SEARCH, 104 Rajdumri Road, Pathumwan, Bangkok, 10330, Thailand.
AIDS Res Ther. 2012 Dec 23;9(1):38. doi: 10.1186/1742-6405-9-38.
The relationship between HIV serostatus disclosure and sexual risk behavior is inconsistent across studies. As men who have sex with men (MSM) are emerging as the key affected population in Bangkok, Thailand with reported HIV prevalence of 30%, we assessed whether HIV disclosure is associated with protected sex in this population.
A risk behavior questionnaire was administered using Audio Computer-Assisted Self-Interviewing (ACASI) to determine whether HIV serostatus disclosure was associated with protected sex in 200 HIV-positive MSM in Bangkok. HIV serostatus disclosure to the most recent sexual partner prior to or at the time of the sexual encounter was assessed. Protected sex was defined as insertive or receptive anal intercourse with a condom at the most recent sexual encounter.
The mean age was 30.2 years, CD4 was 353 cells/mm3, and one-third was on antiretroviral therapy. At the most recent sexual encounter, HIV serostatus disclosure rate was low (26%); 60.5% of subjects had not discussed their serostatus at all, while 5.5% had not revealed their true serostatus. Seventeen percent reported unprotected anal intercourse and about half had sex with their primary partners. The serostatus of the most recent sexual partner was HIV-positive in 19.2%, HIV-negative in 26.4%, and unknown in 54.4% of subjects. There was no association between disclosure and protected sex, with 41 of 48 (85.4%) disclosers and 104 of 126 (82.5%) of non-disclosers reported protected sex (p = .65). Subjects with HIV-positive partners were less likely to report protected sex overall (20 of 33, 60.6%) compared to those with HIV negative (82 of 96, 85.4%) or unknown (41 of 45, 91.1%) partners (p = .001). Age (27-32 years vs. ≤26 years, p = .008), primary partner status (p < .001), and HIV-positive serostatus of sexual partner (p < .001) were significantly associated with disclosure in the multivariate analyses.
Rates of HIV disclosure to sexual partners by HIV-positive MSM in Bangkok are low. Despite low rates of HIV serostatus disclosure, most HIV-positive MSM reported protected sex with their partners at risk for infection. Future studies should focus on understanding barriers to disclosure and factors driving risk behavior amongst MSM in Thailand.
HIV 阳性者的告知状况与性行为风险之间的关系在不同研究中并不一致。由于男男性接触者(MSM)在曼谷成为受影响的关键人群,其 HIV 感染率为 30%,因此我们评估了在该人群中 HIV 告知状况是否与安全性行为相关。
通过音频计算机辅助自我访谈(ACASI)对曼谷 200 名 HIV 阳性 MSM 进行风险行为问卷调查,以确定 HIV 阳性者在性接触前或性接触时告知最近性伴侣的状况是否与安全性行为相关。最近一次性接触时使用安全套进行插入性或接受性肛交被定义为保护性性行为。
平均年龄为 30.2 岁,CD4 为 353 个细胞/立方毫米,三分之一的人正在接受抗逆转录病毒治疗。在最近一次性接触中,HIV 阳性者告知状况的比例较低(26%);60.5%的人根本没有讨论过自己的状况,而 5.5%的人没有透露自己的真实状况。17%的人报告有非保护性肛交行为,约一半人与主要性伴侣发生性行为。最近一次性伴侣的 HIV 阳性者在 19.2%,HIV 阴性者在 26.4%,54.4%的人未知。告知状况与保护性性行为之间无关联,48 名告知者中有 41 名(85.4%)和 126 名非告知者中有 104 名(82.5%)报告有保护性性行为(p=0.65)。总体而言,与 HIV 阴性或未知性伴侣(85.4%和 91.1%)相比,HIV 阳性性伴侣的报告有保护性性行为的比例较低(60.6%)(p=0.001)。多变量分析显示,年龄(27-32 岁 vs. ≤26 岁,p=0.008)、主要性伴侣状况(p<0.001)和性伴侣 HIV 阳性状况(p<0.001)与告知状况显著相关。
曼谷 HIV 阳性 MSM 向性伴侣告知 HIV 状况的比例较低。尽管 HIV 阳性者告知状况的比例较低,但大多数 HIV 阳性 MSM 报告与有感染风险的伴侣发生了保护性性行为。未来的研究应重点关注了解男男性接触者告知状况的障碍以及驱动泰国男男性接触者发生风险行为的因素。