男男性行为者中的交易性性行为：按物质使用和 HIV 状况的差异。
Transactional Sex among Men Who Have Sex with Men: Differences by Substance Use and HIV Status.
机构信息
Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Box 951772, CHS 46-082, Los Angeles, CA, 90095-1772, USA.
Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
出版信息
J Urban Health. 2019 Jun;96(3):429-441. doi: 10.1007/s11524-018-0309-8.
Exchanging money, drugs, and other goods for sex has been associated with sexual risk behaviors and increased STIs/HIV. While female sex work is well described, data on men who exchange sex for money or goods are more limited. This paper examined the prevalence and correlates of transactional sex among young men who have sex with men, especially focusing on substance use and HIV status. We conducted a cohort study of 511 participants recruited between August 2014 and December 2017 in Los Angeles, CA. Eligible participants were: (1) between 18 and 45 years of age; (2) male; and (3) if HIV-negative, reported condomless anal intercourse with a male partner in the past 6 months. By design, half were HIV-positive and half HIV-negative. At baseline and semi-annual follow-up visits, computer-assisted self-interviews were used to collect information on demographics, sexual behaviors including transactional sex which was defined as exchange of money, drugs, or a place to stay for anal intercourse. Laboratory testing was conducted for current STI/HIV status. The average age of participants was 31.4 years with 43% identifying as African American, followed by 36% as Hispanic/Latino. The prevalence of recent transactional sex across 1486 study visits was 17% (n = 255), with 74% of those reporting exchanging sex for drugs. The prevalence of transactional sex was higher among those who reported unstable housing (32 vs. 11%; p value < .01), concurrent sexual partnerships (26 vs. 9%; p value < .01), and transgender sex partners (40 vs. 15%; p value < .01). Those who reported receiving money, drugs, or shelter for sex were also more likely to report giving money, drugs, shelter for sex than men who did not report exchange sex (77 vs. 11%; p value < .01). Based on multivariable analyses after adjusting for age and race/ethnicity, HIV viral load was independently associated with transactional sex [adjusted odds ratio (AOR) = 1.4; 95% confidence interval (CI) 1.1-1.7) per log increase]. Additionally, those testing positive for an STI were nearly twice as likely to report transactional sex as compared to those without STIs (AOR = 1.9; 95% CI 1.2-3.5). These findings underscore the relatively high prevalence of transactional sex and its potential role in ongoing HIV transmission among this cohort of high-risk HIV-negative and HIV-positive men who have sex with men.
金钱、毒品和其他物品换取性服务与性风险行为和性传播感染（STIs/HIV）的增加有关。虽然女性性工作者的情况已得到充分描述，但关于男性性工作者的资料则更为有限。本文研究了男男性行为者（MSM）中易性交易的流行率和相关因素，特别是重点关注物质使用和 HIV 状况。我们在加利福尼亚州洛杉矶进行了一项队列研究，共招募了 511 名参与者，招募时间为 2014 年 8 月至 2017 年 12 月。符合条件的参与者包括：（1）年龄在 18 至 45 岁之间；（2）男性；（3）如果 HIV 检测结果为阴性，则报告在过去 6 个月内与男性伴侣发生过无保护的肛交。按照设计，一半参与者 HIV 检测结果为阳性，另一半 HIV 检测结果为阴性。在基线和半年度随访期间，使用计算机辅助的自我访谈收集人口统计学信息、性行为信息，包括易性交易，其定义为金钱、毒品或住所的交换与肛交。进行了当前 STI/HIV 状况的实验室检测。参与者的平均年龄为 31.4 岁，其中 43%为非裔美国人，其次是 36%为西班牙裔/拉丁裔。在 1486 次研究访问中，最近易性交易的流行率为 17%（n=255），其中 74%的人报告交换性服务以换取毒品。在报告不稳定住房（32%比 11%；p 值<0.01）、同时发生的性伴侣关系（26%比 9%；p 值<0.01）和跨性别性伴侣（40%比 15%；p 值<0.01）的参与者中，易性交易的流行率更高。那些报告因性交易而收到金钱、毒品或住所的人也更有可能报告给予金钱、毒品、住所以换取性服务，而不是那些没有报告性交易的人（77%比 11%；p 值<0.01）。在调整年龄和种族/民族后进行多变量分析，HIV 病毒载量与易性交易独立相关[调整后的优势比（AOR）=1.4；95%置信区间（CI）为 1.1-1.7]。此外，与没有性传播感染的人相比，检测出性传播感染的人报告易性交易的可能性几乎高出一倍（AOR=1.9；95%CI 为 1.2-3.5）。这些发现强调了在这一高危 HIV 阴性和 HIV 阳性的男男性行为者队列中，易性交易的相对高流行率及其在持续 HIV 传播中的潜在作用。
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