| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 99 === Background & Purpose: Little is known about factors contributing to syphilis among HIV-infected patients in Taiwan, especially among men who have sex with men (MSM) , in the era of highly active antiretroviral therapy (HAART).
Methods: From March to May 2011, HIV-infected MSM patients who regularly attended an HIV/AIDS outpatient clinic of a medical center were invited to participate in the study. Quantitative data were collected through a self-administered survey. The structured questionnaire for this study included questions regarding socio-demographic characteristics, HIV infection history, health status, sexual partners and patterns of sexual behavior, and use of recreational drugs.
Results: During the study period, a total of 200 HIV-infected MSM were voluntarily enrolled and provided valid responses to the questionnaire. In the first stage analysis where association between each sexual or drug related factor and syphilis after diagnosis of HIV infection was examined while adjusting the effect of age, education, occupation, receiving HAART or not, CD4 counts, and plasma HIV RNA load (log10). We demonstrated the following factors that were associated with syphilis: having main sexual partner(s) who were also sero-positive, having casual sexual partner(s), condom use while having anal and oral sex, practice of withdrawal before ejaculation, having sex with sero-positive partner(s) without condom, and use of recreational drugs. Further stepwise multiple logistic regression analysis focusing on patients who were on HAART indicated that CD4 counts (OR, 1.0; 90% CI, 1.00-1.00; p＝0.018), having had sero-positive main partners before or some of the main sexual partners being HIV-positive (OR, 5.42; 90% CI, 2.17-13.52; p＝0.002), and having had casual sexual partner(s) (OR, 2.41; 90% CI, 1.30-4.47; p＝0.019) were statistically significant contributors for syphilis infection experience. This study failed to present a significant relationship between recreational drug use and syphilis. However, it did display an association between recreational drug use and education and risky sexual behaviors in the past 6 months.
Conclusion: Findings of this study demonstrate the critical role the identity of sexual partners (sero-status) and the nature of relationship with sexual partners (steadiness or casualness) play in relation to syphilis. Moreover, association between risky sexual behaviors and recreational drug use and possible synergetic effect of both explicate the emerging challenge to HIV/AIDS control. It suggests the urgency to implement interventions targeting HIV-infected persons in general and HIV-infected MSM in particular.
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