Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Prev Sci. 2020 Oct;21(7):917-925. doi: 10.1007/s11121-020-01135-1.
We sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)-the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being "extremely concerned about getting HIV"; and 17% reported worrying about HIV "all the time". Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.
我们试图研究自我感知的 HIV 风险和 HIV 状态信息回避与黑人男性与男性发生性行为者（BMSM）的 HIV 检测率和常规保健参与之间的关系 - 该群体是美国 HIV 感染风险最高的群体。为此，我们使用广义线性模型和序列中介模型来评估 2017 年至 2019 年在美国佐治亚州亚特兰大收集的 342 名 HIV 阴性 BMSM 的数据。参与者对 HIV 检测呈阳性表示相当关注；40%的人表示相信自己会 HIV 检测呈阳性；27%的人表示“非常担心感染 HIV”；17%的人表示一直担心 HIV“。中介分析表明，对 HIV 的更大关注与上次 HIV 检测和上次医疗保健预约之间的时间间隔更长有关。BMSM 认为自己感染 HIV 的风险相当大，但关键的是，这种看法并没有导致改善医疗保健行为。研究结果强调需要重新构想我们的公共卫生方法，以接触 BMSM。强调风险行为并针对 BMSM 开展工作可能会产生意想不到的后果，需要重新评估。尽管我们一直在努力改善与 HIV 相关的结果，但我们仍未能满足 BMSM 的需求。
