Matser Amy, Heijman Titia, Geskus Ronald, de Vries Henry, Kretzschmar Mirjam, Speksnijder Arjen, Xiridou Maria, Fennema Han, Schim van der Loeff Maarten
Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Postbox 2200, 1000 CE, Amsterdam, The Netherlands,
AIDS Behav. 2014 Dec;18(12):2442-56. doi: 10.1007/s10461-014-0819-7.
The practice of unprotected anal intercourse (UAI) involves at least two partners. We examined the associations between insertive or receptive UAI and perceived HIV seroconcordance and partnership type in self-perceived HIV-negative and self-perceived HIV-positive men who have sex with men (MSM). MSM (age ≥ 18 years) were recruited for a cross-sectional survey at the sexually transmitted infections clinic in Amsterdam, the Netherlands, in 2008-2009. Participants completed a questionnaire concerning partnerships in the preceding 6 months. Associations were quantified via multinomial logistic regression models using generalized estimating equations. The outcomes were 'no, or safe anal intercourse', 'insertive UAI', and 'receptive UAI'. We included 5,456 partnerships from 1,890 self-perceived HIV-negative men and 1,861 partnerships from 558 self-perceived HIV-positive men. Within the partnerships, perceived HIV status of the partner was an important determinant of UAI (p < 0.001). Among HIV-negative men, perceived HIV discordance was negatively associated with receptive UAI compared with no or safe UAI (OR 0.57; 95 % CI 0.36-0.92); when the partners were more familiar with each other, the risk of receptive UAI was increased relative to no or safe anal intercourse. Among HIV-positive men, perceived HIV discordance was negatively associated with insertive UAI (OR 0.05; 95 % CI 0.03-0.08). Within partnerships, perceived HIV status of the partner was one of the strongest determinants of UAI among self-perceived HIV-negative and HIV-positive MSM, and discordant serostatus was negatively associated with UAI. The findings suggest that serosorting is one of the main strategies when engaging in UAI.
无保护肛交（UAI）行为至少涉及两名性伴侣。我们研究了在自我认定为HIV阴性和HIV阳性的男男性行为者（MSM）中，主动或被动UAI与感知到的HIV血清一致性及伴侣关系类型之间的关联。2008年至2009年，在荷兰阿姆斯特丹的性传播感染诊所招募了年龄≥18岁的MSM进行横断面调查。参与者完成了一份关于前6个月伴侣关系的问卷。通过使用广义估计方程的多项逻辑回归模型对关联进行量化。结果分为“无肛交或安全性肛交”、“主动UAI”和“被动UAI”。我们纳入了来自1890名自我认定为HIV阴性男性的5456段伴侣关系，以及来自558名自我认定为HIV阳性男性的1861段伴侣关系。在这些伴侣关系中，伴侣的感知HIV状态是UAI的一个重要决定因素（p<0.001）。在HIV阴性男性中，与无肛交或安全性肛交相比，感知到的HIV血清不一致与被动UAI呈负相关（比值比[OR]0.57；95%置信区间[CI]0.36 - 0.92）；当伴侣彼此更熟悉时，相对于无肛交或安全性肛交，被动UAI的风险增加。在HIV阳性男性中，感知到的HIV血清不一致与主动UAI呈负相关（OR 0.05；95%CI 0.03 - 0.08）。在伴侣关系中，伴侣的感知HIV状态是自我认定为HIV阴性和HIV阳性的MSM中UAI的最强决定因素之一，血清状态不一致与UAI呈负相关。研究结果表明，血清分类是进行UAI时的主要策略之一。
