性取向污名与乌克兰男男性行为者的 HIV 风险行为、检测、治疗和感染之间的关联。
Associations Between Sexual Behavior Stigma and HIV Risk Behaviors, Testing, Treatment, and Infection Among Men Who have Sex with Men in Ukraine.
机构信息
Population Health Sciences, University of Bristol, Bristol, UK.
Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK.
出版信息
AIDS Behav. 2024 Mar;28(3):786-798. doi: 10.1007/s10461-023-04182-1. Epub 2023 Oct 4.
Stigma toward same-sex behaviors may be a structural driver of HIV epidemics among men who have sex with men (MSM) in Eastern Europe and has been linked to adverse HIV-outcomes elsewhere. We explored associations between sexual behavior stigma with HIV risk behaviors, testing, treatment, and infection. From November 2017 to February 2018, MSM across 27 Ukrainian cities were recruited to cross-sectional surveys using respondent driven sampling. Eligible participants were cisgender males aged ≥ 14 years residing in participating cities that reported ≥ 1 sexual contact with another man in the prior 6 months. Participants self-reported experience of stigma (ever) and various HIV-outcomes and were tested for HIV antibodies. Regression models were used to explore associations between three sexual behavior stigma variables with demographic and HIV-related variables. Of 5812 recruited cisgender MSM, 5544 (95.4%) were included. 1663 (30.0%) MSM reported having experienced stigma due to being MSM from family and friends, 698 (12.6%) reported anticipated healthcare stigma, and 1805 (32.6%) reported general public/social stigma due to being MSM (enacted). All forms of stigma were associated with heightened HIV risk behaviors; those experiencing stigma (vs not) had more anal sex partners in the prior month and were less likely to have used condoms during their last anal intercourse. Stigma was not associated with HIV infection, testing, or treatment variables. A sizeable proportion of Ukrainian MSM reported ever experiencing stigma due to being MSM. MSM that had experienced stigma had higher odds of HIV sexual risk behaviors. Further study using longitudinal designs is required to determine causality.
对同性性行为的污名可能是东欧男男性行为者(MSM)中 HIV 流行的结构性驱动因素,并与其他地方的不良 HIV 结果有关。我们探讨了性行为污名与 HIV 风险行为、检测、治疗和感染之间的关联。2017 年 11 月至 2018 年 2 月,在乌克兰 27 个城市招募 MSM 参加横断面调查,采用应答驱动抽样法。合格的参与者是跨性别男性,年龄≥14 岁,居住在参与城市,报告在过去 6 个月内与另一名男性有≥1 次性接触。参与者自我报告经历过污名(曾有过)和各种 HIV 结果,并接受了 HIV 抗体检测。回归模型用于探讨三种性行为污名变量与人口统计学和 HIV 相关变量之间的关联。在招募的 5812 名跨性别 MSM 中,有 5544 名(95.4%)被纳入分析。1663 名(30.0%)MSM 报告因身为男同性恋者而受到来自家人和朋友的污名化,698 名(12.6%)报告预期会受到医疗保健方面的污名化,1805 名(32.6%)报告因身为男同性恋者而受到来自公众/社会的污名化(被实施)。所有形式的污名都与 HIV 风险行为增加有关;经历污名(相比未经历)的人在前一个月有更多的肛交性伴侣,并且在上一次性交中使用安全套的可能性较小。污名与 HIV 感染、检测或治疗变量无关。相当一部分乌克兰 MSM 报告曾因身为男同性恋者而经历过污名。经历过污名的 MSM 发生 HIV 性风险行为的可能性更高。需要进一步使用纵向设计进行研究以确定因果关系。