Mimiaga Matthew J, Biello Katie Brooks, Sivasubramanian Murugesan, Mayer Kenneth H, Anand Vivek Raj, Safren Steven A
a Department of Psychiatry , Harvard Medical School/Massachusetts General Hospital , Boston , MA , USA.
AIDS Care. 2013;25(9):1109-13. doi: 10.1080/09540121.2012.749340. Epub 2013 Jan 23.
Indian men who have sex with men (MSM) are at increased risk for HIV compared to the general Indian population. Psychosocial factors may be uniquely associated with HIV risk among Indian MSM and may moderate the beneficial impact of standard HIV prevention approaches. Psychiatric diagnostic interviews and psychosocial and sexual risk assessments were conducted among 150 MSM in Mumbai, India. Logistic regression was employed to examine the association of psychiatric disorders and psychosocial problems to recent sexual risk behavior. Twenty-five percent of participants reported engaging in unprotected anal sex (UAS) during their last sexual contact with a man. Men who were married to a woman were more likely to have engaged in UAS during their last sexual contact with a man (35% vs. 17%, p=0.018). In multivariable models, significant predictors of engaging in UAS were current major depression (adjusted odds ratio [AOR]=2.61; 95% confidence interval [CI] 1.07, 6.39) and number of stressful life events (AOR=0.91; 95% CI 0.83, 0.99). Alcohol dependence, anxiety, and self-esteem were not associated with engaging in UAS. Indian MSM with depression are at higher odds of engaging in UAS compared to MSM without depression. HIV prevention programs for Indian MSM may benefit from incorporating treatment or triage for mental health problems.
与印度普通人群相比，男男性行为者（MSM）感染艾滋病毒的风险更高。心理社会因素可能与印度男男性行为者的艾滋病毒感染风险有独特关联，并且可能会减弱标准艾滋病毒预防方法的有益影响。在印度孟买的150名男男性行为者中进行了精神科诊断访谈以及心理社会和性风险评估。采用逻辑回归分析来研究精神疾病和心理社会问题与近期性风险行为之间的关联。25%的参与者报告在其与男性的最后一次性接触中发生了无保护肛交（UAS）。与女性结婚的男性在其与男性的最后一次性接触中更有可能发生无保护肛交（35%对17%，p = 0.018）。在多变量模型中，发生无保护肛交的显著预测因素是当前的重度抑郁症（调整后的优势比[AOR]=2.61；95%置信区间[CI] 1.07，6.39）和应激性生活事件的数量（AOR=0.91；95%CI 0.83，0.99）。酒精依赖、焦虑和自尊与发生无保护肛交无关。与没有抑郁症的男男性行为者相比，患有抑郁症的印度男男性行为者发生无保护肛交的几率更高。针对印度男男性行为者的艾滋病毒预防项目可能会受益于纳入针对心理健康问题的治疗或分诊。
