Sapsirisavat Vorapot, Phanuphak Nittaya, Keadpudsa Siriwan, Egan James E, Pussadee Kanitta, Klaytong Preeyarach, Reuel Friedman M, van Griensven Frits, Stall Ron
HIV-NAT, Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
Department of Behavioral and Community Health Sciences Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
AIDS Behav. 2016 Dec;20(Suppl 3):386-397. doi: 10.1007/s10461-016-1519-2.
HIV prevalence remains high in men who have sex with men (MSM) in Bangkok. Even though resources for HIV testing and treatment are available for all, a large proportion of MSM still do not get HIV tested. We studied high risk MSM who are unaware of their HIV status to help maximize effectiveness of our resources. Convenience sampling was conducted among MSM who came for HIV testing at the Thai Red Cross Anonymous Clinic and two popular drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, have not been tested positive for HIV, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection diagnosis. Audio-Computer-Assisted Self-Interview was used to assess psychosocial profile, sexual risks, and HIV testing patterns prior to being informed of their HIV positive status. Among 499 high-risk MSM enrolled, the median age was 24.8 years and 112 (22 %) tested HIV-positive. Among the HIV-positive participants, 92 % self-identified as gay (versus bisexual), 39 % attained a bachelors degree or higher, 65 % had monthly income 10,000-29,999 baht ($280-830 USD), 10 % had vaginal or anal sex with a woman in the past 12 months, 39 % had condomless receptive sex with men and 21 % went to Lat Phrao to find a sexual partner. Compared to HIV negative MSM, HIV-positive MSM had less HIV testing: 31 % had ever been tested for HIV, 12 % had been tested in the past 6 months; but were more likely to guess correctly their positive status (31 %). Regarding psychosocial variables among HIV-positive MSM, 7 % had regular methamphetamine use in the past 3 months, 10 % had >2 sources of discrimination, and 8 % had >2 sources of discrimination due to being MSM. In multivariable model, age<30 year old, self-identified as gay, had monthly income <50,000 baht ($1400 USD), had anal sex with men in past 12 months, had >2 sources of discrimination because of being MSM, did not get HIV test in past 6 months, and guess of positive HIV were significantly associated with HIV positive status. Young MSM with lower socioeconomic status (SES) should be prioritized for innovative approaches to promoting awareness and uptake of HIV testing. Societal stigmatization of MSM should be addressed as a potential barrier to uptake of voluntary HIV testing. Resilience factors among these marginalized MSM who still test frequently and remain HIV-negative despite residing in a context with community viral loads and discrimination should also be studied in order to curb the HIV epidemic in Bangkok.
在曼谷，男男性行为者（MSM）中的艾滋病毒流行率仍然很高。尽管所有人都可获得艾滋病毒检测和治疗资源，但仍有很大一部分男男性行为者未进行艾滋病毒检测。我们对不知道自己艾滋病毒感染状况的高危男男性行为者进行了研究，以帮助最大限度地提高资源利用效率。我们在泰国红十字会匿名诊所及曼谷两个热门的临时救助中心对前来进行艾滋病毒检测的男男性行为者进行了便利抽样。纳入标准为年龄大于18岁、艾滋病毒检测未呈阳性、在过去6个月内报告有以下情况之一的男男性行为者：与男性无保护性行为、为性工作者或有性传播感染诊断。在告知其艾滋病毒阳性状态之前，采用音频计算机辅助自我访谈来评估心理社会状况、性风险和艾滋病毒检测模式。在纳入研究的499名高危男男性行为者中，中位年龄为24.8岁，112人（22%）艾滋病毒检测呈阳性。在艾滋病毒呈阳性的参与者中，92%自我认定为同性恋（与双性恋相对），39%拥有学士学位或更高学历，65%月收入为10,000 - 29,999泰铢（280 - 830美元），10%在过去12个月内与女性有过阴道或肛交，39%与男性有无保护的接受性性行为，21%前往拉抛寻找性伴侣。与艾滋病毒阴性的男男性行为者相比，艾滋病毒阳性的男男性行为者进行艾滋病毒检测的次数较少：31%曾进行过艾滋病毒检测，12%在过去6个月内进行过检测；但更有可能正确猜出自己的阳性状态（31%）。关于艾滋病毒阳性男男性行为者的心理社会变量，7%在过去3个月内经常使用甲基苯丙胺，10%有超过2种歧视来源，8%因身为男男性行为者而有超过2种歧视来源。在多变量模型中，年龄小于30岁、自我认定为同性恋、月收入低于50,000泰铢（1400美元）、在过去12个月内与男性有过肛交、因身为男男性行为者而有超过2种歧视来源、在过去6个月内未进行艾滋病毒检测以及猜出自己艾滋病毒呈阳性与艾滋病毒阳性状态显著相关。社会经济地位较低的年轻男男性行为者应优先采用创新方法来提高对艾滋病毒检测的认识并促进检测。应解决对男男性行为者的社会污名化问题，因为这是阻碍自愿艾滋病毒检测的一个潜在障碍。对于这些边缘化的男男性行为者，尽管生活在社区病毒载量高且存在歧视的环境中，但仍频繁进行检测且保持艾滋病毒阴性，其恢复力因素也应进行研究，以控制曼谷的艾滋病毒流行。
BMC Public Health. 2021-10-9
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