School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, 06477, USA.
Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
BMC Infect Dis. 2019 Mar 29;19(1):294. doi: 10.1186/s12879-019-3925-3.
African, Caribbean, and Black (Black) men account for 16.5% of new HIV diagnoses among men in Ontario. There is substantial evidence that sexually transmitted infections (STIs) are associated with increased likelihood of HIV infection; however, little is known regarding the prevalence of HIV/STI co-infections among Black men in Toronto. Progress has been made in understanding factors contributing to racial/ethnic disparities in HIV between among men who have sex with men (MSM). In this study, we investigate within-racial group patterns of HIV/STI infection between Black MSM and Black men who only have sex with women (MSW).
A cross-sectional descriptive epidemiological study was conducted with a non-probability sample of Black men recruited from Toronto, Ontario. Audio Computer Assisted Self-Interviews (ACASI) surveys were used to collect demographic and behavioral data. Biological specimens were collected to screen for HIV and other STIs. Chi-Square tests were used to compare the prevalence of (1) HIV and current STIs between MSM and MSW and (2) current STIs between people living with HIV and people not living with HIV. Logistic regression models were constructed to assess whether or not history of STIs were associated with current HIV infection.
The prevalence of HIV (9.2%), syphilis (7.2%), hepatitis B (2.7%), and high-risk anal HPV (8.4%) and penile HPV (21.3%) infections were high in Black men (N = 487) and were significantly increased in Black MSM compared with MSW; the prevalence of syphilis and high-risk HPV were also increased in men living with HIV. Men with a history of syphilis (OR = 6.48, 95% CI: 2.68,15.71), genital warts (OR = 4.32, 95% CI: 1.79,10.43) or genital ulcers (OR = 21.3, 95% CI: 1.89,239.51) had an increased odds of HIV infection.
The HIV/STI prevalence was high among this sample of Black men, although the study design may have led to oversampling of men living with HIV. The associations between STIs and current HIV infection highlight the need for integrated of HIV/STI screening and treatment programs for Black men. Public health strategies are also needed to reduce disproportionate HIV/STI burden among Black MSM-including improving HPV vaccine coverage.
在安大略省的男性新艾滋病诊断中，非洲裔加勒比裔和黑人（黑人）占 16.5%。有大量证据表明性传播感染（STIs）与增加艾滋病毒感染的可能性有关；然而，对于多伦多黑人男性中艾滋病毒/性传播感染的合并感染的流行情况知之甚少。在理解男男性行为者（MSM）之间与种族/族裔有关的艾滋病毒差异的因素方面已经取得了进展。在这项研究中，我们调查了黑人 MSM 和仅与女性发生性关系的黑人男性（MSW）之间艾滋病毒/性传播感染的种族内模式。
对来自安大略省多伦多的黑人男性进行了非概率样本的横断面描述性流行病学研究。使用音频计算机辅助自我访谈（ACASI）调查收集人口统计学和行为数据。采集生物标本以筛查艾滋病毒和其他性传播感染。卡方检验用于比较（1）MSM 和 MSW 之间艾滋病毒和当前性传播感染的流行率，以及（2）艾滋病毒感染者和未感染者之间当前性传播感染的流行率。构建逻辑回归模型评估性传播感染史是否与当前艾滋病毒感染相关。
黑人男性（N=487）中艾滋病毒（9.2%）、梅毒（7.2%）、乙型肝炎（2.7%）和高危肛门 HPV（8.4%）和阴茎 HPV（21.3%）感染的流行率较高，并且与 MSW 相比，黑人 MSM 中的这些感染明显增加；艾滋病毒感染者中的梅毒和高危 HPV 感染也有所增加。患有梅毒（OR=6.48，95%CI：2.68，15.71）、生殖器疣（OR=4.32，95%CI：1.79，10.43）或生殖器溃疡（OR=21.3，95%CI：1.89，239.51）的男性感染艾滋病毒的几率增加。
在该黑人男性样本中，艾滋病毒/性传播感染的流行率很高，尽管研究设计可能导致艾滋病毒感染者的抽样过多。性传播感染与当前艾滋病毒感染之间的关联突出表明需要为黑人男性提供艾滋病毒/性传播感染综合筛查和治疗计划。还需要制定公共卫生战略，以减少黑人 MSM 中不成比例的艾滋病毒/性传播感染负担，包括提高 HPV 疫苗接种率。
