Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2018 Feb 28;13(2):e0193269. doi: 10.1371/journal.pone.0193269. eCollection 2018.
Non-disclosure criminal prosecutions among gay, bisexual and other men who have sex with men (MSM) are increasing, even though transmission risk is low when effective antiretroviral treatment (ART) is used. Reduced HIV testing may reduce the impact of HIV "test and treat" strategies. We aimed to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM.
MSM attending an HIV and primary care clinic in Toronto completed an audio computer-assisted self-interview questionnaire. HIV-negative participants were asked concern over non-disclosure prosecution altered their likelihood of HIV testing. Responses were characterized using cross-tabulations and bivariate logistic regressions. Flow charts modelled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure.
150 HIV-negative MSM were recruited September 2010 to June 2012. 7% (9/124) were less or much less likely to be tested for HIV due to concern over future prosecution. Bivariate regression showed no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern about prosecution. Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART.
Fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications.
尽管在有效抗逆转录病毒治疗（ART）的情况下，同性恋、双性恋和其他与男性发生性行为的男性（MSM）中的传播风险较低，但针对这些人群的非披露刑事起诉仍在增加。减少 HIV 检测可能会降低 HIV“检测和治疗”策略的效果。我们旨在量化非披露起诉对 MSM 中的 HIV 检测和传播的潜在影响。
在多伦多的一家 HIV 和初级保健诊所就诊的 MSM 完成了一份音频计算机辅助自我访谈问卷。HIV 阴性的参与者被问及对非披露起诉的担忧是否改变了他们进行 HIV 检测的可能性。使用交叉表和双变量逻辑回归对反应进行了特征描述。流程图通过控制 ART 使用、避孕套使用和 HIV 状态披露，模拟了 HIV 检测行为的变化如何影响 HIV 传播率。
2010 年 9 月至 2012 年 6 月，共招募了 150 名 HIV 阴性 MSM。由于担心未来的起诉，有 7%（9/124）的人不太可能或不太可能接受 HIV 检测。双变量回归显示，没有明显的社会/性人口统计学特征与因担心起诉而减少进行 HIV 检测的意愿相关。随后的模型估计，这种检测率降低 7%，可能导致社区 HIV 传播增加 18.5%，其中 73%是由于 HIV 阳性但未确诊的 MSM 未能获得治疗并通过使用 ART 降低 HIV 传播风险而导致的。
在多伦多，有少数 HIV 阴性 MSM 报告称，对 HIV 非披露的起诉恐惧会降低他们进行 HIV 检测的意愿；然而，这种减少可能会显著增加社区层面的 HIV 传播，这对公共卫生具有重要意义。
