背景：截至2016年底為止，台灣的HIV感染人數已突破了三萬人大關，目前仍存活的感染者則約有兩萬七千人。世界衛生組織近年來強力宣導90-90-90的政策，並鼓勵HIV感染者在面臨確診後即開始使用抗病毒藥物。然而，多數研究均聚焦在服藥順從性，缺乏對於更前端之進入醫療體系的就醫意圖與相關因素的討論。
目的：運用計劃行為理論 (Theory of Planned Behavior, TPB) 探討年輕男性間性行為者在面臨感染狀況時之就醫意圖與相關因素，以作為未來衛生教育或是政策宣導之實證研究依據。
方法：本研究於2016年12月至2017年2月間，以TPB為架構編製之網路匿名自填式問卷進行資料收集，共蒐集2,940份樣本。考量本次研究之目的，扣除自陳其HIV狀態已為陽性及拒絕揭露篩檢結果者，最終共納入2,709位男性間性行爲者於本分析中。運用多變項羅吉斯迴歸，探討台灣年輕男性間性行為者，若HIV篩檢結果為陽性時之就醫意圖及其相關因素。
結果：本研究以7分與1-6分作為高、低意圖之切點。研究發現HIV匿名篩經驗具有調節作用，有無篩檢經驗會造成測量TPB構念時產生不同的就醫意圖差異。有篩檢經驗之年輕男性間性行為者，若有下列特質，則會在HIV篩檢為陽性後會有較高之就醫意圖：對於正向行為結果評價之態度為相對中性 (AOR=2.00) 及相對正向 (AOR=3.95) 者、在有利情境下相對高度自我控制者 (AOR=1.79)，以及在阻礙情境下具有相對高度自我控制者 (AOR=1.54)。無篩檢經驗者在正向行為結果評價之態度為相對中性 (AOR=2.50) 及相對正向 (AOR=3.72)、主觀規範為高度支持 (AOR=1.28)、在有利情境下自我控制為相對高度 (AOR=2.73) 時，會有較高的就醫意圖。然而，無篩檢經驗者在負向行為結果評價之態度為相對正向 (AOR=0.61) 與主觀規範為中度支持 (AOR=0.78) 的情況下，則會出現較低之就醫意圖。
結論：本研究以TPB理論為架構，探討台灣男性間性行為者若HIV篩檢為陽性後之就醫意圖，並發現無論是行為態度、主觀規範或是自覺行為控制，皆為影響就醫意圖之重要因素，另也發現HIV匿名篩檢經驗具調節作用。本研究之結果，可提供未來於男同志與感染者之醫療需求的實證參考數據。

Background: The number of HIV cases in Taiwan reached over 30,000 in 2016, and people living with HIV in Taiwan have mostly been young men who have sex with men (YMSM). According to the UNAIDS 90-90-90 target, 90% of people living with HIV should receive highly active antiretroviral therapy (HAART) if diagnosed with HIV immediately. However, numerous previous studies focused on adherence but relative little attention has been paid to the factors that are associated with healthcare seeking intention.
Objectives: Based on the Theory of Planned Behavior (TPB), this study aimed to examine the factors associated with healthcare seeking intention if diagnosed with HIV among YMSM in Taiwan.
Methods: An anonymous online survey was conducted from December 2016 to February 2017 among YMSM aged 15-39 years in Taiwan via various channels. Data from 2,940 YMSM were collected on background characteristics, TPB constructs, and intention to seek healthcare. After excluding self-identified HIV+ MSM and those who had HIV voluntary counseling and testing (VCT) experience but refused to divulge their HIV status, a total of 2,709 responses were included for analysis. Multivariate logistic regression, stratified by VCT experience, was performed to examine factors associated with healthcare seeking intention if diagnosed with HIV among YMSM.
Results: This study found that YMSM with VCT experience who had the following characteristics had higher intention to seek healthcare if diagnosed with HIV: relatively neutral (AOR=2.00) and positive (AOR=3.95) ATB about positive outcomes, relatively high PBC (AOR=1.79) under facilitating conditions, and high PBC (AOR=1.54) under constraining conditions. Among YMSM without VCT experience, those having relatively neutral (AOR=2.50) and positive (AOR=3.72) ATB about positive outcomes, relatively supportive SN (AOR=1.28), and relatively high PBC (AOR=2.73) under facilitating conditions had higher healthcare seeking intention. However, relatively positive ATB (AOR=0.61) about negative outcomes and relatively neutral SN (AOR=0.78) were associated with lower intention to seek healthcare.
Conclusions: According to the results, ATB about positive outcomes and PBC under facilitating conditions may be the most important factors that influence YMSM’s intention to seek healthcare if they are diagnosed with HIV. Also, the significance and strength of association between different TPB factors and healthcare seeking intention varied by VCT experience. Most of all, since the TPB factors are modifiable, the findings of this study can inform future HIV/AIDS prevention efforts, which are tailored according to the VCT experience, to optimize the program effectiveness.

Contents
誌謝 i
中文摘要 iv
Abstract vi
Contents viii
List of Tables x
Chapter 1 Introduction 1
1.1 HIV prevention and epidemic surveillance 1
1.1.1 HIV prevention and epidemic surveillance around the world 1
1.1.2 HIV prevention and epidemic surveillance in Taiwan 2
1.2 Healthcare system 3
1.2.1 Medical situation of YMSM with HIV infection in Taiwan 4
1.2.2 HIV voluntary counseling and testing (VCT) experience 5
1.2.3 Infection status 6
1.3 Background characteristics 6
1.3.1 Socioeconomic status 6
1.3.2 Sex/gender-related characteristics 7
1.4 Theory of Planned Behavior (TPB) 8
1.5 The current study 9
Chapter 2 Methods 11
2.1 Research design 11
2.2 Participants 11
2.3 Measures 12
2.3.1 Outcome variable 12
2.3.2 TPB constructs 12
2.3.3 Background characteristics 15
2.4 Procedure 15
Chapter 3 Results 18
3.1 Sample characteristics of YMSM in Taiwan 18
3.2 Background characteristics and TPB factors and their bivariate associations with intention to seek healthcare, and with VCT experience 18
3.3 Background characteristics and TPB factors and their bivariate associations with intention to seek healthcare, by VCT experience 20
3.4 Multivariate logistic regression for factors associated with intention to seek healthcare, by VCT experience 21
3.5 Multivariate logistic regression models for individual TPB items associated with high intention to seek healthcare if diagnosed with HIV, by VCT experience 23
Chapter 4 Discussion 25
4.1 Perceived high risk of HIV infection associated with low intention to seek healthcare among YMSM 25
4.2 ATB about positive and negative outcomes differentially related to intention to seek healthcare 26
4.3 Neutral and supportive SN differentially associated with intention to seek healthcare 28
4.4 Higher PBC linked to higher intention to seek healthcare 28
4.5 Individual TPB items associated with intention to seek healthcare varied with VCT experience 30
4.6 Limitations and future directions 33
Chapter 5 Conclusions 34
References 35
Appendix 48

List of Tables
Table 1 Distributions of background characteristics and TPB factors of YMSM in Taiwan 40
Table 2 Background characteristics and TPB factors and their bivariate associations with intention to seek healthcare if diagnosed with HIV, and with VCT experience among YMSM in Taiwan 41
Table 3 Background characteristics and TPB factors and their bivariate associations with intention to seek healthcare if diagnosed with HIV among YMSM in Taiwan, by VCT experience 43
Table 4 Multivariate logistic regression models estimating the odds of having high intention to seek healthcare if diagnosed with HIV among YMSM in Taiwan, by VCT experience 45
Table 5 Multivariate logistic regression models for individual TPB items associated with high intention to seek healthcare if diagnosed with HIV among YMSM in Taiwan, by VCT experience 47
Appendix Factor analysis: multiple-item scales of the TPB constructs 48

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