Rietmeijer Cornelis A, Patnaik Jennifer L, Judson Franklyn N, Douglas John M
Denver Public Health Department, Denver Health Medical Center, Colorado 80204-4506, USA.
Sex Transm Dis. 2003 Jul;30(7):562-7. doi: 10.1097/00007435-200307000-00006.
Recent increases in rates of sexually transmitted diseases (STDs) and decreases in safe sex behaviors among men who have sex with men (MSM) in several American and European cities have been noted by researchers. It has been suggested that these trends are the result of perceptions that HIV/AIDS is less serious because of the availability of highly active antiretroviral therapy (HAART).
The goal of the study was to examine trends in STD rates and risk behaviors among MSM and men who have sex with women (MSW) visiting a public STD clinic in Denver and to determine whether there is an ecological association with the availability of HAART.
This is a two-part retrospective analysis of male visits to the Denver Metro Health Clinic (DMHC). The first part describes gonorrhea and early (primary and secondary) syphilis trends among MSM between 1982 and 2001. For the second part, data were grouped into two 6-year time periods to represent pre-HAART and post-HAART time frames, 1990 to 1995 and 1996 to 2001.
Gonorrhea and early syphilis cases among MSM declined precipitously between 1982 and 1988 and then stabilized at low rates. The proportion of male visits to the clinic made by MSM decreased from 14.1% in 1990 to 7.2% in 1995 and then increased to 13.0% in 2001. Gonorrhea positivity rates among MSM increased after 1995 and were significantly higher in the period 1996 to 2001 (12.9%) than in the period 1990 to 1995 (8.1%; P<0.0001). Conversely, gonorrhea rates among MSW dropped from 11.2% in the first period to 6.9% in the second (P<0.0001). Among MSM known to be HIV-infected, gonorrhea rates increased from 11.6% in the first time period to 24.0% in the second period (P<0.0001). Reports of anal sex among MSM increased from 64.4% to 70.9% (P<0.0001). Reporting more than one sex partner increased for MSM from 65.2% to 70.3% (P<0.0001), but it significantly decreased from 52.6% to 46.2% for MSW (P<0.0001). No or inconsistent condom use increased from 60.9% to 63.0% for MSM (P=NS) and decreased from 85.1% to 82.4% among MSW (P<0.0001).
These trends appear to reflect a change toward higher risk-taking behaviors among MSM but not MSW since the time HAART became available and raise concerns about the potential for increased HIV transmission in this group.
研究人员注意到，在美国和欧洲的几个城市，男男性行为者（MSM）中性传播疾病（STD）发病率最近有所上升，而安全性行为有所减少。有人认为，这些趋势是由于人们认为高效抗逆转录病毒疗法（HAART）的出现使得艾滋病毒/艾滋病不再那么严重。
本研究的目的是调查前往丹佛一家公共性病诊所就诊的男男性行为者和男女发生性行为者（MSW）的性传播疾病发病率趋势和风险行为，并确定其与HAART可用性之间是否存在生态学关联。
这是对丹佛地铁健康诊所（DMHC）男性就诊情况的两部分回顾性分析。第一部分描述了1982年至2001年间男男性行为者中淋病和早期（一期和二期）梅毒的发病趋势。第二部分，数据被分为两个6年时间段，以代表HAART出现之前和之后的时间框架，即1990年至1995年和1996年至2001年。
1982年至1988年间，男男性行为者中的淋病和早期梅毒病例急剧下降，然后稳定在低发病率水平。男男性行为者到该诊所就诊的男性比例从1990年的14.1%降至1995年的7.2%，然后在2001年升至13.0%。1995年后，男男性行为者中的淋病阳性率上升，1996年至2001年期间（12.9%）显著高于1990年至1995年期间（8.1%；P<0.0001）。相反，男女发生性行为者中的淋病发病率从第一阶段的11.2%降至第二阶段的6.9%（P<0.0001）。在已知感染艾滋病毒的男男性行为者中，淋病发病率从第一阶段的11.6%升至第二阶段的24.0%（P<0.0001）。男男性行为者中肛交的报告比例从64.4%增至70.9%（P<0.0001）。报告有多个性伴侣的男男性行为者比例从65.2%增至70.3%（P<0.0001），但男女发生性行为者的这一比例从52.6%显著降至46.2%（P<0.0001）。男男性行为者中不使用或不坚持使用避孕套的比例从60.9%增至63.0%（P=无统计学意义），而男女发生性行为者中的这一比例从85.1%降至82.4%（P<0.0001）。
这些趋势似乎反映出自HAART出现以来男男性行为者中冒险行为增加的变化，而男女发生性行为者并非如此，并引发了对该群体中艾滋病毒传播可能性增加的担忧。
