Department of Social, Behavioral and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, USA.
Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA.
Curr HIV/AIDS Rep. 2023 Aug;20(4):206-217. doi: 10.1007/s11904-023-00664-y. Epub 2023 Jul 24.
PURPOSE OF REVIEW: Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV "risk." RECENT FINDINGS: We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.
目的综述:全球范围内艾滋病毒感染的差异,特别是男同性恋、双性恋和其他与男性发生性关系的男性(GBMSM)中的差异,表明有必要探索塑造艾滋病毒传播的多层次过程。我们使用复杂系统理论和 PRISMA 指南对 63 项全球综述进行了系统综述,以了解 GBMSM 中的艾滋病毒是如何在社会中形成模式的。目的是对这些综述进行主题分析,(1)综合艾滋病毒风险的多层次风险因素,(2)根据社会生态模型对风险进行分类,(3)制定一个概念模型,直观地展示塑造 GBMSMS 艾滋病毒“风险”的相互关联因素。
最近的发现:我们纳入了 49 项高质量和中等质量的研究。结果表明,GBMSM 的艾滋病毒风险源于社会生态模型的个体、人际和结构层面。我们确定了一些主题,这些主题塑造了与生物医学预防方法相关的 GBMSM 艾滋病毒感染风险;性和寻性行为;行为预防方法;个体层面的特征和综合征感染;生活经历和人际关系;国家层面的收入;国家层面的艾滋病毒流行率;以及结构性耻辱。这些多层次的因素共同导致了全球范围内 GBMSM 艾滋病毒感染的风险。我们对综述的系统综述的主题分析的综合表明,艾滋病毒感染的风险在社会生态模型的多个层面上以一种新兴的、动态的和复杂的方式运作。应用复杂系统理论表明,多层次因素如何在 GBMSM 中创造出一个动态和增强的艾滋病毒风险系统。
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