Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago.
Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Ann Epidemiol. 2021 Feb;54:52-63. doi: 10.1016/j.annepidem.2020.09.004. Epub 2020 Sep 18.
The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas.
This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States.
Our estimates indicate that HIV prevalence among MSM increased, from an across-metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions.
The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.
众所周知，要准确估计男男性行为者（MSM）中的 HIV 流行率存在诸多挑战。据我们所知，目前尚无文献发表在广泛的地理区域内对 MSM 进行长时间的 HIV 流行率年度估计。
本文采用多层模型，整合了多个来源的数据，以估计和验证 1992 年至 2013 年间美国 86 个最大的都会统计区中 MSM 的 HIV 流行率轨迹。
我们的估计表明，MSM 中的 HIV 流行率有所上升，从 1992 年的都会统计区平均 11%上升到 2013 年的 20%（标准差=3.5%）。我们对 MSM 中不同种族/族裔亚群的估计表明，在所有年份和地理区域中，黑人和西班牙裔/拉丁裔 MSM 的平均 HIV 流行率均高于白人 MSM。
所有 MSM 中 HIV 流行率的上升可能主要归因于死亡率的降低，以及少数族裔 MSM 中 HIV 发病率的增加。需要进一步的研究来证实这一点。如果属实，医疗保健措施应重点关注针对少数族裔 MSM 的有针对性的 HIV 预防措施，并培训提供者解决 HIV 阳性 MSM 预期寿命延长带来的交叉健康挑战。
