Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, 02906, USA.
Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
AIDS Behav. 2020 Jun;24(6):1851-1864. doi: 10.1007/s10461-019-02760-w.
In the United States, men who have sex with men (MSM) continue to be at high-risk for HIV and other STIs, and condoms represent the most popular, affordable, and accessible method of prevention. Although a vast body of research has explored various factors associated with condom use in MSM, fewer studies have explored situation-level characteristics that affect their decisions about sex partners and condom use. Daily diary studies are well-suited to help improve our understanding of these event-level factors in detail, including the sex events themselves, partner characteristics, and motivations. As part of a larger study using ecological momentary assessment methods, high-risk MSM completed daily diary surveys about their sexual behavior on their smartphones each day for 30 days. This study explored detailed descriptive characteristics of sex events, partner characteristics, and motivations for sex and condom use, and examined whether specific aspects of these characteristics were associated with having condomless anal sex (CAS) with high-risk partners. High-risk CAS was common among MSM, with the majority of participants having met their partners online and many reporting sex the same day they met. Results showed that the odds of CAS were not higher with partners met online versus those met in other ways, but MSM were more likely to have asked online partners about their HIV status and testing history before sex. The odds of engaging in high-risk CAS was higher when MSM reported intimacy or self-assurance motives. Not having condoms readily available was a CAS motivation reported more commonly when MSM had sex with high-risk partners. Findings suggest that interventions should incorporate strategies that help MSM be safer specifically when meeting partners online and when having sex for intimacy or re-assurance. Interventions that remind MSM to carry condoms at opportune moments may also help reduce some HIV risk.
在美国，男男性行为者（MSM）仍然面临着感染艾滋病毒和其他性传播感染的高风险，而避孕套是最受欢迎、最实惠和最容易获得的预防方法。尽管有大量研究探讨了与 MSM 避孕套使用相关的各种因素，但很少有研究探讨影响他们与性伴侣发生性行为和使用避孕套决定的情境水平特征。日记研究非常适合帮助我们详细了解这些事件水平因素，包括性事件本身、伴侣特征和动机。作为一项使用生态瞬时评估方法的更大研究的一部分，高风险 MSM 在智能手机上每天完成 30 天的关于他们性行为的每日日记调查。本研究探讨了性行为事件、伴侣特征和使用避孕套进行性行为的动机的详细描述性特征，并检查了这些特征的特定方面是否与与高风险伴侣发生无保护肛交（CAS）有关。高风险 CAS 在 MSM 中很常见，大多数参与者是在网上认识他们的伴侣，许多人在与伴侣见面的当天就发生了性关系。结果表明，与其他方式相比，通过网络结识的伴侣发生 CAS 的几率并不高，但 MSM 在发生性行为之前更有可能询问网络伴侣的 HIV 状况和检测史。当 MSM 报告亲密或自信动机时，发生高风险 CAS 的几率更高。当 MSM 与高风险伴侣发生性行为时，更常报告没有避孕套是 CAS 的动机。研究结果表明，干预措施应纳入帮助 MSM 在特定情况下更加安全的策略，例如当他们在网上与伴侣见面以及出于亲密或重新获得自信而发生性行为时。提醒 MSM 在适当的时候携带避孕套的干预措施也可能有助于降低一些艾滋病毒风险。
