稳定伴侣关系的风险：秘鲁利马近期被诊断出感染艾滋病毒和/或性传播感染的男男性行为者及跨性别女性的伴侣关系特征与无保护肛交之间的关联。
The risk of stable partnerships: associations between partnership characteristics and unprotected anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru.
作者信息
Cambou Mary C, Perez-Brumer Amaya G, Segura Eddy R, Salvatierra H Javier, Lama Javier R, Sanchez Jorge, Clark Jesse L
机构信息
David Geffen School of Medicine at UCLA, Department of Medicine, Division of Infectious Diseases and Program in Global Health, Los Angeles, California, United States of America.
David Geffen School of Medicine at UCLA, Department of Medicine, Division of Infectious Diseases and Program in Global Health, Los Angeles, California, United States of America; Mailman School of Public Health, Columbia University, Department of Sociomedical Sciences, New York, New York, United States of America.
出版信息
PLoS One. 2014 Jul 16;9(7):e102894. doi: 10.1371/journal.pone.0102894. eCollection 2014.
BACKGROUND
Partnership type is an important factor associated with unprotected anal intercourse (UAI) and subsequent risk for HIV and sexually transmitted infections (STI). We examined the association of partnership type with UAI among men who have sex with men (MSM) and male-to-female transgender women (TGW) in Lima, Peru, recently diagnosed with HIV and/or STI.
METHODS
We report data from a cross-sectional analysis of MSM and TGW recently diagnosed with HIV and/or STI in Lima, Peru between 2011 and 2012. We surveyed participants regarding UAI with up to their three most recent sexual partners according to partner type. Multivariable Generalized Estimate Equating (GEE) models with Poisson distribution were used to estimate prevalence ratios (PR) for UAI according to partner type.
RESULTS
Among 339 MSM and TGW recently diagnosed with HIV and/or STI (mean age: 30.6 years, SD 9.0), 65.5% self-identified as homosexual/gay, 16.0% as bisexual, 15.2% as male-to-female transgender, and 3.3% as heterosexual. Participants provided information on 893 recent male or TGW partners with whom they had engaged in insertive or receptive anal intercourse: 28.9% stable partners, 56.4% non-stable/non-transactional partners (i.e. casual or anonymous), and 14.7% transactional partners (i.e. transactional sex client or sex worker). Unprotected anal intercourse was reported with 41.3% of all partners. In multivariable analysis, factors associated with UAI included partnership type (non-stable/non-transactional partner APR 0.73, [95% CI 0.59-0.91], transactional partner APR 0.53 [0.36-0.78], p<0.05) and the number of previous sexual encounters with the partner (>10 encounters APR 1.43 [1.06-1.92], p<0.05).
CONCLUSION
UAI was more commonly reported for stable partners and in partnerships with >10 sexual encounters, suggesting UAI is more prevalent in partnerships with a greater degree of interpersonal commitment. Further research assessing partner-level factors and behavior is critical for improving HIV and/or STI prevention efforts among Peruvian MSM and TGW.
背景
伴侣类型是与无保护肛交（UAI）以及后续感染艾滋病毒和性传播感染（STI）风险相关的一个重要因素。我们研究了秘鲁利马最近被诊断出感染艾滋病毒和/或性传播感染的男男性行为者（MSM）和男变女跨性别女性（TGW）中伴侣类型与无保护肛交之间的关联。
方法
我们报告了2011年至2012年期间对秘鲁利马最近被诊断出感染艾滋病毒和/或性传播感染的男男性行为者和男变女跨性别女性进行的横断面分析数据。我们根据伴侣类型，就他们与最近的三个性伴侣发生的无保护肛交情况对参与者进行了调查。采用具有泊松分布的多变量广义估计方程（GEE）模型来估计根据伴侣类型的无保护肛交患病率比（PR）。
结果
在339名最近被诊断出感染艾滋病毒和/或性传播感染的男男性行为者和男变女跨性别女性中（平均年龄：30.6岁，标准差9.0），65.5%自我认定为同性恋/男同性恋，16.0%为双性恋，15.2%为男变女跨性别者，3.3%为异性恋。参与者提供了与他们进行插入式或接受式肛交的893名最近的男性或男变女跨性别伴侣的信息：28.9%为稳定伴侣，56.4%为非稳定/非交易性伴侣（即随意或匿名的），14.7%为交易性伴侣（即性交易客户或性工作者）。据报告，与所有伴侣发生无保护肛交的比例为41.3%。在多变量分析中，与无保护肛交相关的因素包括伴侣类型（非稳定/非交易性伴侣调整患病率比0.73，[95%置信区间0.59 - 0.91]，交易性伴侣调整患病率比0.53 [0.36 - 0.78]，p<0.05）以及与伴侣之前性接触的次数（>10次接触调整患病率比1.43 [1.06 - 1.92]，p<0.05）。
结论
据报告，与稳定伴侣以及有>10次性接触的伴侣发生无保护肛交的情况更为常见，这表明无保护肛交在具有更高程度人际承诺的伴侣关系中更为普遍。评估伴侣层面因素和行为的进一步研究对于改善秘鲁男男性行为者和男变女跨性别女性中的艾滋病毒和/或性传播感染预防工作至关重要。
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