Pathela Preeti, Hajat Anjum, Schillinger Julia, Blank Susan, Sell Randall, Mostashari Farzad
New York City Department of Health and Mental Hygiene and Mailman School of Public Health, Columbia University, New York, New York 10013, USA.
Ann Intern Med. 2006 Sep 19;145(6):416-25. doi: 10.7326/0003-4819-145-6-200609190-00005.
Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases.
To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity-behavior and risk behaviors.
Cross-sectional, random digit-dialed telephone survey of health status and risk behaviors.
New York City.
Population-based sample of 4193 men.
Concurrent measures of sexual identity and sexual behaviors, including number and sex of sex partners, condom use during last sexual encounter, and recent testing for HIV infection. Sex partner information was ascertained in a separate section from sexual identity; all participants were asked about the number of male sex partners and then were asked about the number of female sex partners in the past year.
Of New York City men reporting a sexual identity, 12% reported sex with other men. Men who had sex with men exclusively but self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, be foreign-born, have lower education and income levels, and be married. These men were more likely than gay-identified men who have sex with men to report having only 1 sexual partner in the previous year. However, they were less likely to have been tested for HIV infection during that time (adjusted prevalence ratio, 0.6 [95% CI, 0.4 to 0.9]) and less likely to have used condoms during their last sexual encounter (adjusted prevalence ratio, 0.5 [CI, 0.3 to 1.0]).
The survey did not sample groups that cannot be reached by using residential telephone services.
Many New York City men who have sex with men do not identify as gay. Medical providers cannot rely on patients' self-reported identities to appropriately assess risk for HIV infection and sexually transmitted diseases; they must inquire about behavior. Public health prevention messages should target risky sexual activities rather than a person's sexual identity.
报告的性身份与其性行为不一致的人可能比性身份和行为一致的人有更高风险的性行为。前一组人可能在性传播疾病的传播中起重要作用。
描述男男性行为者自我描述的性身份与行为之间的不一致，以及身份 - 行为与风险行为之间的关联。
关于健康状况和风险行为的横断面随机数字拨号电话调查。
纽约市。
基于人群的4193名男性样本。
同时测量性身份和性行为，包括性伴侣的数量和性别、上次性行为时是否使用避孕套以及最近的艾滋病毒感染检测情况。性伴侣信息在与性身份不同的部分确定；所有参与者被问及男性性伴侣的数量，然后被问及过去一年中女性性伴侣的数量。
在报告有性身份的纽约市男性中，12%报告与其他男性发生过性行为。仅与男性发生性行为但自我认同为异性恋的男性比自我认同为同性恋的男性更有可能属于少数种族或族裔群体、出生在国外、教育和收入水平较低且已婚。这些男性比自我认同为同性恋的男男性行为者更有可能报告前一年只有1个性伴侣。然而，他们在那段时间接受艾滋病毒感染检测的可能性较小（调整后的患病率比为0.6 [95%可信区间，0.4至0.9]），并且在上次性行为时使用避孕套的可能性较小（调整后的患病率比为0.5 [可信区间，0.3至1.0]）。
该调查未对无法通过住宅电话服务联系到的群体进行抽样。
许多纽约市的男男性行为者并不自我认同为同性恋。医疗服务提供者不能仅依靠患者自我报告的身份来适当评估艾滋病毒感染和性传播疾病的风险；他们必须询问行为情况。公共卫生预防信息应针对高风险的性行为，而不是一个人的性身份。
