*Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; †Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; ‡Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Department of Medical Social Sciences, Northwestern University, Chicago, IL; ‖Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA; ¶Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and #Department of Medicine, Georgetown University Medical Center, Washington, DC.
J Acquir Immune Defic Syndr. 2014 Jun 1;66(2):213-20. doi: 10.1097/QAI.0000000000000143.
Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO.
Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion.
MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01).
Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.
横断面研究表明，男男性行为者（MSMW）与仅男男性行为者（MSMO）相比，存在更多与 HIV 相关的健康差异。我们对参加多中心艾滋病队列研究（一项长期前瞻性队列研究）的参与者进行了为期 7 年的二次数据分析，以检查 MSMW 是否与 MSMO 相比，持续存在更高的抑郁症状、多药使用以及（在 HIV 阳性的男男性行为者中）HIV 病毒载量水平。
如果男性在研究波 38 至 50 之间报告了与至少 1 名男性和 1 名女性伴侣的性行为，则将其行为定义为双性恋。我们使用广义混合模型进行重复测量，以测试 CES-D 评分、多药使用和病毒载量在活跃的 MSMO（n = 1514）和 MSMW（n = 111）之间的差异，调整年龄、收入、种族/民族和最近的血清转化。
MSMW 比 MSMO 更有可能出现更高的 CES-D 评分、多药使用和病毒载量水平（均 P < 0.01）。这些组之间的结果轨迹在时间上没有显著差异。与白人 HIV 阳性 MSMW 相比，黑人和西班牙裔 HIV 阳性 MSMW 的病毒载量水平更高（P < 0.01）。
与 MSMO 相比，多中心艾滋病队列研究中的 MSMW 在生物、行为和心理社会领域都遭受着严重且持久的与 HIV 相关的健康差异。建议进一步开展定性和定量研究，以了解这些差异背后的途径，为针对 MSMW 中 HIV 获得和传播风险的干预措施的制定提供参考。
