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Article(id=1325530116956381598, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025268, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742400000000, receivedDateStr=2025-03-20, revisedDate=1753459200000, revisedDateStr=2025-07-26, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960607040, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960607040, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960607040, creator=13701087609, updateTime=1793960607040, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1323, endPage=1327, ext={EN=ArticleExt(id=1325530117174485407, articleId=1325530116956381598, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Analysis of risk prevention behaviors and influencing factors of HIV infection among young students with MSM, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the potential category patterns of risk prevention and control behaviors of HIV infection among young students who have sex with men (MSM) and their impact on HIV infection and late detection, aiming to optimize intervention strategies.

Methods

From September 2017 to December 2024, a total of 1 637 MSM young students in Tianjin were recruited through both online and offline channels. Latent class analysis was applied to classify 11 HIV risk prevention and control behaviors. Multivariate Logistic regression analyzed associations between demographic characteristics/intervention services factors and latent classes. Differences in HIV infection and late detection across behavior patterns were compared.

Results

HIV risk prevention and control behaviors among MSM students were classified into three latent classes: condom-dependent group (38.42%), low prevention group (27.73%), and comprehensive prevention group (33.85%). Students who received condom promotion/testing services were more likely to belong to the comprehensive prevention group (OR=5.58), while those who received peer education were less likely to the comprehensive prevention group (OR=0.43) (both P < 0.01). Among the MSM student population, the HIV infection rate was 4.83%, with 2.26% of cases detected late. The HIV infection rate (1.45%) and late detection proportion (0.82%) in the comprehensive prevention group were lower than those in the low prevention group (7.89% and 3.83%, respectively) (χ2=16.20, 7.31, both P < 0.01).

Conclusions

HIV risk prevention and control behaviors among MSM young students exhibit significant heterogeneity. Comprehensive prevention strategies can effectively reduce HIV infection and late detection risks. It is necessary to optimize peer education content and improve the accessibility of diversified prevention measures such as PrEP/PEP to enhance HIV prevention and control.

, authors=Xiaoyan ZHANG1, Yuanyuan LIU1, Jingran DONG1, Zhan LIN1, Junfeng ZHANG1, Jie YANG2, Maohe YU3, Changping LI*, 1, Zhuang CUI1, authorsList=Xiaoyan ZHANG, Yuanyuan LIU, Jingran DONG, Zhan LIN, Junfeng ZHANG, Jie YANG, Maohe YU, Changping LI, Zhuang CUI, authorCompany=null, correspAuthors=Changping LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325530117921071522, articleId=1325530116956381598, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=男男性行为青年学生感染HIV风险防控行为及影响因素分析, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

探讨男男性行为(MSM)青年学生感染人类免疫缺陷病毒(HIV)风险防控行为的潜在类别模式及其对HIV感染和晚发现的影响，为优化干预策略提供依据。

方法

2017年9月至2024年12月，通过线上、线下相结合方式招募天津市1 637名MSM青年学生，运用潜在类别分析对11项HIV风险防控行为进行分类。通过多因素Logistic回归分析人口学特征和干预服务情况与潜在类别的关联，同时比较不同行为模式在HIV感染及晚发现上的差异。

结果

MSM学生的HIV风险防控行为可分为安全套依赖组(38.42%)、低预防组(27.73%)和综合预防组(33.85%)。接受安全套宣传/检测服务的学生更可能属于综合预防组(OR=5.58)，而接受同伴教育的学生属于综合预防组的可能性更低(OR=0.43)(P值均 < 0.01)。学生MSM人群中，HIV感染率为4.83%，晚发现感染者占2.26%；综合预防组HIV感染率(1.45%)和晚发现病例比例(0.82%)均低于低预防组(7.89%，3.83%)(χ2值分别为16.20，7.31，P值均 < 0.01)。

结论

MSM青年学生的HIV风险防控行为存在较大的异质性，综合预防策略可有效降低HIV感染及晚发现风险；但需优化同伴教育内容，加强PrEP/PEP等多元化预防措施的可及性，以提升HIV防控效果。

, authors=张晓燕1, 刘媛媛1, 董静然1, 蔺展1, 张峻峰1, 杨杰2, 于茂河3, 李长平*, 1, 崔壮1, authorsList=张晓燕, 刘媛媛, 董静然, 蔺展, 张峻峰, 杨杰, 于茂河, 李长平, 崔壮, authorCompany=null, correspAuthors=李长平, authorNote=

张晓燕(2000-)，女，内蒙古巴彦淖尔人，在读硕士，主要研究方向为流行病与卫生统计学

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李长平，E-mail:
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张晓燕(2000-)，女，内蒙古巴彦淖尔人，在读硕士，主要研究方向为流行病与卫生统计学

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Int J STD AIDS, 2020, 31(11): 1040-1046., articleTitle=null, refAbstract=null), Reference(id=1325530124124447236, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530116956381598, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=25, rfOrder=28, authorNames=null, journalName=null, refType=null, unstructuredReference=BOERING P, SEELEY J, BUULE J, et al. A comparison of self-reported condomless sex and yc-DNA biomarker data from young women engaged in high risk sexual activity in Kampala, Uganda[J]. 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Model fit indices for latent class analysis of HIV risk prevention and control behaviors among MSM young students(n=1 637)

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类别AIC值BIC值CAIC值aBIC值Entropy值PLMR值PBLRT值类别概率
14 268.084 327.494 338.494 292.54————
22 111.282 235.492 258.492 162.420.88< 0.01< 0.010.64/0.36
31 678.341 867.361 902.361 756.170.91< 0.01< 0.010.28/0.38/0.34
41 460.401 714.231 761.231 564.920.890.01< 0.010.22/0.14/0.37/0.27
51 290.681 609.321 668.321 421.880.89< 0.09< 0.010.19/0.36/0.27/0.07/0.11
), ArticleFig(id=1325530121733693924, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530116956381598, language=CN, label=表1, caption=

MSM青年学生HIV风险防控行为潜在类别分析拟合指标(n=1 637)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AIC值BIC值CAIC值aBIC值Entropy值PLMR值PBLRT值类别概率
14 268.084 327.494 338.494 292.54————
22 111.282 235.492 258.492 162.420.88< 0.01< 0.010.64/0.36
31 678.341 867.361 902.361 756.170.91< 0.01< 0.010.28/0.38/0.34
41 460.401 714.231 761.231 564.920.890.01< 0.010.22/0.14/0.37/0.27
51 290.681 609.321 668.321 421.880.89< 0.09< 0.010.19/0.36/0.27/0.07/0.11
), ArticleFig(id=1325530121809191397, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530116956381598, language=EN, label=Tab.2, caption=

Univariate analysis of latent classes of HIV risk prevention and control behaviors among MSM young students

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数民族婚姻状况受教育水平居住状态
汉族少数民族单身非单身高中及以下大专或本科硕士及以上≥6个月< 6个月
安全套依赖组629604(96.03)25(3.97)623(99.05)6(0.95)23(3.66)499(79.33)107(17.01)595(94.59)34(5.41)
低预防组454438(96.48)16(3.52)453(99.78)1(0.22)21(4.63)360(79.30)73(16.08)430(94.71)24(5.29)
综合预防组554533(96.21)21(3.79)548(98.92)6(1.08)11(1.99)422(76.17)121(21.84)539(97.29)15(2.71)
合计1 6371 575(96.21)62(3.79)1 624(99.21)13(0.79)55(3.36)1 281(78.25)301(18.39)1 564(95.54)73(4.46)
χ2值0.152.6911.466.04
P值0.910.260.030.05
组别人数性取向HIV/AIDS知识水平接受安全套宣传和发放/艾滋病咨询与检测接受同伴教育近1年是否感染梅毒
同性恋双性恋良好一般是否是否是否
安全套依赖组629601(95.55)28(4.45)42(6.68)587(93.32)384(61.05)245(38.95)261(41.49)368(58.51)7(1.11)622(98.89)
低预防组454434(95.59)20(4.41)37(8.15)417(91.85)233(51.32)221(48.68)161(35.46)293(64.54)9(1.98)445(98.02)
综合预防组554538(97.11)16(2.89)18(3.25)536(96.75)462(83.39)92(16.61)217(39.17)337(60.83)12(2.17)542(97.83)
合计1 6371 573(96.09)64(3.91)97(5.93)1 540(94.07)1 079(65.91)558(34.09)639(39.03)998(60.97)28(1.71)1 609(98.29)
χ2值2.3311.79124.994.042.22
P值0.30< 0.01< 0.010.130.32
), ArticleFig(id=1325530121909854694, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530116956381598, language=CN, label=表2, caption=

MSM青年学生HIV风险防控行为潜在类别的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数民族婚姻状况受教育水平居住状态
汉族少数民族单身非单身高中及以下大专或本科硕士及以上≥6个月< 6个月
安全套依赖组629604(96.03)25(3.97)623(99.05)6(0.95)23(3.66)499(79.33)107(17.01)595(94.59)34(5.41)
低预防组454438(96.48)16(3.52)453(99.78)1(0.22)21(4.63)360(79.30)73(16.08)430(94.71)24(5.29)
综合预防组554533(96.21)21(3.79)548(98.92)6(1.08)11(1.99)422(76.17)121(21.84)539(97.29)15(2.71)
合计1 6371 575(96.21)62(3.79)1 624(99.21)13(0.79)55(3.36)1 281(78.25)301(18.39)1 564(95.54)73(4.46)
χ2值0.152.6911.466.04
P值0.910.260.030.05
组别人数性取向HIV/AIDS知识水平接受安全套宣传和发放/艾滋病咨询与检测接受同伴教育近1年是否感染梅毒
同性恋双性恋良好一般是否是否是否
安全套依赖组629601(95.55)28(4.45)42(6.68)587(93.32)384(61.05)245(38.95)261(41.49)368(58.51)7(1.11)622(98.89)
低预防组454434(95.59)20(4.41)37(8.15)417(91.85)233(51.32)221(48.68)161(35.46)293(64.54)9(1.98)445(98.02)
综合预防组554538(97.11)16(2.89)18(3.25)536(96.75)462(83.39)92(16.61)217(39.17)337(60.83)12(2.17)542(97.83)
合计1 6371 573(96.09)64(3.91)97(5.93)1 540(94.07)1 079(65.91)558(34.09)639(39.03)998(60.97)28(1.71)1 609(98.29)
χ2值2.3311.79124.994.042.22
P值0.30< 0.01< 0.010.130.32
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男男性行为青年学生感染HIV风险防控行为及影响因素分析
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张晓燕 1 , 刘媛媛 1 , 董静然 1 , 蔺展 1 , 张峻峰 1 , 杨杰 2 , 于茂河 3 , 李长平 *, 1 , 崔壮 1
中国学校卫生 | 疾病控制 2025,46(9): 1323-1327
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中国学校卫生 |疾病控制 2025 , 46 (9) : 1323 -1327
男男性行为青年学生感染HIV风险防控行为及影响因素分析
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张晓燕1, 刘媛媛1, 董静然1, 蔺展1, 张峻峰1, 杨杰2, 于茂河3, 李长平*, 1 , 崔壮1
作者信息
  • 1天津医科大学公共卫生学院流行病与卫生统计学系，天津 300070
  • 2天津深蓝公共卫生咨询服务中心，天津 300070
  • 3天津市疾病预防控制中心性病艾滋病预防控制所，天津 300070
通讯作者:
李长平，E-mail:
作者简介:

张晓燕(2000-)，女，内蒙古巴彦淖尔人，在读硕士，主要研究方向为流行病与卫生统计学

Analysis of risk prevention behaviors and influencing factors of HIV infection among young students with MSM
Xiaoyan ZHANG1, Yuanyuan LIU1, Jingran DONG1, Zhan LIN1, Junfeng ZHANG1, Jie YANG2, Maohe YU3, Changping LI*, 1 , Zhuang CUI1
Affiliations
  • 1Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025268
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摘要
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目的

探讨男男性行为(MSM)青年学生感染人类免疫缺陷病毒(HIV)风险防控行为的潜在类别模式及其对HIV感染和晚发现的影响，为优化干预策略提供依据。

方法

2017年9月至2024年12月，通过线上、线下相结合方式招募天津市1 637名MSM青年学生，运用潜在类别分析对11项HIV风险防控行为进行分类。通过多因素Logistic回归分析人口学特征和干预服务情况与潜在类别的关联，同时比较不同行为模式在HIV感染及晚发现上的差异。

结果

MSM学生的HIV风险防控行为可分为安全套依赖组(38.42%)、低预防组(27.73%)和综合预防组(33.85%)。接受安全套宣传/检测服务的学生更可能属于综合预防组(OR=5.58)，而接受同伴教育的学生属于综合预防组的可能性更低(OR=0.43)(P值均 < 0.01)。学生MSM人群中，HIV感染率为4.83%，晚发现感染者占2.26%；综合预防组HIV感染率(1.45%)和晚发现病例比例(0.82%)均低于低预防组(7.89%，3.83%)(χ2值分别为16.20，7.31，P值均 < 0.01)。

结论

MSM青年学生的HIV风险防控行为存在较大的异质性，综合预防策略可有效降低HIV感染及晚发现风险；但需优化同伴教育内容，加强PrEP/PEP等多元化预防措施的可及性，以提升HIV防控效果。

同性恋，男性  /  人免疫缺陷病毒蛋白质类  /  行为  /  回归分析  /  学生
Objective

To explore the potential category patterns of risk prevention and control behaviors of HIV infection among young students who have sex with men (MSM) and their impact on HIV infection and late detection, aiming to optimize intervention strategies.

Methods

From September 2017 to December 2024, a total of 1 637 MSM young students in Tianjin were recruited through both online and offline channels. Latent class analysis was applied to classify 11 HIV risk prevention and control behaviors. Multivariate Logistic regression analyzed associations between demographic characteristics/intervention services factors and latent classes. Differences in HIV infection and late detection across behavior patterns were compared.

Results

HIV risk prevention and control behaviors among MSM students were classified into three latent classes: condom-dependent group (38.42%), low prevention group (27.73%), and comprehensive prevention group (33.85%). Students who received condom promotion/testing services were more likely to belong to the comprehensive prevention group (OR=5.58), while those who received peer education were less likely to the comprehensive prevention group (OR=0.43) (both P < 0.01). Among the MSM student population, the HIV infection rate was 4.83%, with 2.26% of cases detected late. The HIV infection rate (1.45%) and late detection proportion (0.82%) in the comprehensive prevention group were lower than those in the low prevention group (7.89% and 3.83%, respectively) (χ2=16.20, 7.31, both P < 0.01).

Conclusions

HIV risk prevention and control behaviors among MSM young students exhibit significant heterogeneity. Comprehensive prevention strategies can effectively reduce HIV infection and late detection risks. It is necessary to optimize peer education content and improve the accessibility of diversified prevention measures such as PrEP/PEP to enhance HIV prevention and control.

Homosexuality, male  /  Human immunodeficiency virus proteins  /  Behavior  /  Regression analysis  /  Students
张晓燕, 刘媛媛, 董静然, 蔺展, 张峻峰, 杨杰, 于茂河, 李长平, 崔壮. 男男性行为青年学生感染HIV风险防控行为及影响因素分析. 中国学校卫生, 2025 , 46 (9) : 1323 -1327 . DOI: 10.16835/j.cnki.1000-9817.2025268
Xiaoyan ZHANG, Yuanyuan LIU, Jingran DONG, Zhan LIN, Junfeng ZHANG, Jie YANG, Maohe YU, Changping LI, Zhuang CUI. Analysis of risk prevention behaviors and influencing factors of HIV infection among young students with MSM[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1323 -1327 . DOI: 10.16835/j.cnki.1000-9817.2025268
正文
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艾滋病又称获得性免疫缺陷综合征(acquired immune deficiency syndrome, AIDS)，由人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染引起，目前仍无有效治愈方法，是21世纪重大公共卫生问题之一。男男性行为(men who have sex with men, MSM)者是HIV感染的高危人群，联合国艾滋病规划署2021年公布的数据显示，2020年全球23%的HIV新发感染发生在MSM群体中[1]。
2023年新报告青年学生HIV感染者中84.7%为男性同性传播[2]，MSM成为青年学生传播和感染HIV的最主要途径。研究表明，大学生MSM群体处于性活跃期与社会角色转型的交汇点，普遍存在安全套使用率不稳定、HIV检测意识不足等问题，加之社会污名化与心理健康压力，进一步加剧了感染风险[3]。此外，HIV晚发现感染者(就诊时CD4细胞计数 < 350个/μL或出现艾滋病定义性事件)因病耻感与检测服务可及性等原因延误检测[4]，其住院风险与死亡率较非晚发现者升高，且治疗费用增加近2倍，进一步加剧了个体与公共卫生负担[4-6]。潜在类别分析(latent class analysis，LCA)作为一种无监督的统计方法[7]，通过识别观察变量背后的潜在类别，能够揭示不同亚群体在HIV风险防控行为上的系统性差异。本研究通过LCA方法对学生MSM群体的HIV风险防控行为进行分类，识别潜在行为模式，并分析其对HIV感染及晚发现的影响，为制定更具针对性的HIV预防干预策略提供理论依据。
1　对象与方法
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1.1　对象
2017年9月至2024年12月，依托天津深蓝公共卫生咨询服务中心通过线上、线下相结合方式招募天津市青年学生MSM。根据文献资料[8-9]，中国MSM青年学生的HIV感染率为2.9%~5.2%，本研究以该感染率范围的最低值(2.9%)和最高值(5.2%)作为两组风险防控行为模式人群感染率，设定α=0.05，检验效能为80%，估计最少需要1 172个样本。招募方式：线下在咨询检测服务中向参与者提供免费安全套、润滑剂，并鼓励其推荐同伴及圈内好友加入研究；线上通过交友软件和男同论坛发布招募信息。纳入标准：年龄≥16岁，过去6个月中至少与1名男性发生过性行为，当前主要职业为学生；排除标准：社会人口学特征等缺失。最终共纳入青年学生MSM群体1 637人作为研究对象，年龄21.78(20.42~23.30)岁。本研究经天津医科大学伦理委员会审查和批准(批号: TMUhMEC2021010)，所有参与者均自愿参加、签署知情同意书。
1.2　方法
1.2.1　调查问卷
内容包括社会人口学特征[年龄、民族、婚姻状况、受教育水平、居住状态(天津市连续居住的时间)等]、性行为特征(性取向、首次同性性行为年龄)、HIV风险防控行为[近6个月最近1次肛交使用安全套，近6个月肛交坚持使用安全套，使用水性润滑剂，禁用娱乐药物，定期现场专业检测，固定性伴，伴侣检测，了解性伴HIV检测结果，性行为前检测，核酸检测，使用暴露前预防(pre-exposure prophylaxis, PrEP)/暴露后预防(post-exposure prophylaxie, PEP)]、HIV/AIDS知识水平(8题测试中，正确回答≥7题即视为HIV/AIDS知识水平良好[10])、接受HIV相关干预服务情况(接受安全套宣传和发放/AIDS咨询与检测、接受同伴教育)、近一年是否感染梅毒以及HIV检测结果。
1.2.2　调查过程
首先采集调查对象右手食指指纹，并赋予唯一指纹编码以实现匿名化管理，随后由调查员开展面对面问卷调查。
调查完成后由具备采血资质的专业人员采静脉血后送实验室进行HIV检测：采用北京万泰生物快速检测试剂进行初筛，阳性样本以珠海丽珠酶联免疫吸附试验复验，复验阳性者通过新加坡MP生物医学公司(MP Biomedicals)的免疫印迹试验试剂确证，确证不确定或阴性样本进一步用罗氏病毒载量检测试剂进行定量核酸试验；初筛及复验无反应样本则实施集合核酸试验。所有调查人员均完成统一培训课程(含伦理规范、问卷逻辑校验及生物安全操作)，并通过理论与实操考核；问卷由天津市疾病预防控制中心专业人员经严格论证后制定，在预试验中验证其信、效度(Cronbach α=0.85，KMO=0.80)后投入正式调查。
1.3　质量控制
在调查实施前，对所有调查员和采血人员进行了统一的标准化培训，培训内容涵盖研究伦理规范、问卷询问技巧、逻辑校验要点及静脉血采集与保存的生物安全操作规程，通过考核后方可参与调查。所有问卷均由调查员现场审核后即时回收，确保填写的完整性与逻辑一致性。生物样本检测过程中严格遵循标准操作程序：使用具有国家批号的试剂，初筛、复验、确证试验均由经验丰富的专业人员操作，并定期对实验室进行质控考核。数据收集后进行双人独立录入与比对，并对所有变量的合理范围进行逻辑核查，以确保数据录入的准确性。
1.4　统计学分析
通过指纹编码识别调查对象，选取其末次或确证HIV阳性时的调查情况进行分析。问卷分别采用EpiData 3.1软件、R软件和SAS 9.4软件进行数据录入、整理与描述及LCA。使用PROC LCA对11项HIV风险防控行为进行分类，研究从一个类别模型开始，逐步增加至5个类别以确定最佳分类。
基于所获得的最佳潜类别模型，使用LCA Covariates 3-Step宏分析人口学等特征与潜在类别的关联。首先通过单变量分析(筛选阈值P < 0.2)[11]筛选协变量，采用逐步回归法进行多因素Logistic回归分析。通过LCA Distal BCH宏，基于调整的χ2检验评估不同行为模式组间HIV感染及晚发现比例的差异，结果以比值比(OR)和95%置信区间(95%CI)呈现。2个SAS宏均采用Vermunt三步法进行LCA模型的协变量与结局变量建模[12]。其中HIV晚发现病例比例定义为确诊时已处于晚发现阶段的HIV感染者人数占全部MSM学生的比例。LCA模型适配检验指标包括似然比χ2统计量(G2)、对数似然值(log-likelihood, LL)检验和信息评价指标。信息评价指标主要有赤池信息准则(akaike information criterion, AIC)、贝叶斯信息准则(Bayesian information criterion, BIC)、样本校正贝叶斯信息准则(adjusted Bayesian information criterion, aBIC)、一致的Akaike信息准则(consistent Akaike information criterion, CAIC)。分类精确度用熵值(Entropy)进行衡量，熵值范围在0~1，取值越接近1，说明分类准确度越高[13-14]。检验水准α=0.05。
2　结果
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2.1　MSM学生HIV风险防控行为潜在类别模型的拟合与选择
对11项HIV风险防控行为进行LCA，1~5个类别的拟合评价指标见表1。三类别模型Entropy值为0.91，是5个类别中分类准确性最高且三类别在行为模式上区分更清晰，可解释性强，因此最终选择三类别为最佳类别。根据HIV风险防控行为在3个潜在类别上的条件概率, 分别命名为安全套依赖组(629名，38.42%)、低预防组(454名，27.73%)和综合预防组(554名，33.85%)。安全套依赖组以近6个月最近1次肛交使用安全套、近6个月肛交坚持使用安全套两项行为的概率较高为特征；低预防组在11项风险防控行为上的条件概率均处于较低水平；综合预防组在定期现场专业检测、伴侣检测、性行为前检测等多项措施上表现出较高概率，但使用PrEP/PEP的条件概率仍低于0.20。见图1。
2.2　MSM学生HIV风险防控行为潜类别的单因素分析
单因素分析结果显示，安全套依赖组、低预防组、综合预防组MSM学生受教育水平、居住状态、HIV/AIDS知识水平、接受安全套宣传和发放/AIDS咨询与检测和接受同伴教育与HIV风险防控行为的关联均有统计学意义(P值均 < 0.05)。见表2。
以HIV风险防控行为的潜在类别为因变量(以安全套依赖组为参照组)，通过多因素Logistic回归分析其与人口学特征和干预服务情况的关系，结果显示，接受安全套宣传和发放/艾滋病咨询与检测的MSM学生属于低预防组的可能性更低(OR=0.65，95%CI=0.47~0.91)，属于综合预防组的可能性更高(OR=5.58，95%CI=3.96~7.87)；而接受同伴教育的学生属于综合预防组的可能性更低(OR=0.43，95%CI=0.32~0.57)(P值均 < 0.01)。
2.3　HIV风险防控行为潜类别与MSM青年学生HIV感染及晚发现的关联
在1 637名学生MSM中，HIV感染率为4.83%(79名)，HIV晚发现感染者占2.26%(37名)。为减少潜在类别分类不确定性带来的偏倚，本研究采用BCH法对HIV感染及晚发现比例进行了加权调整，结果显示不同HIV风险防控行为模式在HIV感染上差异有统计学意义，综合预防组的HIV感染率最低(1.45%，95%CI=0.36%~2.54%)，且低于安全套依赖组(5.65%，95%CI=3.80%~7.50%)和低预防组(7.89%，95%CI=5.36%~10.43%)(χ2值分别为10.52，16.20，P值均 < 0.01)。在HIV晚发现方面，综合预防组的晚发现病例占全部MSM学生人群的比例最低(0.82%，95%CI=0.01%~1.64%)，与安全套依赖组(2.41%，95%CI=1.45%~4.00%)的差异无统计学意义(χ2=3.52，P=0.06)，而与低预防组(3.83%，95%CI=2.03%~5.64%)的差异有统计学意义(χ2=7.31，P < 0.01)。
3　讨论
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本研究通过LCA将1 637名MSM学生的HIV风险防控行为分为“安全套依赖组”“低预防组”和“综合预防组”三类行为模式，差异源于社会文化压力、结构性资源可及性与经济状况等多重因素。LCA结果显示，即便在综合预防组中，使用PrEP/PEP的后验概率仍低于0.20，尽管PrEP/PEP被证明在降低HIV传播风险方面具有显著效果，但中国学生MSM群体PrEP的实际使用率仅13.8%[15]。这种依赖安全套而忽视新型预防手段的现象，提示同性恋身份带来的隐性压力(社会偏见、歧视等)，使其规避需要机构介入的措施(HIV检测、PrEP/PEP等)[16-17]，转而强化自主可控的传统防护手段(安全套)。正如既往研究所示，部分性少数群体因心理健康问题难以预约检测或获取PrEP，依赖自主防护以避免触发心理创伤[18]。此外，学生的行为选择受各类结构性资源(如医疗服务、政策支持)的可及性与经济因素的影响，一方面校园HIV检测服务的便捷度、对PrEP的支持政策，直接影响MSM学生对多元预防手段的接触机会[19]；另一方面学生经济收入有限，HIV检测、PrEP的长期费用阻碍其采取行动，经济不稳定还可能影响其对长期检测、药物治疗等预防措施的持续参与。
本研究发现，接受安全套宣传/艾滋病咨询与检测服务的学生更可能属于综合预防组，而接受同伴教育并未有效提升学生采取综合预防策略的可能性，这可能反映当前同伴教育内容未能有效推广安全套之外的预防措施。同伴教育效果因群体特征与教育内容而异。教育内容的系统性设计直接影响知识传递效果，内容简化会导致参与者对安全套使用、病毒传播途径等关键信息理解偏差，弱化效果[20]。例如，若未系统讲解PrEP的适应症与副作用，可能会使高风险群体误判感染风险[21]，导致预防措施选择偏差(如过度依赖单一预防手段)。
本研究还发现，综合预防组的HIV感染率(1.45%)低于安全套依赖组和低预防组，其HIV晚发现病例比例(0.82%)也低于低预防组，表明多元化预防策略能够有效降低HIV感染风险并避免HIV晚发现，结果与南非一项研究一致，即结合行为干预(如安全套推广、社区教育)与生物医学手段(PrEP、定期检测)，感染率可降至基线水平的50%以下[22]。作为最易实现的预防手段，单一依赖安全套(安全套依赖组感染率为5.65%)虽能减少感染率，但无法完全规避其他风险(如安全套破裂、润滑剂使用不当等)[23-25]，因此需结合多层次预防策略提高整体防护效果。
本研究也存在一定的局限性：首先，数据收集跨越2017—2024年，期间PrEP/PEP等策略普及可能对行为产生潜在影响，分析时虽采用个体末次调查数据反映最新行为状态，但外部环境的动态变化仍可能干扰行为模式与HIV感染/晚发现的关联。未来需通过纵向设计，控制不同时期防控措施的影响，以验证风险行为动态变化的长期效应。其次，数据来源于天津市MSM学生，可能受地域文化、检测服务可及性等因素影响，限制了结论的外推性。最后，性行为与风险防控行为依赖参与者主观报告，可能存在信息偏倚。
综上所述，学生MSM群体的HIV风险防控行为模式具有较大异质性，不同行为模式与HIV感染及晚发现的风险密切相关。提示现有同伴教育措施可能存在一定局限性，而综合预防策略的实施可降低HIV感染的风险并减少晚发现可能。因此，针对学生MSM群体，可能需要在教育内容上进一步多样化，同时加强PrEP/PEP等新型预防手段的普及和可及性。此外，如何通过政策支持降低HIV预防措施的经济负担，也可能是提高该群体防控效果的关键因素。
基金
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  • 国家自然科学基金面上项目(72374153)
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025268
  • 接收时间：2025-03-20
  • 首发时间：2026-11-06
  • 出版时间：2025-09-25
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  • 收稿日期：2025-03-20
  • 修回日期：2025-07-26
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国家自然科学基金面上项目(72374153)
作者信息
    1天津医科大学公共卫生学院流行病与卫生统计学系，天津 300070
    2天津深蓝公共卫生咨询服务中心，天津 300070
    3天津市疾病预防控制中心性病艾滋病预防控制所，天津 300070

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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