Bauermeister José A, Eaton Lisa, Andrzejewski Jack, Loveluck Jimena, VanHemert William, Pingel Emily S
Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA.
University of Connecticut, Storrs, CT, USA.
AIDS Behav. 2015 Dec;19(12):2358-69. doi: 10.1007/s10461-015-1180-1.
Structural characteristics are linked to HIV/STI risks, yet few studies have examined the mechanisms through which structural characteristics influence the HIV/STI risk of young men who have sex with men (YMSM). Using data from a cross-sectional survey of YMSM (ages 18-29) living in Detroit Metro (N = 328; 9 % HIV-positive; 49 % Black, 27 % White, 15 % Latino, 9 % Other race), we used multilevel modeling to examine the association between community-level characteristics (e.g., socioeconomic disadvantage; distance to LGBT-affirming institutions) and YMSM's HIV testing behavior and likelihood of engaging in unprotected anal intercourse with serodiscordant partner(s). We accounted for individual-level factors (race/ethnicity, poverty, homelessness, alcohol and marijuana use) and contextual factors (community acceptance and stigma regarding same-sex sexuality). YMSM in neighborhoods with greater disadvantage and nearer to an AIDS Service Organization were more likely to have tested for HIV and less likely to report serodiscordant partners. Community acceptance was associated with having tested for HIV. Efforts to address YMSM's exposure to structural barriers in Detroit Metro are needed to inform HIV prevention strategies from a socioecological perspective.
结构特征与艾滋病毒/性传播感染风险相关，但很少有研究探讨结构特征影响男男性行为者（YMSM）艾滋病毒/性传播感染风险的机制。利用对居住在底特律都会区的18至29岁男男性行为者进行的横断面调查数据（N = 328；9%为艾滋病毒阳性；49%为黑人，27%为白人，15%为拉丁裔，9%为其他种族），我们使用多层次模型来研究社区层面特征（如社会经济劣势；与支持LGBT的机构的距离）与男男性行为者的艾滋病毒检测行为以及与血清学不一致伴侣进行无保护肛交的可能性之间的关联。我们考虑了个体层面因素（种族/民族、贫困、无家可归、饮酒和使用大麻）和背景因素（社区对同性性行为的接受和污名化）。处于劣势程度较高且距离艾滋病服务组织较近社区的男男性行为者进行艾滋病毒检测的可能性更大，报告血清学不一致伴侣的可能性更小。社区接受度与进行艾滋病毒检测相关。需要做出努力，解决底特律都会区男男性行为者面临的结构障碍，以便从社会生态角度为艾滋病毒预防策略提供信息。
