Mimiaga Matthew J, Reisner Sari L, Tinsley Jake P, Mayer Kenneth H, Safren Steven A
The Fenway Institute, Fenway Community Health, Prudential Tower, 4th Floor, 800 Boylston Street, Boston, MA 02119, USA.
J Urban Health. 2009 Jan;86(1):54-66. doi: 10.1007/s11524-008-9316-5. Epub 2008 Sep 9.
Sex work has been associated with elevated risk for HIV infection among men who have sex with men (MSM) in many settings. This mixed methods study examined sexual risk among MSM sex workers in Massachusetts, collecting formative data on HIV risk behavior by sex worker type in order to gain a better understanding of how to tailor prevention interventions to this unique and high-risk subgroup of MSM. Two groups of MSM sex workers were recruited between January and March 2008: street workers (n=19) and internet escorts (n=13). Participants completed a semistructured qualitative interview and quantitative psychosocial assessment battery; interviews were conducted until redundancy in responses was achieved. Almost one third (31%) were HIV-infected. The majority of participants (69%) reported at least one episode of unprotected serodiscordant anal sex (either insertive or receptive) with a mean of 10.7 (SD=42.2) male sex partners of an unknown or different HIV serostatus in the past 12 months. Salient findings included: (a) internet sex workers reported being paid substantially more for sex than street sex workers; (b) inconsistent condom use, high rates of unprotected sex, and low rates of HIV status disclosure with sex work partners for both internet and street workers; general perceptions of a lack of trust on the part of sex work partners (i.e., telling them what they want to hear), offers of more money for unprotected sex; (c) contextual differences in risk taking: internet sex workers reported that they are more likely to engage in sexual risk-taking with noncommercial sex partners than sex partners who pay; (d) HIV status and STI history: two street workers became infected in the context of sex work, and 25% of the entire sample had never been tested for sexually transmitted infections (STI); and (e) motivations and reasons for doing sex work, such as the "lucrativeness" of sex work, as a means to obtain drugs, excitement, power, "why not?" attitude, and because social norms modeled this behavior. Study findings can be used to generate hypotheses for designing and providing tailored primary and secondary prevention interventions for this at-risk subgroup of MSM.
在许多情况下,性工作与男男性行为者(MSM)感染艾滋病毒的风险升高有关。这项混合方法研究调查了马萨诸塞州男男性行为性工作者的性风险,按性工作者类型收集了关于艾滋病毒风险行为的形成性数据,以便更好地了解如何针对这一独特且高危的男男性行为亚群体量身定制预防干预措施。2008年1月至3月期间招募了两组男男性行为性工作者:街头工作者(n = 19)和网络陪护者(n = 13)。参与者完成了半结构化定性访谈和定量心理社会评估量表;访谈持续进行,直至回答出现冗余。近三分之一(31%)的人感染了艾滋病毒。大多数参与者(69%)报告在过去12个月里至少有过一次与艾滋病毒血清学状态未知或不同的男性性伴侣进行无保护的血清学不一致肛交(插入式或接受式),平均有10.7名(标准差 = 42.2)男性性伴侣。显著发现包括:(a)网络性工作者报告性行为的报酬比街头性工作者高得多;(b)网络和街头工作者在使用避孕套方面都不一致,无保护性行为发生率高,与性工作伙伴透露艾滋病毒感染状况的比例低;普遍认为性工作伙伴缺乏信任(即告诉他们想听的话),提供更多钱以换取无保护性行为;(c)冒险行为的背景差异:网络性工作者报告说,他们与非商业性伴侣发生性冒险行为的可能性比付费性伴侣更高;(d)艾滋病毒感染状况和性传播感染史:两名街头工作者在性工作过程中感染,整个样本中有25%的人从未接受过性传播感染检测;以及(e)从事性工作的动机和原因,如性工作的“赚钱能力”、作为获取毒品的手段、刺激、权力、“为什么不呢?”的态度,以及因为社会规范塑造了这种行为。研究结果可用于为设计和提供针对这一高危男男性行为亚群体的量身定制的一级和二级预防干预措施生成假设。