Mimiaga Matthew J, Reisner Sari L, Cranston Kevin, Isenberg Deborah, Bright Donna, Daffin Gary, Bland Sean, Driscoll Maura A, Vanderwarker Rodney, Vega Benny, Mayer Kenneth H
The Fenway Institute, Fenway Community Health, 1340 Boylston Street, Boston, MA 02215, USA.
J Urban Health. 2009 Jul;86(4):602-23. doi: 10.1007/s11524-009-9363-6. Epub 2009 May 23.
Black men who have sex with men (MSM) are at increased risk for HIV infection in the United States compared to other MSM. The aim of this study was to investigate Black MSM's sexual mixing patterns and partner characteristics in relation to sexual risk taking, as a possible explanation for this observed increase in HIV incidence. Between January and July 2008, 197 Black MSM were recruited via modified respondent-driven sampling and completed optional pretest and post-test HIV serological testing, counseling, and a demographic, behavioral, and psychosocial assessment battery. Bivariate and multivariable logistic regression procedures were used to examine predictors of risky sex across partner types. Overall, 18% of the sample was HIV-infected; 50% reported unprotected intercourse with men, 30% with women, and 5% with transgender partners. Fifty-three percent identified as bisexual or straight, although all reported oral or anal sex with another man in the prior 12 months. Significant predictors of engaging in at least one episode of: (1) serodiscordant unprotected anal sex (UAS) with a male partner in the past 12 months: individuals at risk for social isolation (AOR = 4.23; p = 0.03), those with unstable housing (AOR = 4.19; p = 0.03), and those who used poppers at least weekly during sex (AOR = 5.90; p = 0.05); (2) UAS and/or unprotected vaginal intercourse with a female partner in the past 12 months: those with unstable housing (AOR = 4.85; p = 0.04), those who used cocaine at least weekly during sex (AOR = 16.78; p = 0.006), being HIV-infected (AOR = 0.07; p = 0.02), and feeling social norms favor condom use (AOR = 0.60; p = 0.05); (3) UAS with the participants' most recent nonmain male sex partner: use of alcohol and drugs during last sex by participant (AOR = 4.04; p = 0.01), having sex with a Hispanic/Latino male (AOR = 2.71; p = 0.04) or a Black male (AOR = 0.50; p = 0.05) compared to a White male, and lower education (AOR = 1.31; p = 0.02). Findings suggest that sexual risk behaviors of Black MSM differ across partner type and by the characteristics of their sexual networks and that this subpopulation of MSM are at high risk for HIV acquisition and transmission. Effective prevention strategies need to address the distinct sexual and behavioral risk patterns presented by different sexual partnerships reported by Black MSM.
与其他男男性行为者相比，美国男男性行为的黑人感染艾滋病毒的风险更高。本研究的目的是调查黑人男男性行为者的性混合模式以及与性风险行为相关的伴侣特征，以此作为观察到的艾滋病毒发病率上升的一种可能解释。2008年1月至7月期间，通过改良的应答者驱动抽样招募了197名黑人男男性行为者，他们完成了可选的艾滋病毒血清学检测前测和后测、咨询以及人口统计学、行为学和社会心理评估。采用双变量和多变量逻辑回归程序来检验不同伴侣类型中性风险行为的预测因素。总体而言，18%的样本感染了艾滋病毒；50%报告与男性有未采取保护措施的性行为，30%与女性有此类行为，5%与跨性别伴侣有此类行为。53%的人认定为双性恋或异性恋，尽管所有人都报告在过去12个月内与另一名男性有过口交或肛交。至少有一次以下行为的显著预测因素：（1）在过去12个月内与男性伴侣进行血清学不一致的未采取保护措施的肛交（UAS）：有社会隔离风险的个体（比值比[AOR]=4.23；p=0.03）、住房不稳定的个体（AOR=4.19；p=0.03）以及在性行为期间至少每周使用一次Poppers的个体（AOR=5.90；p=0.05）；（2）在过去12个月内与女性伴侣进行UAS和/或未采取保护措施的阴道性交：住房不稳定的个体（AOR=4.85；p=0.04）、在性行为期间至少每周使用一次可卡因的个体（AOR=16.78；p=0.006）、感染艾滋病毒的个体（AOR=0.07；p=0.02）以及认为社会规范有利于使用避孕套的个体（AOR=0.60；p=0.05）；（3）与参与者最近的非主要男性性伴侣进行UAS：参与者在上一次性行为中使用酒精和毒品（AOR=4.04；p=0.01）、与西班牙裔/拉丁裔男性（AOR=2.71；p=0.04）或黑人男性（AOR=0.50；p=0.05）而非白人男性发生性行为，以及受教育程度较低（AOR=1.31；p=0.02）。研究结果表明，黑人男男性行为者的性风险行为因伴侣类型及其性网络特征而异，并且这一男男性行为亚群体面临艾滋病毒感染和传播的高风险。有效的预防策略需要针对黑人男男性行为者报告的不同性伴侣所呈现的独特性和行为风险模式。
