Batchelder Abigail W, Safren Steven, Mitchell Avery D, Ivardic Ivan, O'Cleirigh Conall
Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA.
Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA.
Sex Health. 2017 Feb;14(1):59-71. doi: 10.1071/SH16083.
Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.
尽管在艾滋病毒预防和治疗方面不断取得进展，但男同性恋者、双性恋男性以及其他与男性发生性行为的男性（男男性行为者）在美国和许多其他西方国家仍然是受艾滋病毒/艾滋病影响最严重的人群。此外，男男性行为者受到各种心理问题的影响尤为严重，包括抑郁、痛苦、创伤和药物使用。这些挑战经常同时出现，并与更高的艾滋病毒感染和传播相关行为发生率、艾滋病毒感染率相关，而对于艾滋病毒/艾滋病感染者来说，则与较低的治疗参与度相关。此外，美国男男性行为者中存在种族差异；例如，年轻的非裔美国男男性行为者在持续的艾滋病毒流行中承担着不成比例的负担，这可能与性伴群体中不同的艾滋病毒流行率以及长期存在的结构性不平等有关。在本综述中，阐述了主要在美国男男性行为者面临的与艾滋病毒和性传播感染预防以及整个艾滋病毒治疗流程相关的心理健康挑战，包括艾滋病毒诊断、治疗参与和留存以及抗逆转录病毒药物依从性。还描述了男男性行为者之间的差异，包括与艾滋病毒预防和治疗相关的种族和族裔、年龄相关及结构性障碍，以及当前的干预措施。展望2020年，将需要资源来评估和实施可扩展的干预策略，以解决男男性行为者减少艾滋病毒和性传播感染风险及治疗方面的心理和社会障碍，尤其关注最脆弱的亚人群体。随着预防和治疗策略的普及，新的突破不断涌现，到2020年及以后，仍将需要行为策略来降低风险，并提高风险最高的男男性行为者的接受度和参与度。
