跨越性界限:洛杉矶街头抽样调查中的双性恋男性

Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles.

作者信息

Gorbach Pamina M, Murphy Ryan, Weiss Robert E, Hucks-Ortiz Christopher, Shoptaw Steven

机构信息

Department of Epidemiology, UCLA School of Public Health, University of California-Los Angeles, 10880 Wilshire Blvd., Los Angeles, CA 90095-7353, USA.

出版信息

J Urban Health. 2009 Jul;86 Suppl 1(Suppl 1):63-76. doi: 10.1007/s11524-009-9370-7. Epub 2009 Jun 19.

Abstract

The purpose of the study was to determine the potential contribution of bisexual men to the spread of HIV in Los Angeles. We compare the characteristics and behaviors of men who have sex with men and women (MSMW) to men who have sex with only women (MSW) and men who have sex with only men (MSM) in Los Angeles. Men (N = 1,125) who participated in one of the two waves of data collection from 2005 to 2007 at the Los Angeles site for NIDA's Sexual Acquisition and Transmission of HIV-Cooperative Agreement Program were recruited using Respondent Driven Sampling. Participants completed Audio Computer Assisted Self Interviews and received oral HIV rapid testing with confirmatory blood test by Western Blot and provided urine specimens for detection of recent powder cocaine, crack cocaine, methamphetamine, or heroin use. MSM, MSW, or MSMW were defined by the gender of whom they reported sex with in the past 6 months. Chi-square tests and ANOVAs were used to test independence between these groups and demographic characteristics, substance use, and sexual behaviors. We fit generalized linear random intercept models to predict sexual risk behaviors at the partner level. Men were mostly of low income, unemployed, and minority, with many being homeless; 66% had been to jail or prison, 29% had ever injected drugs, and 25% had used methamphetamine in the past 30 days. The sample had high HIV prevalence: 12% of MSMW, 65% of MSM, and 4% of MSW. MSMW were behaviorally between MSW and MSM, except that more MSMW practiced sex for trade (both receiving and giving), and more MSMW had partners who are drug users than MSW. Generalized linear random intercept models included a partner-level predictor with four partner groups: MSM, MSMW-male partners, MSMW-female partners, and MSW. The following were significantly associated with unprotected anal intercourse (UAI): MSW (AOR 0.15, 95% CI 0.08, 0.27), MSMW-female partners (AOR 0.4, 95% CI 0.27, 0.61), HIV-positive partners (AOR 2.03, 95% CI 1.31, 3.13), and being homeless (AOR 1.37, 95% CI 1.01, 1.86). The factors associated with giving money or drugs for sex were MSMW-female partners (AOR 1.70, 95% CI 1.09, 2.65), unknown HIV status partners (AOR 1.72, 95% CI 1.29, 2.30), being older (AOR 1.02, 95% CI 1.00, 1.04), history of incarceration (AOR 1.64, 95% CI 1.17, 2.29), and being homeless (AOR 1.73, 95% CI 1.27, 2.36). The following were associated with receiving money or drugs for sex: MSW (AOR 0.53, 95% CI 0.32, 0.89), African American (AOR 2.42, 95% CI 1.56, 3.76), Hispanic (AOR 1.85, 95% CI 1.12, 3.05), history of incarceration (AOR 1.44, 95% CI 1.04, 2.01), history of injecting drugs (AOR 1.57, 95% CI 1.13, 2.19), and had been recently homeless (AOR 2.14, 95% CI 1.57, 2.94). While overall HIV-positive MSM had more UAI with partners of any HIV status than MSMW with either partner gender, among HIV-positive MSMW, more had UAI with HIV-negative and HIV status unknown female partners than male partners. Findings highlight the interconnectedness of sexual and drug networks in this sample of men-as most have partners who use drugs and they use drugs themselves. We find a concentration of risk that occurs particularly among impoverished minorities-where many men use drugs, trade sex, and have sex with either gender. Findings also suggest an embedded core group of drug-using MSMW who may not so much contribute to spreading the HIV epidemic to the general population, but driven by their pressing need for drugs and money, concentrate the epidemic among men and women like themselves who have few resources.

摘要

该研究的目的是确定双性恋男性对洛杉矶艾滋病病毒传播的潜在影响。我们比较了在洛杉矶与男性和女性都有过性行为的男性(MSMW)、只与女性有过性行为的男性(MSW)和只与男性有过性行为的男性(MSM)的特征和行为。2005年至2007年在洛杉矶站点参与美国国立药物滥用研究所艾滋病病毒性传播与感染合作协议项目两波数据收集之一的男性(N = 1125),采用应答驱动抽样法招募。参与者完成了音频计算机辅助自我访谈,并接受了艾滋病病毒快速口腔检测,随后通过蛋白免疫印迹法进行确证血液检测,并提供尿液样本以检测近期是否使用过粉末可卡因、快克可卡因、甲基苯丙胺或海洛因。MSM、MSW或MSMW根据他们在过去6个月内报告的性伴侣性别来定义。使用卡方检验和方差分析来检验这些组与人口统计学特征、物质使用和性行为之间的独立性。我们拟合了广义线性随机截距模型,以预测伴侣层面的性风险行为。男性大多低收入、失业且为少数族裔,许多人无家可归;66%曾入狱,29%曾注射毒品,25%在过去30天内使用过甲基苯丙胺。该样本中艾滋病病毒感染率很高:MSMW为12%,MSM为65%,MSW为4%。MSMW在行为上介于MSW和MSM之间,只是更多MSMW进行性交易(包括接受和提供),且与吸毒者有性伴侣的MSMW比MSW更多。广义线性随机截距模型包括一个伴侣层面的预测变量,有四个伴侣组:MSM、MSMW的男性伴侣、MSMW的女性伴侣和MSW。以下因素与无保护肛交(UAI)显著相关:MSW(调整后比值比[AOR] 0.15,95%置信区间[CI] 0.08,0.27)、MSMW的女性伴侣(AOR 0.4,95% CI 0.27,0.6)、艾滋病病毒阳性伴侣(AOR 2.03,95% CI 1.31,3.13)以及无家可归(AOR 1.37,95% CI 1.01,1.86)。与为性交易给钱或毒品相关的因素有:MSMW的女性伴侣(AOR 1.70,95% CI 1.09,2.65)、艾滋病病毒感染状况未知的伴侣(AOR 1.72,95% CI 1.29,2.30)、年龄较大(AOR 1.02,95% CI 1.00,1.04)、有监禁史(AOR 1.64,95% CI 1.17,2.29)以及无家可归(AOR 1.73,95% CI 1.27,2.36)。以下因素与因性交易接受钱或毒品相关:MSW(AOR 0.53,95% CI 0.32,0.89)、非裔美国人(AOR 2.42,95% CI 1.56,3.76)、西班牙裔(AOR 1.85,95% CI 1.12,3.05)、有监禁史(AOR 1.44,95% CI 1.04,2.01)、有注射毒品史(AOR 1.57,95% CI 1.13,2.19)以及近期无家可归(AOR 2.14,95% CI 1.57,2.94)。虽然总体上艾滋病病毒阳性的MSM与任何艾滋病病毒感染状况的伴侣发生无保护肛交的情况比MSMW与任何一种性别的伴侣都多,但在艾滋病病毒阳性MSMW中,与艾滋病病毒阴性和感染状况未知的女性伴侣发生无保护肛交的情况比男性伴侣更多。研究结果突出了该男性样本中性网络和毒品网络的相互关联性——因为大多数人有吸毒的伴侣且自己也吸毒。我们发现风险集中在贫困少数族裔中——许多男性吸毒、进行性交易且与两性都有性行为。研究结果还表明,有一个吸毒的MSMW核心群体,他们可能并非将艾滋病病毒疫情传播到普通人群的主要因素,但由于对毒品和金钱的迫切需求,将疫情集中在像他们自己一样资源匮乏的男性和女性中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04ec/2705489/c5695d10f56f/11524_2009_9370_Fig1_HTML.jpg

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