Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
AIDS Behav. 2023 Jan;27(1):257-278. doi: 10.1007/s10461-022-03761-y. Epub 2022 Jul 12.
Men who have sex with men (MSM) often change sexual behaviors following HIV diagnosis. This systematic review examined such changes, including sero-adaptive behaviors (i.e., deliberate safer-sex practices to reduce transmission risk) to better understand the magnitude of their association with HIV diagnosis. We searched four databases (1996-2017) and reviewed references from other systematic reviews. We included studies conducted in the United States that compared sexual behavior among HIV-infected "aware" versus "unaware" MSM. We meta-analytically pooled RRs and associated 95% confidence intervals (CI) using random-effects models, and assessed risk of bias and evidence quality. Twenty studies reported k = 131 effect sizes on sexual practices outcomes, most of which reported changes in unprotected sex (k = 85), and on sex with at-risk partners (k = 76); 11 reported sero-adaptive behaviors. Unprotected anal intercourse with an HIV-uninfected/unknown-status partner was less likely among aware MSM (insertive position: k = 2, RR 0.26, 95% CI 0.17, 0.41; receptive position: k = 2, RR 0.53, 95% CI 0.37, 0.77). Risk of not always serosorting among aware MSM (k = 3) was RR = 0.92 (0.83, 1.02). Existing evidence, although low-quality, suggests that HIV-infected MSM tend to adopt safer sexual practices once aware of their diagnosis. Variation in reporting of outcomes limits their comparability. Sero-adaptive behavior data are sparse.
男男性行为者（MSM）在感染 HIV 后通常会改变性行为。本系统评价旨在通过研究此类行为改变，包括血清适应性行为（即通过采取更安全的性行为来降低传播风险），以更好地了解这些行为改变与 HIV 诊断的关联程度。我们检索了四个数据库（1996-2017 年），并查阅了其他系统评价的参考文献。我们纳入了在美国进行的、比较 HIV 感染的“知情”与“不知情”MSM 之间性行为的研究。我们采用随机效应模型对 RR 进行荟萃分析，并对 RR 及其 95%置信区间（CI）进行合并，同时评估偏倚风险和证据质量。20 项研究报告了 131 项性行为结局的效应量，其中大部分研究报告了无保护性行为（k=85）和与高危性伴侣发生性行为（k=76）的变化；11 项研究报告了血清适应性行为。在知晓自身 HIV 感染状况的 MSM 中，与 HIV 未感染/未知感染状况的性伴侣进行无保护肛交的可能性较低（插入性体位：k=2，RR 0.26，95%CI 0.17,0.41；接受性体位：k=2，RR 0.53，95%CI 0.37,0.77）。在知晓自身 HIV 感染状况的 MSM 中，始终进行血清学匹配的可能性降低（k=3，RR=0.92，95%CI 0.83,1.02）。现有证据质量较低，但表明感染 HIV 的 MSM 倾向于在知晓自身诊断后采取更安全的性行为。由于结局报告的差异，限制了其可比性。血清适应性行为的数据较为匮乏。
