Article(id=1241319156948194118, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501086, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736092800000, receivedDateStr=2025-01-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883149611, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883149611, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883149611, creator=13701087609, updateTime=1773883149611, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2133, endPage=2139, ext={EN=ArticleExt(id=1241319158361674629, articleId=1241319156948194118, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Status and related factors of condom use among MSM based on random forest algorithm, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the status quo and influencing factors of condom use in MSM population, and to provide reference for the formulation of intervention strategies.

Methods

From August to October 2022, a questionnaire survey was conducted among 281 MSM in Chengdu, Sichuan Province, including social demographic information, AIDS-related services, behavioral and psychological status. The random forest algorithm was used to reduce and screen the influencing factors of condom use, and then SHAP analysis was used to explain the random forest model after variable screening.

Results

The rate of consistent condom use among MSM in the past 6 months was 65.5 %. When the number of variables after dimensionality reduction was 7, the random forest model had the best performance (AUC: 0.834). The results of SHAP analysis showed that the mean value of the importance of variables and the absolute value of SHAP were the score of condoms use self-efficacy (0.079 0), the score of AIDS-related discrimination (0.051 3), whether there was heterosexual behavior (0.029 9), living conditions (0.011 4), the way to find homosexual partners in the last six months (0.007 8), occupation (0.004 8) and sexual role (0.002 6). MSM who had low condom use self-efficacy scores, high AIDS-related discrimination scores, had heterosexual sex, and had contact with same-sex partners at home had poor condom use adherence, while MSM who lived alone, were students, and had both sex roles had better condom use adherence.

Conclusion

Improving the condom use self-efficacy of MSM, reducing HIV-related discrimination, focusing on and intervening in MSM with heterosexual partners, and MSM who often contact with homosexual partners at home may help to improve the condom use rate of MSM.

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目的

分析MSM人群安全套坚持使用现状及影响因素,为艾滋病防控干预策略制定提供参考依据。

方法

2022年8—10月对四川成都281名MSM进行问卷调查,内容包括社会人口学信息、艾滋病相关服务、行为学以及心理状况等信息。采用随机森林算法对安全套坚持使用的影响因素进行降维并筛选,再利用SHAP分析对变量筛选后的随机森林模型进行解释。

结果

MSM最近6个月安全套坚持使用率为65.5%,当降维后变量数为7时,随机森林模型具有最佳的性能(AUC:0.834)。SHAP分析结果表明变量重要性及其SHAP绝对值的均值依次为安全套使用自我效能得分情况(0.079 0)、艾滋病相关歧视得分情况(0.051 3)、是否有过异性性行为(0.029 9)、居住情况(0.011 4)、最近六个月同性性伴寻找途径(0.007 8)、职业(0.004 8)以及性角色(0.002 6),其中,安全套使用自我效能得分较低、艾滋病相关歧视得分较高、有过异性性行为、在家中接触同性性伴的MSM安全套坚持使用情况较差,独居、职业为学生、性角色为两者都有的MSM安全套坚持使用情况较好。

结论

提高MSM的安全套使用自我效能,减少HIV相关歧视,重点关注并干预有异性性伴的MSM,以及经常在家中接触同性性伴的MSM可能有助于提高MSM的安全套坚持使用率。

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李苑和杨义为共同通信作者。李苑,Email:
杨义,Email:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=DjwRgskSSgFsISfx82fDMQ==, magXml=IpI6V9vcbTSV+jVP91k+qw==, pdfUrl=null, pdf=62RHaAPwXRVFQS4cokek3A==, pdfFileSize=1245522, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=U4ufhwmJqGYRp3jx0EY01Q==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=x9mGySRjTFuUeQmQV5PHvg==, mapNumber=null, authorCompany=null, fund=null, authors=

杨碧辉和袁将为共同第一作者。

杨碧辉(1998—),男,硕士在读,研究方向:流行病学与卫生统计学

袁将(2001—),男,硕士在读,研究方向:流行病学与卫生统计学

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(In Chinese), articleTitle=Research progress on behavioral characteristics and prevalence of HIV in men who have sex with men among college students, refAbstract=null), Reference(id=1241319175243747887, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=10, pageStart=1159, pageEnd=1163, url=null, language=null, rfNumber=[21], rfOrder=23, authorNames=王晗, 童俊然, 陈怀良, journalName=中国艾滋病性病, refType=null, unstructuredReference=王晗,童俊然,陈怀良,等.重庆市不同性角色MSM行为特征及HIV和梅毒感染现状[J].中国艾滋病性病2022,28(10):1159-1163., articleTitle=重庆市不同性角色MSM行为特征及HIV和梅毒感染现状, refAbstract=null), Reference(id=1241319175382159921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=10, pageStart=1159, pageEnd=1163, url=null, language=null, rfNumber=[21], rfOrder=24, authorNames=Wang H, Tong JR, Chen HL, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Wang H, Tong JR, Chen HL, et al. Sexual roles, behavioral characteristics and HIV/syphilis infection among MSM in Chongqing[J]. Chinese Journal of AIDS & STD, 2022, 28(10): 1159-1163. (In Chinese), articleTitle=Sexual roles, behavioral characteristics and HIV/syphilis infection among MSM in Chongqing, refAbstract=null), Reference(id=1241319175466046004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=11, pageStart=1130, pageEnd=1135, url=null, language=null, rfNumber=[22], rfOrder=25, authorNames=王斌, 陈琳, 柴程良, journalName=中国艾滋病性病, refType=null, unstructuredReference=王斌,陈琳,柴程良,等.基于结构方程模型的大学生男男性行为者HIV暴露后预防药物使用情况及相关因素研究[J].中国艾滋病性病2024,30(11):1130-1135., articleTitle=基于结构方程模型的大学生男男性行为者HIV暴露后预防药物使用情况及相关因素研究, refAbstract=null), Reference(id=1241319175549932086, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=11, pageStart=1130, pageEnd=1135, url=null, language=null, rfNumber=[22], rfOrder=26, authorNames=Wang B, Chen L, Chai CL, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Wang B, Chen L, Chai CL, et al. 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The status of consistent condom use among MSM

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变量总计(构成比/%)安全套坚持使用数(坚持使用率/%)
年龄
≤25岁116(41.3)85(73.3)
26~39岁96(34.2)62(64.6)
≥40岁69(24.5)37(53.6)
户口类型
城镇户口128(45.6)79(61.7)
农村户口153(54.4)105(68.6)
外出务工情况
未外出务工过187(66.5)62(66.0)
外出务工过94(33.5)122(65.2)
文化程度
初中及以下40(14.2)21(52.5)
中专/职高/技校或普通高中80(28.5)52(65.0)
大专及以上161(57.3)111(68.9)
职业
工人、农民48(17.1)29(60.4)
企业或事业单位88(31.3)58(65.9)
个体服务或其他职业95(33.8)59(62.1)
学生50(17.8)38(76.0)
婚姻状况
未婚195(69.4)142(72.8)
已婚63(22.4)32(50.8)
离异或丧偶23(8.2)10(43.5)
居住情况
独居87(31.0)62(71.3)
仅与配偶(或固定性伴)居住55(19.6)30(54.5)
与家人一起居住121(43.1)80(66.1)
集中居住或其他18(6.4)12(66.7)
个人月收入
低于1 000元47(16.7)33(70.2)
1 000~4 999元149(53.0)95(63.8)
5 000元及以上85(30.2)56(65.9)
艾滋病相关知识宣传
未接受过41(14.6)27(65.9)
接受过240(85.4)157(65.4)
艾滋病相关服务
未接受过62(22.1)44(71.0)
接受过219(77.9)140(63.9)
HIV抗体检测结果
阳性24(8.5)13(54.2)
阴性257(91.5)171(66.5)
艾滋病知识知晓情况
知晓45(16.0)29(64.4)
不知晓236(84.0)155(65.7)
性角色
插入方101(35.9)61(60.4)
被插入方65(23.1)44(67.7)
两者都有115(40.9)79(68.7)
最近六个月同性固定性伴有无
172(61.2)105(61.0)
109(38.8)79(72.5)
最近六个月同性临时性伴有无
179(63.7)113(63.1)
102(36.3)71(69.6)
最近六个月与同性性伴接触的主要渠道
在家中接触140(49.8)92(65.7)
互联网接触118(42.0)73(61.9)
同性酒吧、浴池以及同性茶楼等其他途径23(8.2)19(82.6)
最近六个月不专一性行为的有无
98(34.9)62(63.3)
183(65.1)122(66.7)
是否和异性发生过性关系
发生过107(38.1)52(48.6)
未发生过174(61.9)132(75.9)
最近六个月,使用rush(或零号胶囊等类似物品)情况
使用过92(32.7)56(60.9)
未使用过189(67.3)128(67.7)
是否吸过毒
5(1.8)1(50.0)
276(98.2)183(65.8)
性取向
同性恋181(64.4)123(68.0)
双性恋80(28.5)49(61.3)
不确定20(7.1)12(60.0)
安全套使用自我效能得分
较低82(29.2)27(32.9)
中等123(43.8)90(73.2)
较高76(27.0)67(88.2)
艾滋病相关歧视得分
较低76(27.0)58(76.3)
中等121(43.1)86(71.1)
较高84(29.9)40(47.6)
), ArticleFig(id=1241319171246576073, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, language=CN, label=表1, caption=

MSM安全套坚持使用现状

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(构成比/%)安全套坚持使用数(坚持使用率/%)
年龄
≤25岁116(41.3)85(73.3)
26~39岁96(34.2)62(64.6)
≥40岁69(24.5)37(53.6)
户口类型
城镇户口128(45.6)79(61.7)
农村户口153(54.4)105(68.6)
外出务工情况
未外出务工过187(66.5)62(66.0)
外出务工过94(33.5)122(65.2)
文化程度
初中及以下40(14.2)21(52.5)
中专/职高/技校或普通高中80(28.5)52(65.0)
大专及以上161(57.3)111(68.9)
职业
工人、农民48(17.1)29(60.4)
企业或事业单位88(31.3)58(65.9)
个体服务或其他职业95(33.8)59(62.1)
学生50(17.8)38(76.0)
婚姻状况
未婚195(69.4)142(72.8)
已婚63(22.4)32(50.8)
离异或丧偶23(8.2)10(43.5)
居住情况
独居87(31.0)62(71.3)
仅与配偶(或固定性伴)居住55(19.6)30(54.5)
与家人一起居住121(43.1)80(66.1)
集中居住或其他18(6.4)12(66.7)
个人月收入
低于1 000元47(16.7)33(70.2)
1 000~4 999元149(53.0)95(63.8)
5 000元及以上85(30.2)56(65.9)
艾滋病相关知识宣传
未接受过41(14.6)27(65.9)
接受过240(85.4)157(65.4)
艾滋病相关服务
未接受过62(22.1)44(71.0)
接受过219(77.9)140(63.9)
HIV抗体检测结果
阳性24(8.5)13(54.2)
阴性257(91.5)171(66.5)
艾滋病知识知晓情况
知晓45(16.0)29(64.4)
不知晓236(84.0)155(65.7)
性角色
插入方101(35.9)61(60.4)
被插入方65(23.1)44(67.7)
两者都有115(40.9)79(68.7)
最近六个月同性固定性伴有无
172(61.2)105(61.0)
109(38.8)79(72.5)
最近六个月同性临时性伴有无
179(63.7)113(63.1)
102(36.3)71(69.6)
最近六个月与同性性伴接触的主要渠道
在家中接触140(49.8)92(65.7)
互联网接触118(42.0)73(61.9)
同性酒吧、浴池以及同性茶楼等其他途径23(8.2)19(82.6)
最近六个月不专一性行为的有无
98(34.9)62(63.3)
183(65.1)122(66.7)
是否和异性发生过性关系
发生过107(38.1)52(48.6)
未发生过174(61.9)132(75.9)
最近六个月,使用rush(或零号胶囊等类似物品)情况
使用过92(32.7)56(60.9)
未使用过189(67.3)128(67.7)
是否吸过毒
5(1.8)1(50.0)
276(98.2)183(65.8)
性取向
同性恋181(64.4)123(68.0)
双性恋80(28.5)49(61.3)
不确定20(7.1)12(60.0)
安全套使用自我效能得分
较低82(29.2)27(32.9)
中等123(43.8)90(73.2)
较高76(27.0)67(88.2)
艾滋病相关歧视得分
较低76(27.0)58(76.3)
中等121(43.1)86(71.1)
较高84(29.9)40(47.6)
), ArticleFig(id=1241319171670200786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, language=EN, label=Table 2, caption=

Variable assignment

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变量赋值
因变量
最近六个月安全套坚持使用情况未坚持使用=0;坚持使用=1
一般人口学特征
年龄≤25岁=0;26~39岁=1;≥40岁=2
户口类型城镇户口=0;农村户口=1
外出务工情况无=0;有=1
文化程度初中及以下=0;中专/职高/技校或普通高中=1;大专及以上=2
职业工人、农民=0;企业或事业单位=1;个体服务或其他职业=2;学生=3
婚姻状况未婚=0;已婚=1;离异或丧偶=2
居住情况独居=0;仅与配偶(或固定性伴)居住=1;与家人一起居住=2;集中居住或其他=3
个人月收入低于1 000元=0;1 000~4 999元=1;5 000元及以上=2
艾滋病知识知晓及相关服务情况
艾滋病相关知识宣传未接受过=0;接受过=1
艾滋病相关服务未接受过=0;接受过=1
HIV抗体检测结果阴性=0;阳性=1
艾滋病知识知晓情况不知晓=0;知晓=1
行为学情况
性角色插入方=0;被插入方=1;两者都有=2
最近六个月同性固定性伴有无无=0;有=1
最近六个月同性临时性伴有无无=0;有=1
最近六个月与同性性伴接触的主要渠道在家中接触=0;互联网接触=1;同性酒吧、浴池以及同性茶楼等其他途径=2
最近六个月不专一性行为的有无无=0;有=1
是否和异性发生过性关系无=0;有=1
最近六个月,使用rush(或零号胶囊等类似物品)情况无=0;有=1
是否吸过毒无=0;有=1
心理特征
性取向同性恋=0;双性恋=1;不确定=2
安全套使用自我效能得分较低=0;中等=1;较高=2
艾滋病相关歧视得分较低=0;中等=1;较高=2
), ArticleFig(id=1241319171766669782, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319156948194118, language=CN, label=表2, caption=

变量赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
因变量
最近六个月安全套坚持使用情况未坚持使用=0;坚持使用=1
一般人口学特征
年龄≤25岁=0;26~39岁=1;≥40岁=2
户口类型城镇户口=0;农村户口=1
外出务工情况无=0;有=1
文化程度初中及以下=0;中专/职高/技校或普通高中=1;大专及以上=2
职业工人、农民=0;企业或事业单位=1;个体服务或其他职业=2;学生=3
婚姻状况未婚=0;已婚=1;离异或丧偶=2
居住情况独居=0;仅与配偶(或固定性伴)居住=1;与家人一起居住=2;集中居住或其他=3
个人月收入低于1 000元=0;1 000~4 999元=1;5 000元及以上=2
艾滋病知识知晓及相关服务情况
艾滋病相关知识宣传未接受过=0;接受过=1
艾滋病相关服务未接受过=0;接受过=1
HIV抗体检测结果阴性=0;阳性=1
艾滋病知识知晓情况不知晓=0;知晓=1
行为学情况
性角色插入方=0;被插入方=1;两者都有=2
最近六个月同性固定性伴有无无=0;有=1
最近六个月同性临时性伴有无无=0;有=1
最近六个月与同性性伴接触的主要渠道在家中接触=0;互联网接触=1;同性酒吧、浴池以及同性茶楼等其他途径=2
最近六个月不专一性行为的有无无=0;有=1
是否和异性发生过性关系无=0;有=1
最近六个月,使用rush(或零号胶囊等类似物品)情况无=0;有=1
是否吸过毒无=0;有=1
心理特征
性取向同性恋=0;双性恋=1;不确定=2
安全套使用自我效能得分较低=0;中等=1;较高=2
艾滋病相关歧视得分较低=0;中等=1;较高=2
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基于可解释随机森林算法的MSM安全套使用现状及其影响因素分析
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杨碧辉 1 , 袁将 1 , 李娜 2 , 何佳 3 , 吐玛丽斯·卡依沙尔 1 , 梁姝 4 , 廖瑞平 2 , 冯善志 5 , 杨义 3 , 李苑 1
现代预防医学 | 流行病与统计方法 2025,52(12): 2133-2139
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现代预防医学 | 流行病与统计方法 2025, 52(12): 2133-2139
基于可解释随机森林算法的MSM安全套使用现状及其影响因素分析
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杨碧辉1, 袁将1, 李娜2, 何佳3, 吐玛丽斯·卡依沙尔1, 梁姝4, 廖瑞平2, 冯善志5, 杨义3 , 李苑1
作者信息
  • 1.成都中医药大学公共卫生学院,四川 成都 611137
  • 2.彭州市疾病预防控制中心
  • 3.成都中医药大学管理学院/健康四川研究院
  • 4.四川省疾病预防控制中心
  • 5.金堂县六色彩虹健康关爱服务中心
  • 杨碧辉(1998—),男,硕士在读,研究方向:流行病学与卫生统计学

    袁将(2001—),男,硕士在读,研究方向:流行病学与卫生统计学

通讯作者:

李苑和杨义为共同通信作者。李苑,Email:
杨义,Email:
Status and related factors of condom use among MSM based on random forest algorithm
Bi-hui YANG1, Jiang YUAN1, Na LI2, Jia HE3, TUMALISI Kayishaer1, Shu LIANG4, Rui-ping LIAO2, Shan-zhi FENG5, Yi YANG3 , Yuan LI1
Affiliations
  • School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202501086
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目的

分析MSM人群安全套坚持使用现状及影响因素,为艾滋病防控干预策略制定提供参考依据。

方法

2022年8—10月对四川成都281名MSM进行问卷调查,内容包括社会人口学信息、艾滋病相关服务、行为学以及心理状况等信息。采用随机森林算法对安全套坚持使用的影响因素进行降维并筛选,再利用SHAP分析对变量筛选后的随机森林模型进行解释。

结果

MSM最近6个月安全套坚持使用率为65.5%,当降维后变量数为7时,随机森林模型具有最佳的性能(AUC:0.834)。SHAP分析结果表明变量重要性及其SHAP绝对值的均值依次为安全套使用自我效能得分情况(0.079 0)、艾滋病相关歧视得分情况(0.051 3)、是否有过异性性行为(0.029 9)、居住情况(0.011 4)、最近六个月同性性伴寻找途径(0.007 8)、职业(0.004 8)以及性角色(0.002 6),其中,安全套使用自我效能得分较低、艾滋病相关歧视得分较高、有过异性性行为、在家中接触同性性伴的MSM安全套坚持使用情况较差,独居、职业为学生、性角色为两者都有的MSM安全套坚持使用情况较好。

结论

提高MSM的安全套使用自我效能,减少HIV相关歧视,重点关注并干预有异性性伴的MSM,以及经常在家中接触同性性伴的MSM可能有助于提高MSM的安全套坚持使用率。

MSM  /  安全套使用  /  自我效能  /  随机森林算法  /  SHAP分析  /  成都
Objective

To analyze the status quo and influencing factors of condom use in MSM population, and to provide reference for the formulation of intervention strategies.

Methods

From August to October 2022, a questionnaire survey was conducted among 281 MSM in Chengdu, Sichuan Province, including social demographic information, AIDS-related services, behavioral and psychological status. The random forest algorithm was used to reduce and screen the influencing factors of condom use, and then SHAP analysis was used to explain the random forest model after variable screening.

Results

The rate of consistent condom use among MSM in the past 6 months was 65.5 %. When the number of variables after dimensionality reduction was 7, the random forest model had the best performance (AUC: 0.834). The results of SHAP analysis showed that the mean value of the importance of variables and the absolute value of SHAP were the score of condoms use self-efficacy (0.079 0), the score of AIDS-related discrimination (0.051 3), whether there was heterosexual behavior (0.029 9), living conditions (0.011 4), the way to find homosexual partners in the last six months (0.007 8), occupation (0.004 8) and sexual role (0.002 6). MSM who had low condom use self-efficacy scores, high AIDS-related discrimination scores, had heterosexual sex, and had contact with same-sex partners at home had poor condom use adherence, while MSM who lived alone, were students, and had both sex roles had better condom use adherence.

Conclusion

Improving the condom use self-efficacy of MSM, reducing HIV-related discrimination, focusing on and intervening in MSM with heterosexual partners, and MSM who often contact with homosexual partners at home may help to improve the condom use rate of MSM.

MSM  /  Random forest algorithm  /  High-risk sexual behavior  /  Self-efficacy of condom use  /  SHAP analysis  /  Sichuan Chengdu
杨碧辉, 袁将, 李娜, 何佳, 吐玛丽斯·卡依沙尔, 梁姝, 廖瑞平, 冯善志, 杨义, 李苑. 基于可解释随机森林算法的MSM安全套使用现状及其影响因素分析. 现代预防医学, 2025 , 52 (12) : 2133 -2139 . DOI: 10.20043/j.cnki.MPM.202501086
Bi-hui YANG, Jiang YUAN, Na LI, Jia HE, TUMALISI Kayishaer, Shu LIANG, Rui-ping LIAO, Shan-zhi FENG, Yi YANG, Yuan LI. Status and related factors of condom use among MSM based on random forest algorithm[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2133 -2139 . DOI: 10.20043/j.cnki.MPM.202501086
艾滋病是严重危害人类身心健康以及全球公共卫生的问题。男男性行为者(men who have sex with men, MSM)的HIV(human immunodeficiency virus, HIV)感染率正在世界范围内逐渐上升[1],MSM是中国艾滋病感染的最高风险群体[2]。尽管正确且持续使用安全套已被证实是预防HIV传播最有效的方式[3],但MSM群体因存在特殊性行为模式(如肛交、多性伴侣等)以及复杂性角色特征(插入方/接受方的),导致其安全套坚持使用率偏低[4],Meta分析显示中国MSM的安全套坚持使用率仅为47%[5]。既往研究表明,MSM安全套使用行为受多维度的因素影响:个体层面涉及个人的性角色、性伴类型等因素;群体层面包括特定场所(同性酒吧、浴池等)的社交网络;认知层面涵盖安全套的使用知识、污名化感知等;行为层面涉及物质和药物使用(酒精、rush药物等)[6]。影响因素分析常用Logistic回归,可通过计算OR值来推断预测因子与结果之间的方向与程度,但在处理多变量数据时,容易出现模型复杂度过高并增加过拟合风险从而出现错误假设的问题[7]
随着机器学习技术在公共卫生领域的应用拓展,随机森林(RandomForest,RF)算法凭借其处理多变量预测及非线性关系的优势,在HIV感染预测中展现出卓越的性能[8-9],然而其“黑箱”特性制约了结果的可解释性[10]。SHAP分析(Shapley Additive Explanations,SHAP)可量化各变量对预测结果的边际贡献,从而弥补了RF模型在可解释性上的不足[11]。本研究旨在结合RF模型与SHAP分析,探讨MSM人群安全套坚持使用现状及影响因素,为提高MSM人群安全套坚持使用率、降低MSM人群的HIV感染率的干预政策制定提供参考依据。
本研究通过四川省疾病预防控制中心伦理委员会和成都中医药大学附属医院医学伦理委员会审查(编号:2022KL-057-01)。
MSM,纳入标准:①年龄大于18岁男性;②最近六个月内有过插入性口交或肛交同性性行为;③沟通交流无障碍;④自愿接受调查,并提供知情同意。排除标准为:①已接受过本轮调查;②精神病史。
2022年8月至10月之间在成都市及周边市区7个MSM社会组织(non-governmental organizations,NGO)固定检测处通过立意抽样、滚雪球抽样进行招募,借助社会组织微信公众号发布招募信息,每位调查对象至多推荐3名MSM参加本研究,NGO志愿者严格筛选剔除重复。样本含量计算公式如下:
π为MSM安全套坚持使用率,参考中国西部地区MSM相关研究,π取57.58%[12]α为0.05,μα(双侧检验)为1.96,δ为7%,计算出n=192。考虑到无效问卷不超过20%,样本为231人。最终,共招募286人,完成有效问卷281份,有效率98.25%。
调查对象签署知情同意书后,首先接受HIV抗体检测,然后在NGO志愿者指导下自填问卷,调查结束后,调查员立即检查是否有缺项和错项,并及时更正。基于前期相关课题及文献回顾,问卷包括:一般人口学信息、艾滋病相关服务情况、行为学信息及安全套使用情况、心理情况。
艾滋病相关服务情况:艾滋病相关宣传与服务接受、艾滋病检测以及艾滋病知识知晓情况,艾滋病知识知晓采用《全国艾滋病哨点监测实施方案》(2022年修订版)针对MSM的艾滋病知识题目,8个题目回答正确≥6道即为“知晓”;
行为学信息:包括最近6个月性伴寻找方式、性行为情况,Rush及毒品使用情况。与同性发生性行为时安全套使用情况:“从未使用”、“偶尔使用”和“经常使用”为未坚持使用安全套,“每次都用”为坚持使用安全套。
心理情况:包括性心理(如性取向)、安全套使用自我效能情况、艾滋病相关歧视情况。安全套使用自我效能借鉴Hanna博士设计的安全套使用自我效能量表CSES(Condom Self-Efficacy Scale ,CSES)[13],保留三个维度13个条目(Cronbach α=0.946),采用5分李克特量表,回答范围从1到5,得分范围从13~65分,分数越高表示安全套使用自我效能越好。艾滋病相关歧视借鉴Zelaya设计的量表[14],保留四个维度10个条目(Cronbach α=0.852),包括4个正向条目与6个负向条目,采用5分李克特量表,答案选项均为非常同意、同意、不确定、反对和非常反对。正向条目依次记为1、2、3、4、5分,负向则相反,得分范围从10~50分,得分越高,表示歧视越严重。
采用Epidata 3.1软件建立数据库并双输核查。使用SPSS 25.0软件进行描述性分析。定量变量采用均值和标准差描述,定性变量采用频率和构成比描述。使用R 4.4.2软件完成RF模型的变量排序、变量筛选、预测分析、模型评估以及SHAP分析。
281名MSM平均年龄31.10±11.38岁,25岁及以下者116名(占41.3%);农村户口153 名(占54.4%);未外出务工者187名(占66.5%);大专及以上学历者161名(占57.3%);个体服务或其他职业95名(占33.8%);未婚者195名(占69.4%);与家人一起居住者121名(占43.1%);个人月收入在1 000~4 999者146名(占52.0%);详见表1
281名MSM艾滋病知识知晓者占80.0%,曾接受过艾滋病相关知识宣传的占85.4%,接受艾滋病相关服务的占77.9%。HIV(+)24(8.5%)人,其中1人为新检测阳性;HIV(-)257(91.5%)人,257名HIV(-)MSM中25人报告此前从未进行过HIV抗体检测。详见表1
281名MSM性角色为两者都有者占40.9%(115名),与同性性伴的接触的主要渠道为在家中接触和互联网接触,分别占49.8%与42.0%,107人(38.1%)曾与异性伴侣发生过性关系,5人(1.8%)曾吸过毒。最近6个月中,172人(61.2%)有同性固定性伴,179人(63.9%)有同性临时性伴,98人(34.9)人有过不专一性行为(即在有固定性伴的情况下,仍与临时性伴发生了性行为),92人(32.7%)使用过Rush(或零号胶囊等类似物品),97人(34.5%)未坚持使用安全套。具体情况见表1
281名MSM性取向为同性恋者占64.4%(181名);安全套使用自我效能平均得分为48.41±11.77分,得分较高组为57~65分,中等组为45~56分,较低组为13~44分[15];艾滋病相关歧视平均得分为21.09±6.57分,得分较高组为25~39分,中等组组为17~24分,较低组为10~16分[15]。详见表1
281名MSM最近6个月坚持使用安全套的有184人,安全套坚持使用率为65.5%。
将所有变量纳入RF模型后(变量赋值见表2),基于RF模型的变量重要性排序情况详见图1,当变量数量为7时,拥有最低的袋外估算误差率(详见图2),此时RF模型具有最佳性能(AUC:0.834,详见图3),保留的变量为安全套使用自我效能得分情况、居住情况、职业、艾滋病相关歧视得分情况、是否有过异性性行为、最近六个月同性性伴寻找途径以及性角色。
采用SHAP分析对变量筛选后的RF模型进行可视化分析,结果如图4所示,纵轴表示各变量及其SHAP平均效应,按重要性大小自上而下排列,横轴表示SHAP值,SHAP值为正值代表该因素对因变量为正向影响,负值代表负向影响,散点颜色由紫色到黄色表示变量赋值由小到大,点的集合表示变量对预测结果整体方向及大小。结果显示:变量重要性及其SHAP绝对值的均值依次为安全套使用自我效能得分情况(0.079 0)、艾滋病相关歧视得分情况(0.051 3)、是否有过异性性行为(0.029 9)、居住情况(0.011 4)、最近六个月同性性伴寻找途径(0.007 8)、职业(0.004 8)以及性角色(0.002 6),其中,安全套使用自我效能得分较低、艾滋病相关歧视得分较高、有过异性性行为、在家中接触同性性伴的MSM最近六个月安全套坚持使用情况较差,而独居、职业为学生、性角色为两者的MSM最近六个月安全套坚持使用情况较好。
在本研究中MSM最近6个月安全套坚持使用率为65.5%,高于全国平均水平(47%)[5],但HIV患病率为8.5%,以既往感染为主,略高于既往哨点监测6%的结果[16]
本研究的结果显示,安全套使用自我效能是MSM安全套坚持使用的首要预测因子,得分较低的MSM安全套坚持使用率较低(32.9%),该指标综合反映安全套使用的决策自主性(主动提出使用安全套)、技能掌握度(能否正确使用安全套)以及沟通效能(与伴侣协商使用安全套)三个维度。当安全套使用协商被伴侣误解为忠诚度质疑时[3],低自我效能感的MSM更易回避继续沟通[4],导致无法坚持使用安全套。这提示未来干预需突破个体层面,对MSM伴侣双方进行联合干预,着力强化伴侣间关于安全套使用的沟通,以提高MSM的安全套使用自我效能。艾滋病相关歧视是本研究的另一重要预测因子,本研究中艾滋病相关歧视得分较高的MSM有着更低的安全套坚持使用率(47.6%),研究发现对艾滋病患者的歧视,同时担心对方认为自己感染HIV的矛盾的心理驱使MSM更有可能降低安全套使用意愿[17]。提示消除对艾滋病患者刻板的不良印象,减少对艾滋病的恐惧,降低艾滋病相关歧视是有效提高MSM安全套坚持使用的正确干预方向。本研究的结果显示,有过异性性行为的MSM安全套坚持使用率更低(48.6%),与近年我国东部地区研究结果相似[18],这类MSM是将艾滋病从高危的MSM人群向普通女性传播的“桥梁”人群[19],需重点精准干预。
本研究的结果还显示:独居MSM安全套坚持使用情况较好(71.3%)。考虑到独居MSM在日常生活中的决策较少受到他人的干扰,这可能使得他们在性行为决策上更具自主性,而独立生活环境又强化了他们对自身健康的管理能力,从而能在发生性行为时不受伴侣干扰地作出使用安全套的决策。本研究中,习惯在家中接触同性性伴的MSM安全套使用率较差(65.7%),熟悉的环境和熟悉的伴侣之间带来的“信任感”会降低安全套使用意愿[4],这一发现突破了传统公共场所干预模式,提示干预重心需由公共场所干预转移至居家干预。
本研究中,学生群体及双重性角色MSM的安全套坚持使用情况更好(76.0%,68.7%),与过往研究相异[20-21]。这一结果可能反映了近年来高校防艾活动的深入推广,使大学生在预防艾滋病传播方面的意识显著提高,并能够更有效地运用艾防知识加以自我保护[22],而由于双重性角色群体作为重点干预对象,往往接受更为频繁的检测与干预服务,从而在安全套使用行为上形成了正向反馈效应。这反应了精准干预工作的有效成果,未来还需继续根据新的研究成果对MSM特定风险特征和行为模式设计新的精准干预策略。
综上所述,提高MSM的安全套使用自我效能,减少HIV相关歧视,重点关注并干预有异性性伴的MSM,以及经常在家中接触同性性伴的MSM可能有助于提高MSM的安全套坚持使用率。本研究不足之处是横断面研究限制了对研究结果的因果解释。
  • 国家自然科学基金青年基金项目(81803300)
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2025年第52卷第12期
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doi: 10.20043/j.cnki.MPM.202501086
  • 接收时间:2025-01-06
  • 首发时间:2026-03-19
  • 出版时间:2025-06-25
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  • 收稿日期:2025-01-06
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国家自然科学基金青年基金项目(81803300)
作者信息
    1.成都中医药大学公共卫生学院,四川 成都 611137
    2.彭州市疾病预防控制中心
    3.成都中医药大学管理学院/健康四川研究院
    4.四川省疾病预防控制中心
    5.金堂县六色彩虹健康关爱服务中心

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2种不同金属材料的力学参数

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Percentage of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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