Paul J P, Stall R, Davis F
Department of Epidemiology and Biostatistics, University of California, San Francisco.
AIDS Educ Prev. 1993 Spring;5(1):11-24.
A sample of San Francisco gay/bisexual men in substance-abuse treatment (N = 314) was compared to the San Francisco Men's Health Study (SFMHS) cohort to compare levels of sexual behaviors that are high-risk for HIV transmission. Quantitative data were supplemented by analysis of transcripts of focus group discussions with gay men in treatment at the same agency. Sexual risk for HIV infection was significantly higher for gay/bisexual men in substance-abuse treatment than among the community-based (SFMHS) sample of gay/bisexual men. Among those entering outpatient alcohol/drug treatment, 21% reported unprotected insertive and sex, 23% reported unprotected receptive anal sex, and 32% reported unprotected insertive and/or receptive anal sex during the previous 3 months. In comparison, in the SFMHS cohort, 17% reported unprotected insertive and sex, 15% reported unprotected receptive anal sex, and 22% reported unprotected insertive and/or receptive anal sex during the previous 6 months. Substance abusers in focus groups identified a number of factors that made it difficult to reduce their sexual risk behavior, including the perceived disinhibiting effects of alcohol and other drugs, learned patterns of association between substance use and sex (especially methamphetamine use and anal sex), low self-esteem, lack of assertiveness and negotiating skills, and perceived powerlessness.
选取了314名正在接受药物滥用治疗的旧金山男同性恋者/双性恋者作为样本，与旧金山男性健康研究（SFMHS）队列进行比较，以对比具有HIV传播高风险的性行为水平。通过对在同一机构接受治疗的男同性恋者焦点小组讨论记录进行分析，对定量数据进行补充。接受药物滥用治疗的男同性恋者/双性恋者感染HIV的性风险显著高于以社区为基础的男同性恋者/双性恋者样本（SFMHS）。在那些开始接受门诊酒精/药物治疗的人中，21%报告在前三个月有过无保护的插入式性行为，23%报告有过无保护的被动肛交，32%报告有过无保护的插入式和/或被动肛交。相比之下，在SFMHS队列中，17%报告在前六个月有过无保护的插入式性行为，15%报告有过无保护的被动肛交，22%报告有过无保护的插入式和/或被动肛交。焦点小组中的药物滥用者指出了一些难以降低其性风险行为的因素，包括酒精和其他药物的感知去抑制作用、习得的物质使用与性行为（尤其是甲基苯丙胺使用与肛交）之间的关联模式、自卑、缺乏自信和谈判技巧以及感到无力。
