Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California-San Diego, La Jolla, California; San Diego State University, San Diego, California.
Am J Prev Med. 2024 Nov;67(5):722-729. doi: 10.1016/j.amepre.2024.07.002. Epub 2024 Jul 11.
Men who have sex with men (MSM) and are engaged in transactional sex (MSM-TS) experience complex social and structural vulnerabilities that increase their HIV risk. This study aimed to estimate the prevalence of TS and associations between TS and sexually transmitted infection (STI) outcomes among cisgender MSM in the U.S.
Using 2017-2021 data from an online survey of U.S. MSM, characteristics of MSM-TS were summarized, and adjusted prevalence ratios (aPRs) calculated for the associations between past-year TS and bacterial STI diagnosis, HIV status, and either antiretroviral or pre-exposure prophylaxis use. Analyses were conducted in 2023.
TS prevalence was 3.7% (n=1,848/49,539). Compared to other MSM, MSM-TS more commonly reported homelessness, being uninsured, condomless anal sex with partners of any HIV status and condomless anal sex with serodifferent partners, and illicit drug use. TS was associated with increased HIV (aPR 1.44, 95% CI 1.25-1.66) and bacterial STI prevalence (aPR 2.40, 95% CI=2.09-2.52) and lower antiretroviral therapy use (among MSM living with HIV; PR 0.92, 95% CI=0.87-0.97).
Structural and behavioral risks converged among U.S. MSM engaging in TS leading to greater HIV and bacterial STI prevalence in this group. HIV interventions for U.S. MSM-TS should address individual as well as structural risks, including poverty and housing instability.
男男性行为者（MSM）和从事商业性性行为（MSM-TS）的人面临着复杂的社会和结构性脆弱性，这增加了他们感染 HIV 的风险。本研究旨在估计美国顺性别 MSM 中 TS 的流行率以及 TS 与性传播感染（STI）结局之间的关联。
使用美国 MSM 在线调查 2017-2021 年的数据，总结 MSM-TS 的特征，并计算过去一年 TS 与细菌性 STI 诊断、HIV 状况以及抗逆转录病毒或暴露前预防用药之间关联的调整后患病率比（aPR）。分析于 2023 年进行。
TS 的流行率为 3.7%（n=1,848/49,539）。与其他 MSM 相比，MSM-TS 更常见的报告包括无家可归、没有保险、与任何 HIV 状况的性伴侣发生无保护的肛交和与血清学不同的性伴侣发生无保护的肛交，以及使用非法药物。TS 与 HIV（aPR 1.44，95%CI 1.25-1.66）和细菌性 STI 流行率（aPR 2.40，95%CI=2.09-2.52）增加以及抗逆转录病毒治疗使用率降低（HIV 感染者；PR 0.92，95%CI=0.87-0.97）相关。
美国从事 TS 的 MSM 中，结构性和行为风险相互叠加，导致该人群 HIV 和细菌性 STI 的流行率更高。针对美国 MSM-TS 的 HIV 干预措施应解决个体和结构性风险，包括贫困和住房不稳定。
