介紹.與確診多年的HIV陽性男男性接觸者（MSM）相比，新確診的HIV陽性男男性接觸者（N-MSM）傳播HIV的危險性更高，承受更多的心理健康問題，但愛滋病相關知識相對缺乏。目前的研究已經描述了N-MSM的心理健康和危險行為情況，但關於二者影響因素的調查卻甚少，且暫無關於N-MSM獨特相關因素，如疾病認知，安全套使用認知，安全使用的社會道德等的研究报告。目前，中國只有少量關於HIV陽性MSM的研究，無關於N-MSM的研究。 / 目的.本研究的目的包括： 1）描述中國N-MSM的心理健康和危險行為情況；2）驗證疾病認知量表在N-MSM人群的適應性；3）探討N-MSM疾病認知與心理健康（自殺意念，抑鬱，自我歧視和創傷後成長）的關係，並進一步研究在認知表徵與心理健康結果關係中，情感表徵的仲介作用與交互作用； 4）探索疾病認知與心理因素（抑鬱、自我歧視和創傷後成長）對自殺意念的獨立作用與交互作用；和5）研究愛滋病傳播相關危險行為的多方面因素。 / 對象與方法：本研究採用橫斷面研究設計，對中國成都共225名N-MSM進行了面對面訪談和電腦輔助移動電話訪談。根據Moss-Morris的方法，驗證疾病認知問卷的信度及效度； 使用單變量、多變量及分層的logistic和線性回歸等方法進行資料分析。 / 結果.在225名研究對象中，48%有自殺意念和抑鬱表現，35%自我歧視得分較高，17%有積極的創傷後成長。N-MSM的危險行為普遍存在：31%在確診感染後發生過非保護肛交性行為，40%認為在未來6個月意願與HIV陰性男性發生非保護肛交性行為，20%在感染後想過故意將HIV傳染給別人。經驗證，疾病認知問卷在N-MSM中具有良好的心理測量特徵。疾病認知的多個維度，如情感反應和治療控制等，與心理健康結果顯著相關。在認知表徵與心理健康結果的關係中，情感表徵表現出強烈的仲介作用。兩個疾病認知維度（情感反應與治療控制）和兩個心理因素（抑鬱和創傷後成長）對自殺意念有獨立作用，但無交互作用。影響N-MSM危險行為的多方面因素包括安全套相關認知，情感因素，心理健康和社會道德。 / 結論.本研究結果顯示中國N-MSM心理健康問題和危險行為是普遍存在的。疾病認知與心理健康結果的顯著聯繫，提示了可以通過改善N-MSM的疾病認知從而減少該人群的心理健康問題；在HIV領域中，這是一個新的研究方向。在對N-MSM危險行為的幹預研究中，需考慮影響N-MSM的獨特因素，如安全套相關認知，情感反應和社會責任等。 / Introduction.Newly diagnosed HIV positive men who have sex with men (N-MSM) comprise a special subgroup of HIV positive MSM, as they have higher risks of transmission via anal sex, suffer from more mental health problems, and possess less knowledge of HIV/AIDS than those who have been diagnosed for many years. Previous studies have investigated the prevalence of mental health and risk behaviours among N-MSMs, while few studies have explored the risk factors associated with these health-related outcomes, particularly the factors unique to N-MSMs, like illness perception, cognitions regarding condom use, social morality of condom use, etc. China provides only limited data about HIV positive MSM, and no such data is about N-MSMs. / Objectives.The aims of the study were to 1) investigate the characteristics of mental health and risk behaviours among N-MSMs in China; 2) validate the revised illness perception questionnaire (IPQ-R) modified for N-MSMs; 3) examine the effects of patients’ illness perception on their mental health outcomes and determine the mediating or moderating effects of emotional representation on the associations between cognitive representation and mental health outcomes; 4) examine the main effects and interaction effects of illness perception and psychological variables on suicidal ideation; and 5) investigate the multidimensional factors associated with risk behaviours related to HIV transmission. / Subjects and Methods.A cross-sectional study was conducted in Chengdu, China. A total of 225 N-MSMs participated in this study. Both face-to-face and computer-assisted mobile phone interviews were applied. The methodology by Moss-Morris was used to validate IPQ-R among N-MSMs. Univariate, multivariate, hierarchical logistic, and linear regression methods were used for data analysis. / Results.Of all participants, 48% had suicidal ideation and depression, and 36% reported self-stigma, but only 17% experienced posttraumatic growth (PTG). Risk behaviours were prevalent: 32% had had unprotected anal intercourse (UAI) since HIV diagnosis, 40% had the intention to have UAI with HIV negative men in the coming 6 months, and 20% had had thoughts of transmitting HIV to others purposely since HIV diagnosis. The modified IPQ-R for N-MSMs was validated and found to have acceptable psychometric properties. Most dimensions of illness perception (such as emotional response, treatment control and consequences) were significantly associated with mental health outcomes. Emotional representation had strong mediation effects rather than moderator effects on the associations between cognitive representation and mental health outcomes. Two illness perception dimensions (emotional response and treatment control) and two psychological variables (depression and PTG) showed independent effects on suicidal ideation, but not interaction effects on suicidal ideation. Multidimensional factors, such as variables related to cognitions of condom use, emotional affect (feelings of guilt regarding HIV transmission to others), mental health, and social morality (perceptions regarding responsibility for condom use), were associated with risk behaviours among N-MSMs. / Conclusions.The results show that mental health problems and risk behaviours are prevalent among Chinese N-MSM. Illness perception has a strong influence on mental health outcomes, indicating a new direction for the reduction of mental health problems via the modification of patients’ illness perception. Multidimensional factors are associated with risk behaviours related to HIV transmission, such as cognitions of condom use, emotional affection and social morality, which are unique to HIV infectors and should be considered in the development of intervention programs among N-MSMs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wu, Xiaobing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 257-276). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.i / Acknowledgements --- p.iii / List of Contents --- p.v / List of Tables --- p.xi / List of Figures --- p.xv / Abbreviations --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2.1 --- The importance of HIV positive men who have sex with men as a source of HIV transmission --- p.1 / Chapter 1.2.2 --- The importance of newly diagnosed HIV positive MSM (N-MSM) --- p.3 / Chapter 1.2.3 --- Knowledge gaps about N-MSM --- p.4 / Chapter 1.2.4 --- Illness perception as a relative new perceptive in HIV research --- p.5 / Chapter 1.2 --- Aims --- p.7 / Chapter 1.3 --- Structure of the thesis --- p.10 / Chapter 1.4 --- Summary --- p.15 / Chapter Chapter 2 --- Literature review --- p.16 / Chapter 2.1 --- HIV epidemic --- p.16 / Chapter 2.1.1 --- Global HIV/AIDS epidemic --- p.16 / Chapter 2.1.2 --- HIV/AIDS in China --- p.17 / Chapter 2.2 --- MSM and HIV --- p.22 / Chapter 2.2.1 --- HIV epidemic among MSM worldwide --- p.22 / Chapter 2.2.2 --- HIV prevalence and incidence among MSM in China --- p.24 / Chapter 2.2.3 --- Risk sexual behavior among HIV positive MSM and its determinants --- p.25 / Chapter 2.2.4 --- Mental health problems faced by HIV positive MSM --- p.31 / Chapter 2.2.5 --- Studies of PLWH in China --- p.38 / Chapter 2.3 --- Newly diagnosed HIV positive MSM (N-MSM) --- p.43 / Chapter 2.3.1 --- HIV transmission risk varies at different stages of HIV infection --- p.43 / Chapter 2.3.2 --- More risky sexual behavior among N-MSM --- p.45 / Chapter 2.3.3 --- More stress and lack of knowledge among N-MSM --- p.46 / Chapter 2.3.4 --- Definition of N-MSM --- p.47 / Chapter 2.3.5 --- Studies about N-MSM --- p.47 / Chapter 2.4 --- Self-regulation model and illness representation --- p.51 / Chapter 2.4.1 --- Self-regulation model --- p.51 / Chapter 2.4.2 --- Illness representation --- p.52 / Chapter 2.4.3 --- Application of illness representation in HIV research --- p.60 / Chapter 2.5 --- Audio computer-assisted self-interviewing (ACASI) --- p.61 / Chapter 2.5.1 --- Types of questionnaire deliver modes --- p.61 / Chapter 2.5.2 --- Comparisons of sexual behavior reporting between ACASI and other delivery modes --- p.63 / Chapter 2.5.3 --- Limitations of ACASI --- p.65 / Chapter Chapter 3 --- Subjects and Methods --- p.67 / Chapter 3.1 --- The study site --- p.67 / Chapter 3.2 --- Study population --- p.68 / Chapter 3.3 --- Recruitment of study participants --- p.68 / Chapter 3.4 --- Data collection procedure --- p.69 / Chapter 3.4.1 --- Face-to-face interview --- p.70 / Chapter 3.4.2 --- Computer-assisted mobile phone interview --- p.70 / Chapter 3.4.3 --- Service provision and incentives --- p.71 / Chapter 3.4.4 --- Sample size and the representativeness --- p.71 / Chapter 3.5 --- Quality control --- p.71 / Chapter 3.6 --- Establishment of the CAMP system --- p.72 / Chapter 3.7 --- Collaborator --- p.73 / Chapter 3.8 --- Measurements --- p.74 / Chapter 3.9 --- Statistical analysis --- p.83 / Chapter 3.10 --- Ethical approval --- p.85 / Chapter Chapter 4 --- Participant profiles --- p.86 / Chapter 4.1 --- Background --- p.86 / Chapter 4.2 --- Objectives --- p.87 / Chapter 4.3 --- Statistical analysis --- p.87 / Chapter 4.4 --- Results --- p.87 / Chapter 4.4.1 --- Background information --- p.87 / Chapter 4.4.2 --- Mental health outcomes --- p.88 / Chapter 4.4.3 --- HIV secondary transmission related behaviours --- p.90 / Chapter 4.4.4 --- Service utilization and quality of life --- p.94 / Chapter 4.5 --- Discussion --- p.95 / Chapter Chapter 5 --- Validation of the revised illness perception questionnaire among newly diagnosed HIV positive MSMs --- p.111 / Chapter 5.1 --- Background --- p.111 / Chapter 5.2 --- Objectives --- p.112 / Chapter 5.3 --- Modification and translation --- p.113 / Chapter 5.4 --- Statistical analysis --- p.114 / Chapter 5.5 --- Results --- p.116 / Chapter 5.5.1 --- Items of the main cognitive representation subscales --- p.116 / Chapter 5.5.2 --- Items of the emotional response subscale --- p.117 / Chapter 5.5.3 --- Items of the causal attribution subscale --- p.118 / Chapter 5.5.4 --- Examination of the identity subscale --- p.118 / Chapter 5.5.5 --- Descriptions of the derived subscales --- p.119 / Chapter 5.5.6 --- Inter-correlations among subscales --- p.119 / Chapter 5.5.7 --- External validity --- p.120 / Chapter 5.5.8 --- Associations between background variables and illness perception --- p.120 / Chapter 5.6 --- Discussion --- p.121 / Chapter Chapter 6 --- Relationships between illness perception and mental health outcomes among N-MSM --- p.132 / Chapter 6.1 --- Background --- p.132 / Chapter 6.2 --- Objectives --- p.134 / Chapter 6.3 --- Statistical analysis --- p.136 / Chapter 6.3.1 --- Analysis of the associations between illness perception and mental health outcomes --- p.136 / Chapter 6.3.2 --- Analysis of the mediation effects of emotional response on the associations between cognitive representation and health related outcomes --- p.137 / Chapter 6.3.3 --- Analysis of moderating effects of emotional response on the associations between cognitive representation and mental health outcomes --- p.139 / Chapter 6.4 --- Results --- p.140 / Chapter 6.4.1 --- Suicidal ideation --- p.140 / Chapter 6.4.2 --- Depression --- p.142 / Chapter 6.4.3 --- Self-stigma --- p.145 / Chapter 6.4.4 --- Posttraumatic growth --- p.147 / Chapter 6.5 --- Summary --- p.149 / Chapter 6.5.1 --- Associations between illness perception and health related outcomes --- p.149 / Chapter 6.5.2 --- Summary of the mediation effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.5.3 --- Summary of the moderating effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.6 --- Discussion --- p.151 / Chapter Chapter 7 --- The main and interaction effects of illness perception and other psychological variables on suicidal ideation among N-MSM --- p.177 / Chapter 7.1 --- Background --- p.177 / Chapter 7.2 --- Objectives and hypothesis --- p.179 / Chapter 7.3 --- Data analysis and results --- p.180 / Chapter 7.3.1 --- Associated factors of suicidal ideation in univariate analysis --- p.180 / Chapter 7.3.2 --- The associations between illness perception / psychological variables and suicidal ideation --- p.180 / Chapter 7.3.3 --- The independent effects of emotional response/treatment control and psychological variables on suicidal ideation --- p.182 / Chapter 7.3.4 --- Analysis of the interaction effects between illness perception and psychological variables onto suicidal ideation --- p.184 / Chapter 7.4 --- Discussion --- p.184 / Chapter Chapter 8 --- Risk behaviours related to HIV transmission and associated factors --- p.197 / Chapter 8.1 --- Background --- p.197 / Chapter 8.2 --- Objectives --- p.199 / Chapter 8.3 --- Statistical analysis --- p.202 / Chapter 8.4 --- Results --- p.203 / Chapter 8.4.1 --- Factors associated with having had UAI with men since HIV diagnosis --- p.203 / Chapter 8.4.2 --- Factors associated with intention to have UAI with HIV negative men in the coming 6 months --- p.205 / Chapter 8.4.3 --- Factors associated with having the thoughts of transmitting HIV to others purposively since HIV diagnosis --- p.206 / Chapter 8.5 --- Discussion --- p.207 / Chapter Chapter 9 --- Conclusions --- p.225 / Chapter 9.1 --- Summaries and interpretations of findings related to mental health --- p.225 / Chapter 9.1.1 --- Poor mental health status --- p.225 / Chapter 9.1.2 --- A validated revised illness perception questionnaire (IPQ-R) among N-MSM --- p.226 / Chapter 9.1.3 --- Strong associations between illness perception and mental health outcomes --- p.226 / Chapter 9.1.4 --- Significant associations between illness perception / other psychological variables and suicidal ideation --- p.227 / Chapter 9.2 --- Summaries and interpretations of findings related to risk behaviours --- p.228 / Chapter 9.2.1 --- Prevalent risk behaviours --- p.228 / Chapter 9.2.2 --- Factors affecting the risk behaviours related to HIV transmission and implications --- p.229 / Chapter 9.3 --- Service implications --- p.231 / Chapter 9.3.1 --- Intervention programs for reducing mental health problems --- p.231 / Chapter 9.3.2 --- Intervention programs for reducing risk behaviours related to HIV transmission --- p.233 / Chapter 9.3.3 --- Policy support in HIV prevention --- p.236 / Chapter 9.4 --- Study limitations --- p.238 / Chapter 9.5 --- Recommendations for future research --- p.239 / Chapter 9.5.1 --- Longitudinal studies --- p.239 / Chapter 9.5.2 --- Behavioural studies --- p.240 / Chapter 9.5.3 --- Intervention studies --- p.240 / Chapter 9.6 --- Conclusions --- p.241 / Chapter Appendix I --- Questionnaire for face-to-face interview --- p.243 / Chapter Appendix II --- Questionnaire for computer-assisted mobile phone interview --- p.254 / Reference --- p.257