Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA.
Sex Transm Infect. 2022 Jun;98(4):269-276. doi: 10.1136/sextrans-2021-055047. Epub 2021 Jun 30.
OBJECTIVE: Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. METHODS: We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. RESULTS: Rates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80). CONCLUSIONS: Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.
目的：性少数群体男性（SMM）的颜色不成比例地受到艾滋病毒和细菌性性传播感染（bSTI）的影响。为了更好地了解种族和民族内部的异质性和不同的风险因素，我们试图研究种族和民族认同与其他社会人口因素交叉处未确诊的艾滋病毒和直肠 bSTI 的比率。
方法：我们检查了 2017 年 11 月至 2018 年 8 月期间在全国性队列研究中进行家庭自我检测的 8105 名 SMM 的数据。我们按种族和族裔群体进行分析，以检查不同群体（即亚群）在一系列特征下的艾滋病毒和直肠 bSTI 感染的未调整感染率。
结果：未确诊的艾滋病毒感染率在黑种人（4.3%，n=39）和拉丁裔（2.4%，n=38）SMM 中最高，而在被确定为多种族（1.6%，n=15）、白种人（1.3%，n=56）和其他种族（1.3%，n=6）的人群中则较低。在对艾滋病毒感染的分层分析中，出现了 15 个显著关联，表明年龄、地区、保险类型、性取向和监禁史对不同种族和族裔群体有不同的影响。特别是，私人和公共保险对白人 SMM 具有保护作用，但对黑人和拉丁裔 SMM 则没有保护作用，监禁与黑人和拉丁裔 SMM 的艾滋病毒感染率显著升高有关，而与白人 SMM 相比。我们发现，那些自我认同为拉丁裔（OR=7.5，95%CI 2.12 至 26.54）、白种人（OR=3.19，95%CI 1.14 至 8.98）和多种族（OR=5.5，95%CI 1.08 至 27.90）的参与者的艾滋病毒和 bSTI 率显著同时发生，但自我认同为黑人（OR=0.82，95%CI 0.10 至 6.56）或其他种族（OR=3.56，95%CI 0.31 至 40.80）的参与者则没有。
结论：分层分析显示，在种族和族裔群体与其他特征的交叉处，艾滋病毒感染率存在差异，特别是保险状况和监禁史，这表明黑人 SMM 和拉丁裔 SMM 中不成比例的高艾滋病毒感染率的背后是结构性不平等，而不是个人行为。
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