計畫編號：DOH94-DC-1031

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7 years ago
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1 DOH94-DC

3 HIV (STDs/HIV) 3. Moos person-environment theory (pilot study) HIV / 94 HIV 7.6%(9/118) TPHA 16.9%(20/118) (2004 ) %(65/103) %(67/101) %(16/103) %(18/104) - 1 -

4 Abstract Backgrounds: Gay bathhouses have been identified as public venues where MSM are more likely to engage in risky sexual behaviors and have been the targets of public venues for the transmission of HIV and STIs among MSM. Study Aims: This study aimed to 1) investigate the inner gay bathhouse environments, 2) develop structural intervention for gay bathhouses, and 3) test the feasibility of conducting the structural intervention. Methods: An ecological study was conducted at eight gay bathhouses, including 16 staffs and 118 bathhouse attendees. Results: The eight bathhouses provided condoms and anonymous HIV testing to attendees. However, distribution of lubrications and HIV/STD prevention education needed to be improved in gay bathhouses. The places where HIV/STD prevention intervention distributed in gay bathhouses are different to sexual venues where bathhouse attendees conducting sexual activities. Only three bathhouse owners knew the updated bathhouse regulation policy to mandate free condom for all bathhouses consumers provided by bathhouses. The pilot study indicated that seroprevalence rates of anti-hiv-1 antibody and specific Treponema pallidum antibodies detected by haemagglutination assay, were 7.6% (9/118) and 16.9%(20/118), respectively. The percentage of condom use in this study is higher than last year. Study showed that 18 men (17.3%) reported having oral sex exclusively with condom use, and 67 (66.3%) had anal intercourse exclusively with condom use. Conclusion: This study is the first collaborative study with gay bathhouse owners and NGOs to develop a structural intervention for gay bathhouses in Taiwan. The pilot study findings indicated promising future for conducting structural intervention in other gay bathhouses across the three major cities next year in Taiwan. Keywords: structural intervention, STD/HIV prevention, and gay bathhouse - 2 -

Study Aims: This study aimed to 1) investigate the inner gay bathhouse environments, 2) develop structural intervention for gay bathhouses, and 3) test the feasibility of conducting the structural

5 HIV (men sex with men, MSM) HIV WHO/UNAIDS 1 HIV 10% HIV 2 HIV 40-70% 2, HIV 36.2% / HIV 5-10% ( ) 4 (sexual transmitted diseases, STDs) %-35.1% 2.7% 8.7%-3% B 36% A 34.1% C % HIV HIV A/B/C

6 13 HIV STDs/HIV STDs/HIV HIV 1998 (outreach program) HIV HIV %(22/138) HIV 9.5 (32/337) 13.1%(44/337) HIV %(21/148) 29.7% HIV 5.5 (17/310) 9.4 (29/310) 20 STDs/HIV : 23.1% 49.9% 17, 78.4% 18 (STDs/HIV)

1%(44/337) 18 2001 HIV-1 14.2%(21/148) 29.7% 19 2002 HIV 5.

7 21 (STDs/HIV) 22 (individual-level intervention) HIV (structural-level intervention) STDs/HIV STDs/HIV 1. (accessibility) 2. (physical structure) 3. (social structure) 4. (media message) 22 ( ) ( ) STDs/HIV - 5 -

8 21 ( ) 23 STDs/HIV STDs/HIV STDs/HIV Moos person-environment theory 1. ( ) ( ) ( ) ( HIV ) - 6 -

10 ( ) Rudolf Moos person-environment theory STDs/HIV 24 Moos 1. (supra personal) 2. (institutional context) 3. (physical features) / ( ) 4. (policies and services) ( ) - 8 -

11 (STDs/HIV ) 25 Moos (social climate) 24, 25 Moos ( ) STDs/HIV ( ) Moos person-environment - 9 -

12 theory ( )

13 - 11 -

14 Moos person-environment theory 1. (supra personal) 2. (institutional context) 3. (physical features) 4. (policies and services) (supra personal) (institutional context)

15 (physical features) / OK / / ( ) /

16 HIV (policies and services) HIV

17 - 15 -

18 (1)

19 (2) ( ) (3) (4) (93 ) (5) (SD+ 7) HIV TPHA (2004 ) ( ) 9 PA (Passive Particle Agglutination Assay) HIV 7.6%(9/118) 20 T. pallidum haemagglutination (TPHA) assay 1:160 TPHA 16.9% (20/118) 20 TPHA 4 (20%) rapid plasma reagin test (RPR Card Test) 1:4 6 (5.7%, 6/105) 11 (10.3%, 11/107) ( )

20 %(65/103) %(67/101) %(16/103) %(18/104)

21 HIV % ( ) ( ) STDs/HIV

22 63.1% 15.5% HIV, TPHA ( ) / /

23 16 HIV / 94 HIV 7.6%(9/118) TPHA 16.9%(20/118) (2004 ) %(65/103) %(67/101) %(16/103) %(18/104)

24 . HIV/STD n, (%) n, (%) 8 0 (0.0) 7 (87.5) 8 4 (50) 0 (0.0) 8 8 (100) 0 (0.0) 8 5 (62.5) 0 (0.0) 8 0 (0.0) 3 (37.5) 8 8 (100) 0 (0.0) 8 0 (0.0) 1 (12.5) 8 0 (0.0) 4 (50) 8 0 (0.0) 1 (12.5) 3 1 (66.6) 0 (0.0) 1 0 (0.0) 0 (0.0) 8 7 (87.5) 0 (0.0) OK 5 0 (0.0) 0 (0.0) / 7 2 (28.6) 0 (0.0) 5 0 (0.0) 0 (0.0) 3 2 (66.7) 0 (0.0)

25 . / Total / A B C F G H D E

26 HIV/THPA No/N, (%) No/N, (%) HIV-1 12/111(10.8) 9/118(7.6) X 2 p TPHA 23/107(21.5) 20/118(16.9) History of STD 10/100(10.0) 19/122(15.2) Illicit drug use 11/107(10.3) 6/105(5.7) Consistent use condom during anal intercourse 65/103(63.1) 67/101(66.3) Consistent use condom during oral intercourse 16/103(15.5) 18/104(17.3) No: Case No. of positive or reactive results, N: No. of cases tested *Fisher's Exact Test

27 1. UNAIDS/WHO. AIDS epidemic update: December Gevena: Joint United Nations Programme on HIV/AIDS (UNAIDS) World Health Organization (WHO); UNAIDS. AIDS and men who have sex with men. Geneva: Joint United Nations Programme on HIV/AIDS; CDC. No turning back: Addressing the HIV crisis among men who have sex with men. Atlanta, GA: Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention; HIV/AIDS (Accessed November 1, 2005, 2005, at / / / / pdf.) 5. Hofmann B, Kryger P, Pedersen NS, et al. Sexually transmitted diseases, antibodies to human immunodeficiency virus, and subsequent development of acquired immunodeficiency syndrome. Visitors of homosexual sauna clubs in Copenhagen: Sex Transm Dis 1988;15(1): Pedersen NS, Hofmann B, Kryger P, et al. [Syphilis among homosexual men attending 2 sauna clubs in Copenhagen]. Ugeskr Laeger 1985;147(18): Kryger P, Hofmann B, Pedersen NS, et al. [Hepatitis among homosexual men in 2 saunas in Copenhagen]. Ugeskr Laeger 1984;146(17): Bradford DL. Syphilis case-finding in an Australian men's sauna club. Med J Aust 1983;2(11): Lumey LH, Kok J, Coutinho RA. Screening for syphilis among homosexual men in bars and saunas in Amsterdam. Br J Vener Dis 1982;58(6): Bleeker A, Coutinho RA, Bakker-Kok J, Tio D, de Koning GA. Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam. Br J Vener Dis 1981;57(3): Fairley CK, Leslie DE, Nicholson S, Gust ID. Epidemiology and hepatitis C virus in Victoria. Med J Aust 1990;153(5): Lister NA, Smith A, Tabrizi S, et al. Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas. Sex Transm Dis 2003;30(12): de Wit JB, de Vroome EM, Sandfort TG, van Griensven GJ. Homosexual encounters in different venues. Int J STD AIDS 1997;8(2):

28 14. Debattista J, Clementson C, Mason D, et al. Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men. Sex Transm Dis 2002;29(4): Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA. Differential HIV risk in bathhouses and public cruising areas. Am J Public Health 2001;91(9): Van Beneden CA, O'Brien K, Modesitt S, Yusem S, Rose A, Fleming D. Sexual behaviors in an urban bathhouse 15 years into the HIV epidemic. J Acquir Immune Defic Syndr 2002;30(5): ,.. : ; ,,,. HIV. : ; ,,,. / HIV. : ; ,, J,. HIV. : p ; Woods WJ, Binson D, Pollack LM, Wohlfeiler D, Stall RD, Catania JA. Public policy regulating private and public space in gay bathhouses. J Acquir Immune Defic Syndr 2003;32(4): Cohen DA, Scribner R. An STD/HIV prevention intervention framework. AIDS Patient Care STDS 2000;14(1): Spielberg F, Branson BM, Goldbaum GM, Kurth A, Wood RW. Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability. J Homosex 2003;44(3-4): Binson D, Woods WJ. A theoretical approach to bathhouse environments. J Homosex 2003;44(3-4): Moos RH, Lemke S. Evaluating residential facilities: The multiphasic environmental assessment procedure. Thousand Oasks: CA: Sage Publications; Woods WJ, Binson DK, Mayne TJ, Gore LR, Rebchook GM. HIV/sexually transmitted disease education and prevention in US bathhouse and sex club environments. Aids 2000;14(5):

29 (STDs/HIV)

30 / / / / (STDs/HIV) (STDs/HIV)

31 /

32 ( )

33 2005 (100) (100) (402) 110 (804) ( ) HIV ( ) HIV ( ) ( )

34 1. 2. ( ) ( ) ( ) ( ) 6. 疱

35 λ λ λ λ λ λ ( )

36 2. 3. HIV STD (

38 λ λ

20110420

20110420 愛滋病與結核病防治台北榮民總醫院感染科國立陽明大學醫學系王永衛醫師它是什麼? 愛滋病毒 (HIV) 後天免疫缺乏病毒愛滋病 (AIDS) 後天免疫缺乏症候群愛滋病 1980 年迄今 Million 50 45 40 35 30 25 20 15 1 First cases of