From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Sex Transm Dis. 2024 Mar 1;51(3):178-185. doi: 10.1097/OLQ.0000000000001915. Epub 2023 Dec 28.
Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities.
We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus.
Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV.
The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.
对人类免疫缺陷病毒（HIV）治疗的积极态度，如减少对 HIV 传染性的担忧，与可能增加男同性恋者、双性恋者和其他与男性发生性关系的男性（GBM）中细菌性性传播感染（STI）风险的性行为有关。我们研究了加拿大三个最大城市的 GBM 中 HIV 治疗态度与细菌性 STI 诊断之间的关系。
我们通过 Engage 研究基线数据中的性行为，在 HIV 治疗态度和 STI 诊断之间拟合结构方程模型。我们通过男性肛交伴侣数量、无保护肛交和口交来估计 HIV 治疗态度与 STI 之间的直接和间接途径。我们对 HIV 血清阳性和阴性的参与者进行了亚分析。
在 2017 年至 2019 年期间招募的 2449 名 GBM 中，HIV 治疗态度与当前 STI 诊断之间存在直接关联（β=0.13；95%CI，0.07-0.19；P<0.001）。中介模型显示了通过 2 条途径的积极总间接效应：（1）进行无保护的肛交，（2）男性肛交伴侣数量和无保护的肛交。这 2 条间接途径在 HIV 阴性 GBM 和 HIV 阳性 GBM 的分层中介模型中仍然存在。
HIV 治疗态度与诊断出的 STI 之间的关联是通过更多的男性肛交伴侣和无保护的肛交来介导的。结果强调了提供者在为 GBM 提供有效 STI 咨询、检测和预防时，在教育患者时的重要性，说明准确的 HIV 治疗态度可能会无意中与细菌性 STI 流行有关。
