Meanley Steven, Egan James E, Ware Deanna, Brennan-Ing Mark, Haberlen Sabina A, Detels Roger, Palella Frank, Friedman Mackey R, Plankey Michael W
Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
AIDS Patient Care STDS. 2022 Dec;36(12):462-473. doi: 10.1089/apc.2022.0167. Epub 2022 Nov 17.
Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM ( = 566) from the Multicenter AIDS Cohort Study Healthy Aging Substudy. Stratified by HIV serostatus, we used latent class analyses to identify CHP classes based on self-reported sociobehavioral and biobehavioral prevention strategies that participants and their male partners used in the prior 6 months. We identified three CHP classes among men living without HIV (MLWOH), including the following: high CHP overall (43.0%), high anal sex abstention (15.0%), and low prevention overall (42.0%). Among men living with HIV (MLWH), we identified four CHP classes, including the following: high CHP overall (20.9%), high CHP/low condom use (27.1%), high condom reliance (22.3%), and low prevention overall (29.7%). There were small differences by sociodemographic characteristics and sexual behavior practices between the classes; however, poppers use was often linked to being in high CHP groups. Our findings support that CHP is not one-size-fits-all for midlife and older adult MSM. There remains a need to scale up clinical providers' sexual health communication practices to assist midlife and older MSM incorporate prevention strategies, particularly biobehavioral prevention strategies that align with their patients' lived experiences.
关于联合预防艾滋病病毒（CHP）策略以降低中年及老年男男性行为者（MSM）中艾滋病病毒感染率的见解有限。本研究是一项二次数据分析，评估了来自多中心艾滋病队列研究健康老龄化子研究的性活跃中年及老年男男性行为者样本（n = 566）中的CHP情况。根据艾滋病病毒血清学状态分层，我们使用潜在类别分析，根据参与者及其男性伴侣在过去6个月中自我报告的社会行为和生物行为预防策略来确定CHP类别。我们在未感染艾滋病病毒的男性（MLWOH）中确定了三类CHP，包括：总体CHP较高（43.0%）、肛交禁欲率较高（15.0%）以及总体预防水平较低（42.0%）。在感染艾滋病病毒的男性（MLWH）中，我们确定了四类CHP，包括：总体CHP较高（20.9%）、CHP较高/避孕套使用率较低（27.1%）、高度依赖避孕套（22.3%）以及总体预防水平较低（29.7%）。不同类别之间在社会人口学特征和性行为习惯方面存在细微差异；然而，使用Poppers通常与处于CHP较高的群体有关。我们的研究结果支持，CHP并非适用于所有中年及老年男男性行为者的一刀切策略。仍有必要扩大临床提供者的性健康沟通实践，以帮助中年及老年男男性行为者纳入预防策略，特别是与患者生活经历相契合的生物行为预防策略。
