Doll L S, Harrison J S, Frey R L, McKirnan D, Bartholow B N, Douglas J M, Joy D, Bolan G, Doetsch J
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Am J Prev Med. 1994 May-Jun;10(3):125-9.
We analyzed data from a multisite study of 1,063 gay or bisexual men attending sexually transmitted disease clinics to evaluate factors predicting failure to disclose human immunodeficiency virus (HIV) risk behaviors to clinic staff and the extent of such failure. We compared data from a brief screening assessment on unprotected anal and oral sex with data on the same behaviors from a subsequent detailed interview. We also compared behavioral data from screening and the interview with data on diagnoses of rectal gonorrhea abstracted from medical charts. Of 523 men reporting unprotected anal sex at interview, 29% failed to report this behavior at screening. Men failing to disclose unprotected anal sex were also less likely to disclose engaging in unprotected oral sex. Among men reporting no unprotected anal sex, either at screening or interview, 1.6% were diagnosed with rectal gonorrhea. Logistic regression analyses comparing men who did and did not disclose at screening having engaged in unprotected anal sex showed that men who failed to disclose reported greater involvement in gay organizations, greater perceived peer support for condoms, fewer episodes of unprotected anal sex in the last four months, and lower rates of substance abuse treatment. Our data suggest that men who failed to disclose may have lower risk levels, and may be more integrated into the gay community. Brief interviews, as opposed to detailed ones, also may underestimate incidence of unsafe sex. Where feasible, HIV risk assessment and counseling and laboratory screening should be routinely provided to all clinic attendees, regardless of self-reports.
我们分析了一项多地点研究的数据，该研究涉及1063名到性传播疾病诊所就诊的男同性恋者或双性恋男性，以评估预测未向诊所工作人员披露人类免疫缺陷病毒（HIV）风险行为的因素以及此类未披露情况的程度。我们将简短筛查评估中关于无保护肛交和口交的数据与后续详细访谈中关于相同行为的数据进行了比较。我们还将筛查和访谈中的行为数据与从病历中提取的直肠淋病诊断数据进行了比较。在访谈中报告有无保护肛交的523名男性中，29%在筛查时未报告这种行为。未披露无保护肛交行为的男性也不太可能披露有无保护口交行为。在筛查或访谈中均报告无无保护肛交行为的男性中，1.6%被诊断出患有直肠淋病。逻辑回归分析比较了在筛查时披露和未披露有无保护肛交行为的男性，结果显示，未披露的男性报告称更多地参与同性恋组织，更多地感受到同伴对使用避孕套的支持，在过去四个月中无保护肛交的次数较少，以及药物滥用治疗率较低。我们的数据表明，未披露风险行为的男性可能风险水平较低，并且可能更融入同性恋社区。与详细访谈相比，简短访谈也可能低估不安全性行为的发生率。在可行的情况下，应向所有诊所就诊者常规提供HIV风险评估、咨询和实验室筛查，无论其自我报告情况如何。
