『保健医療科学』 2023 第72巻 第2号 p.110-118（2023年5月）
特集 : with コロナ時代の持続可能なエイズ対策—新規感染ゼロへの挑戦—＜報告＞
コロナ禍を経た MSM・ゲイコミュニティにおける HIV 感染症の予防 ―その影響と有効な対策―
塩野徳史
大阪青山大学 健康科学部看護学科
Prevention of HIV infection in MSM and gay communities under COVID-19 epidemic: the impact and effective countermeasures
SHIONO Satoshi
School of Nursing, Faculty of Health Science, Osaka Aoyama University
抄録
新型コロナウイルス感染症が全国に広まり，HIV検査機会が奪われたと言われている．同時にゲイコミュニティの中でも一時的に商業施設が休業や閉店が相次ぎ，クラブイベントも中止となった．そして三密を避ける等行動の自粛ムードは高まり，街が閑散となった時期もあった．それでも，保健所の業務逼迫により検査機会が中止となった時期は短く，予約制に移行した機関もあるが，現状ではほぼコロナ禍以前の状況に回復しつつある．しかし検査件数が伸び悩んでいる背景には，当事者の自粛意識や検査プロモーションの減少も一因であると考える．
ゲイコミュニティの当事者にとって検査を受けたくても受けられない状況が続き，全国 6 ヶ所に設置されたコミュニティセンターとMSMを対象に予防啓発活動を継続している10NGOは，市販されている郵送検査キットを活用し対面やインターネットの広報により，検査機会の提供を行った．また 1 府４県では民間医療機関と協働し検査機会の提供を持続した．いずれの検査機会も実際の利用者実数はMSM全体からみれば少ないが，検査ニーズの高い層に届いている．郵送検査は全国では初めての取り組みとなったが，郵送検査会社と各地の当事者NGOが連携を図り，検査結果後のフォローアップもより良いものとなった．
コロナ禍の中でも，MSM・ゲイコミュニティの調査結果よりPrEP利用は増加しており，安心して利用できる環境の整備や定期検査の潜在的なニーズは高まっている．また，コロナ禍以前よりコンドーム使用行動は低下しており，セーファーセックスに関する規範の担い手の意識が変容していることが懸念される．そのため，複合的に予防啓発を展開していく必要があり，これを持続的な活動とするには，コミュニティセンターやコミュニティで働く当事者ヘルスワーカーを育て，支える仕組みが必要である．
キーワード：MSM，ゲイコミュニティ，HIV，AIDS，予防
Abstract
Since the COVID-19 has spread across the country, commercial establishments were temporarily closed or closed in succession and club events were cancelled in the gay community. The mood of self-restraint in behavior, such as avoiding the three Cs (closed, crowded, contact) increased, and there were periods when the city was deserted. The period during which testing opportunities were suspended due to the tight workload at public health centers was relatively short, and the situation has now nearly returned to that before the pandemic, although some centers have shifted to an appointment system for testing. However, the current slow growth in the number of tests is partly due to a sense of self-restraint and a decrease in activities for promoting testing.
For those in the gay community who wanted to be tested but were unable to do so, the six community centers that have been established nationwide and the 10 NGOs that continue to conduct preventive awareness-raising activities targeting MSM have provided testing opportunities through face-to-face and internet publicity, utilizing commercially available postal testing kits. In one province and four prefectures, they have continued to provide testing opportunities in collaboration with private medical institutions. The actual number of users of the provided testing opportunities has been small compared to the total number of MSM, they are reaching the population with high testing needs. Although the postal testing service was the first initiative of its kind in the country, the postal testing company and the NGOs that were involved in each region worked together to provide better follow-up after the test results.
Even amidst the COVID-19 epidemic, PrEP use has increased according to the results of the MSM and gay community survey, and the potential needs for a safe environment and regular testing are growing. In addition, condom-use behaviour has declined since before the COVID-19, and there is a concern that the attitudes of norm bearers regarding safer sex are changing. Therefore, it is necessary to develop preventive awareness-raising in a complex way. To make this a sustainable activity, a system to train and support party health workers working in community centers and communities is needed.
keywords: MSM, Gay community, HIV, AIDS, Prevention