比较加拿大、英国和美国的黑人男同性恋者和其他男同性恋者中 HIV 感染的差异和风险：一项荟萃分析。

Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis.

机构信息

National Center for HIV/AIDS, Viral, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

出版信息

Lancet. 2012 Jul 28;380(9839):341-8. doi: 10.1016/S0140-6736(12)60899-X. Epub 2012 Jul 20.

DOI:10.1016/S0140-6736(12)60899-X

PMID:22819656

Abstract

BACKGROUND

We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA.

METHODS

We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM.

FINDINGS

We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38-0·75, for Canada and 0·67, 0·50-0·92, for the USA). Black MSM in the UK (1·86, 1·58-2·18) and the USA (3·00, 2·06-4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23-1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes.

INTERPRETATION

Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes.

FUNDING

None.

摘要

背景

我们进行了一项荟萃分析，以评估与加拿大、英国和美国的黑人男男性行为者（MSM）中 HIV 感染相关的差异因素。

方法

我们检索了 Embase、Medline、Google Scholar 和在线会议记录，时间从 1981 年 1 月 1 日至 2011 年 12 月 31 日，以寻找与 HIV 风险或 HIV 感染相关的、具有定量结果的种族比较研究。与加拿大、英国和美国的同性恋相关的关键词和医学主题词（美国国立医学图书馆）与相关的引用进行了交叉参考。针对每个感兴趣的结果，将数据汇总到各个研究中，以估算总体效应大小，并将其转换为 106148 名黑人 MSM 相对于 581577 名其他 MSM 的汇总比值比（OR）。

结果

我们分析了来自加拿大的 7 项研究、来自英国的 13 项研究和来自美国的 174 项研究。在每个国家，黑人 MSM 与其他 MSM 一样，同样可能进行无保护的、具有传播风险的异性性行为。与其他 MSM 相比，加拿大和美国的黑人 MSM 较少有药物使用史（比值比，OR，0.53，95%置信区间 0.38-0.75，加拿大；0.67，0.50-0.92，美国）。与其他 MSM 相比，英国（1.86，1.58-2.18）和美国（3.00，2.06-4.40）的黑人 MSM 更有可能 HIV 阳性，但每个国家的 HIV 阳性黑人 MSM 更不可能开始联合抗逆转录病毒治疗（cART）（英国为 22%，美国为 60%）。与其他 HIV 阳性 MSM 相比，美国的 HIV 阳性黑人 MSM 也较少有医疗保险、高 CD4 计数、坚持 cART 或病毒抑制。值得注意的是，尽管与其他美国 MSM 相比，黑人 MSM 具有两倍以上的任何增加 HIV 风险的结构性障碍（例如失业、低收入、先前监禁或受教育程度较低）的可能性，但美国黑人 MSM 更有可能采取任何预防 HIV 感染的行为（1.39，1.23-1.57）。就与 HIV 感染相关的结果而言，美国黑人 MSM 与其他 MSM 相比，结构性障碍、性伴侣人口统计学特征（例如年龄、种族）和 HIV 护理结局方面的差异最大，而性风险结局方面的差异最小。