Forsyth Andrew D, Valdiserri Ronald O
Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services, Washington, DC.
AIDS Educ Prev. 2015 Dec;27(6):493-504. doi: 10.1521/aeap.2015.27.6.493.
We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.
我们应用健康的社会决定因素模型，来研究美国各州中选定的社会和结构因素对男男性行为者（MSM）艾滋病诊断率的影响。获取并分析了关键社会和结构变量的二手数据。使用标准描述性和推断性统计方法，来检验选定的社会和结构变量与2010年每10万名男男性行为者中估计的3期艾滋病毒感染（艾滋病）率之间的双变量和多变量关联。我们发现，生活在女同性恋、男同性恋、双性恋和跨性别者人口密度较高的州，与男男性行为者中较低的艾滋病诊断率独立相关。此外，我们发现男性中更大的收入不平等和更高的梅毒发病率与男男性行为者中更高的艾滋病诊断率相关，这可能归因于对有益于人群健康的社会福利投入不足的州政策环境，以及溃疡性性传播感染会增加艾滋病毒传播和感染的生物学风险这一事实。为在美国终结这一流行病，识别并解决可能与男男性行为者不良艾滋病毒结局相关的州级社会和结构因素至关重要。
