美国男男性行为者的性风险轨迹：对暴露前预防措施传播的启示。
Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery.
机构信息
Departments of *Epidemiology; †Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA; Departments of ‡Family Medicine; §Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA; ‖Center for Clinical AIDS Research & Education, David Geffen School of Medicine, University of California, Los Angeles, CA; ¶David Ostrow & Associates, LLC Chicago, IL; #The Chicago MACS, Northwestern University, Evanston, IL; **Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and ††Department of Medicine, Georgetown University Medical Center, Washington, DC.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):579-86. doi: 10.1097/QAI.0000000000000101.
BACKGROUND
Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, sexual risk trajectories among HIV-negative MSM were characterized.
METHODS
At semiannual visits from 2003 to 2011, HIV-negative MSM (N = 419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors (SRBs) since their last visit. Based on their reported behaviors, participants were assigned a SRB score at each visit as follows: 0 = no insertive or receptive anal intercourse, 1 = no unprotected insertive or receptive anal intercourse, 2 = only unprotected insertive anal intercourse, 3 = unprotected receptive anal intercourse with 1 HIV-negative partner, 4 = condom serosorting, 5 = condom seropositioning, and 6 = no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores (<4 vs. ≥4) and identify groups with distinct sexual risk trajectories.
RESULTS
Three sexual risk trajectory groups were identified: low-risk (n = 264; 63.0%), moderate-risk (n = 96; 22.9%; mean duration of consecutive high-risk intervals ∼1 year), and high-risk (n = 59; 14.1%; mean duration of consecutive high-risk intervals ∼2 years). Compared to low-risk group membership, high-risk group membership was associated with younger age (in years) [adjusted odds ratio (AOR) = 0.92, 95% confidence interval (CI): 0.88 to 0.96], being White (AOR = 3.67, 95% CI: 1.48 to 9.11), earning an income ≥$20,000 (AOR = 4.98, 95% CI: 2.13 to 11.64), distress/depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16) (AOR = 2.36, 95% CI: 1.14 to 4.92), and substance use (AOR = 2.00, 95% CI: 1.01 to 3.97).
CONCLUSIONS
Screening for the sociodemographic and behavioral factors described above may facilitate targeted PrEP delivery during high-risk periods among MSM.
背景
尽管有证据支持暴露前预防（PrEP）的疗效，但人们对男男性行为者（MSM）广泛实施 PrEP 的可行性仍存在担忧。为了为有针对性的 PrEP 实施提供指导，本研究对 HIV 阴性 MSM 的性风险轨迹进行了描述。
方法
2003 年至 2011 年期间，在参加艾滋病多中心队列研究的 HIV 阴性 MSM（N=419）每半年进行一次随访，提供自上次就诊以来性行为风险行为（SRB）的数据。根据他们报告的行为，参与者在每次就诊时被分配一个 SRB 评分如下：0=无插入性或接受性肛交；1=无保护的插入性或接受性肛交；2=仅无保护的插入性肛交；3=与 1 名 HIV 阴性伴侣进行无保护的接受性肛交；4= condom serosorting；5= condom seropositioning；6=无血清适应行为。采用基于群组的轨迹建模来检验 SRB 评分（＜4 与≥4），并确定具有不同性风险轨迹的群组。
结果
确定了三个性风险轨迹群组：低风险（n=264；63.0%）、中风险（n=96；22.9%；连续高风险间隔的平均持续时间约为 1 年）和高风险（n=59；14.1%；连续高风险间隔的平均持续时间约为 2 年）。与低风险组相比，高风险组与以下因素相关：年龄较轻（岁）[调整后的优势比（AOR）=0.92，95%置信区间（CI）：0.88 至 0.96]、白人（AOR=3.67，95%CI：1.48 至 9.11）、收入≥$20,000（AOR=4.98，95%CI：2.13 至 11.64）、抑郁/抑郁症状（流行病学研究中心抑郁量表≥16）（AOR=2.36，95%CI：1.14 至 4.92）和物质使用（AOR=2.00，95%CI：1.01 至 3.97）。
结论
筛查上述社会人口学和行为因素，可能有助于在 MSM 的高风险期间有针对性地提供 PrEP。
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