Raymond H F, Ick T O, Chen Y-H
San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA.
AIDS Behav. 2016 Feb;20(2):417-22. doi: 10.1007/s10461-015-1181-0.
HIV in the United States is concentrated in populations such as men who have sex with men (MSM), people who inject drugs (PWID), women of color and people living in poverty. These populations are labeled high-risk for HIV infection because of the higher levels of HIV or HIV risk taking behaviors seen in these groups compared to other sub-populations. It is also possible that a group may engage in behaviors that are "high-risk" for HIV infection but never become infected since HIV is not present or not present to a great extent in their social or sexual networks. We analyzed samples of MSM, PWID and high-risk heterosexuals (HRH) collected through the National HIV Behavioral Surveillance (NHBS) system in San Francisco to examine HIV risk taking and HIV burden to determine if the label "high-risk" is appropriately applied. NHBS samples MSM using time location sampling and PWID and HRH using Respondent Driven Sampling. We sampled 508 MSM in 2011, 570 PWID in 2012 and 267 HRH in 2013. There were, as expected, differences in demographic characteristics across the three groups. HRH had a greater number of high-risk behaviors compared to MSM and PWID but had the lowest HIV prevalence. Focusing on risk behavior alone to label populations without considering the background HIV prevalence in communities, the types of risks engaged in and actual HIV infections may obscure which populations truly merit the label "high-risk" for HIV infection.
美国的艾滋病病毒集中在男男性行为者（MSM）、注射毒品者（PWID）、有色人种女性和贫困人口等人群中。这些人群被标记为艾滋病病毒感染的高危人群，因为与其他亚人群相比，这些群体中的艾滋病病毒水平或艾滋病病毒风险行为水平更高。也有可能一个群体可能从事对艾滋病病毒感染“高危”的行为，但由于其社交或性网络中不存在或不存在大量艾滋病病毒，所以从未被感染。我们分析了通过旧金山国家艾滋病病毒行为监测（NHBS）系统收集的男男性行为者、注射毒品者和高危异性恋者（HRH）的样本，以检查艾滋病病毒风险行为和艾滋病病毒负担，以确定“高危”标签是否适用得当。NHBS对男男性行为者采用时间地点抽样，对注射毒品者和高危异性恋者采用应答驱动抽样。我们在2011年对508名男男性行为者、2012年对570名注射毒品者和2013年对267名高危异性恋者进行了抽样。正如预期的那样，三组人群在人口特征方面存在差异。与男男性行为者和注射毒品者相比，高危异性恋者有更多的高危行为，但艾滋病病毒感染率最低。仅关注风险行为来标记人群，而不考虑社区中的背景艾滋病病毒感染率、所从事的风险类型和实际艾滋病病毒感染情况，可能会掩盖哪些人群真正应被贴上艾滋病病毒感染“高危”标签。
