoff), to examine the associations between body image and unsafe anal sex behavior with three types of sex partners (regular, casual, and apps-met) among YMSM. Results: Among these YMSM, 87.2% self-identified as gay and 12.8% as bisexual. Most of them (90.2%) were sexually experienced, more than half (61.1%) were single and lived with others (74.0%), and the majority were aged between 20 and 39 (87.9%). Among low-SSS YMSM, those with mid-level body area satisfaction (BASS) had greater odds of having condomless anal sex with regular partners (AOR=2.26). Low-SSS YMSM in a romantic relationship had lower odds of engaging in sexual risk behaviors with casual sex partners and apps-met partners (AOR=0.24 and 0.51, respectively), but if older than 25 years old, they had higher odds of unsafe anal sex with casual sex partners (AOR= 2.68). Among high-SSS YMSM, on the other hand, those with mid and high appearance orientation (AO) had lower odds of condomless anal sex (AOR= 0.42 and 0.50, respectively) with casual sex partners. With regard to unsafe anal sex with apps-met partners, low-SSS YMSM with mid overweight preoccupation (OP), and mid and high BASS had higher odds of sexual risk behaviors (AOR= 1.92, 2.59, and 2.58, respectively). Conclusions: The overall BASS, OP, and AO were significantly associated with unsafe anal sex with different types of sex partners, after controlling for background variables. The patterns of sexual risk behaviors were also different between low-SSS and high-SSS YMSM. Therefore, while promoting healthy body image in the YMSM population, we may also need to simultaneously advocate the importance of safer sex and develop body image related sexual health promotion programs geared towards YMSM.