White Darcy, Rosenberg Eli S, Cooper Hannah L F, del Rio Carlos, Sanchez Travis H, Salazar Laura F, Sullivan Patrick S
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Drug Alcohol Depend. 2014 May 1;138:146-53. doi: 10.1016/j.drugalcdep.2014.02.025. Epub 2014 Feb 26.
Men who have sex with men (MSM), particularly young black MSM, are disproportionately affected in the United States' HIV epidemic. Drug use may contribute to these disparities, yet previous studies have failed to provide evidence of elevated use among black MSM, relying exclusively on self-reported usage. This study uses biological assays to validate self-reports of drug use and explore the potential for misclassification to distort findings on racial patterns of use in this population.
From an Atlanta-based cohort study of 454 black and 349 white MSM from 2010 to 2012, participants' self-reported drug use was compared to urine drug screening findings. The sensitivity of self-report was calculated as the proportion reporting recent usage among those who screened positive. Multivariable regression models were constructed to examine racial patterns in self-report, urine-detection, and self-report sensitivity of marijuana and cocaine usage, adjusted for socio-demographic factors.
In analyses that adjusted for age, education, income, sexual orientation, and history of arrest, black MSM were less likely to report recent use of marijuana (P<0.001) and cocaine (P=0.02), but equally likely to screen positive for either drug. This discrepancy between self-reported and urine-detected drug use was explained by significantly lower sensitivity of self-report for black participants (P<0.001 for marijuana, P<0.05 for cocaine).
The contribution of individual drug-related risk behaviors to the HIV disparities between black and white MSM should be revisited with methods that validate self-reports of illegal drug use.
男男性行为者（MSM），尤其是年轻黑人男男性行为者，在美国的艾滋病毒疫情中受到的影响尤为严重。药物使用可能是造成这些差异的原因之一，但以往的研究未能提供黑人男男性行为者药物使用增加的证据，这些研究完全依赖自我报告的使用情况。本研究使用生物学检测方法来验证药物使用的自我报告，并探讨错误分类对该人群药物使用种族模式研究结果的潜在扭曲作用。
在一项于2010年至2012年对454名黑人男男性行为者和349名白人男男性行为者进行的亚特兰大队列研究中，将参与者自我报告的药物使用情况与尿液药物筛查结果进行比较。自我报告的敏感性计算为在筛查呈阳性的人群中报告近期使用药物的比例。构建多变量回归模型，以检验在调整社会人口学因素后，大麻和可卡因使用的自我报告、尿液检测及自我报告敏感性方面的种族模式。
在对年龄、教育程度、收入、性取向和被捕史进行调整的分析中，黑人男男性行为者报告近期使用大麻（P<0.001）和可卡因（P=0.02）的可能性较低，但两种药物筛查呈阳性的可能性相同。自我报告的药物使用情况与尿液检测结果之间的这种差异，可通过黑人参与者自我报告的敏感性显著较低来解释（大麻P<0.001，可卡因P<0.05）。
应采用验证非法药物使用自我报告的方法，重新审视个体药物相关风险行为对黑人和白人男男性行为者之间艾滋病毒差异的影响。
