Page 118 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第2期
·264 · Journal of Nanjing Medical University（Natural Sciences） 2022年2月

·公共卫生与预防医学·

运用结构方程模型探索男男性行为人群心理因素对 HIV 暴露

前预防使用意愿和药物依从性影响

张 莹 ，闫红静 ，傅更锋 ，史灵恩 ，张钏沨 ，鲁华业 ，羊海涛 1*
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东南大学公共卫生学院，江苏 南京 210009；江苏省疾病预防控制中心性病艾滋病防制所，江苏 南京 210009
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［摘 要］ 目的：通过结构方程模型对男男性行为（men who have sex with men，MSM）人群心理量表数据进行分析，探索该人群
心理相关因素对HIV暴露前预防（pre⁃exposure prophylaxis，PrEP）使用意愿和药物依从性影响，为我国有效实施MSM人群PrEP
干预策略提供依据。方法：采用网络平台招募和时间场所抽样方法在南京市招募MSM人群，利用问卷星软件进行问卷调查。
采用结构方程模型对MSM人群HIV预期耻辱感、社会性向歧视和抑郁症状3个心理量表数据进行分析，探索其与PrEP使用意

愿和药物依从性之间的作用机制。结果：75.73%的调查对象愿意使用PrEP；55.34%自报能保持高药物依从性。调查对象HIV
预期耻辱感和社会性向歧视得分较高，中位数分别为20（17~23）和27（22~30），抑郁症状得分较低，中位数为1（0~2）。HIV预
期耻辱感对PrEP使用意愿与药物依从性存在直接正向作用，效应值分别为0.13（P < 0.05）和0.14（P < 0.05）。社会性向歧视负
向预测药物依从性（β=-0.15，P < 0.05）；抑郁症状在社会性向歧视与药物依从性之间起部分中介作用，效应值为 0.03（P <
0.01）。结论：MSM人群PrEP使用意愿度较高，但药物依从性较低。心理因素对MSM人群的PrEP使用意愿和药物依从性影响
显著，应将心理卫生服务与PrEP防治策略结合起来，更好发挥PrEP预防干预效果。
［关键词］ 结构方程模型；暴露前预防；男男性行为者；心理因素
［中图分类号］ R512.91 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）02⁃264⁃06
doi：10.7655/NYDXBNS20220220

Exploring the effects of psychological factors on willingness to use and adherence to HIV

pre⁃exposure prophylaxis among men who have sex with men by structural equation model
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ZHANG Ying ，YAN Hongjing ，FU Gengfeng ，SHI Ling’en ，ZHANG Chuanfeng ，LU Huaye ，YANG Haitao 1*
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1 Southeast University，School of Public Health，Nanjing 210009；STD/AIDS Prevention Center，Jiangsu Provincial
Center for Disease Control and Prevention，Nanjing 210009，China
［Abstract］ Objective：The structural equation model（SEM）was used to analyze the data of psychological scales to explore the
effects of these on willingness to use and adherence to HIV pre ⁃ exposure prophylaxis（PrEP）among men who have sex with men
（MSM），and to provide the basis for effective implementation of PrEP intervention strategy among MSM in China. Methods：Online
recruitment and time⁃location sampling（TLS）were used to recruit MSM in Nanjing. Questionnaire survey was filled by Questionnaire
Star software. Three psychological factors of anticipated HIV stigma，community homophobia and depressive symptoms were included
in the SEM to explore the mechanism of these interaction with willingness to use and adherence to PrEP among MSM. Results：There
were 75.73% of participants willing to use PrEP and 55.34% of participants self⁃reported high intention to adhere to PrEP. Participants
had high anticipated HIV stigma and community homophobia，with median 20（17~23）and 27（22~30），respectively，but had few
depression symptoms，with median 1（0~2）. Anticipated HIV stigma had a direct positive effect on willingness to use and adherence to
PrEP，with effect sizes of 0.13（P < 0.05）and 0.14（P < 0.05），respectively. Community homophobia negatively predicted PrEP
adherence（β=-0.15，P < 0.05）. Depression symptoms played a partially mediating role between community homophobia and PrEP
adherence，with an effect size of 0.03（P < 0.01）. Conclusion：High willingness to use PrEP，but low drug adherence were indicated
among MSM. Psychological factors had significant effects on the willingness to use and adherence to PrEP. Psychological services

［基金项目］ 美国国立卫生院（R21MH118945⁃01A1）
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通信作者（Corresponding author），E⁃mail：yanghtjscdc@163.com