Seage G R, Mayer K H, Wold C, Lenderking W R, Goldstein R, Cai B, Gross M, Heeren T, Hingson R
Institute for Urban Health Policy and Research, Boston Department of Health and Hospitals, Massachusetts, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Apr 1;17(4):368-75. doi: 10.1097/00042560-199804010-00012.
The objective of this study was to evaluate the relation between drinking, drug use, and unprotected anal intercourse in young men who have sex with men. A cross-sectional analysis of first-visit data from a prospective cohort of 508 young gay men recruited from 1993 through 1994 from bars, college campuses, and the Fenway Community Health Center in Boston was performed. The major outcome measures were any unprotected anal intercourse, after drinking and when sober, stratified by type of sexual partner (steady or nonsteady) during the previous 6 months and during the most recent sexual encounter. The average age of the cohort was 23.3 years; 77.6% were white, and 76.4% were in college. These young men had a median of 10.5 male sexual partners in their lifetimes, and 3 sexual partners in the previous 6 months before enrollment. One hundred and thirty-four (26%) reported unprotected anal intercourse during the previous 6 months. Individuals who had unprotected anal intercourse were more likely to have a drinking problem (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.26-3.01) and drank more (20.4 ml/day versus 13.9 ml/day; p < or = 0.01), compared with individuals who did not engage in unprotected anal intercourse. Overall, men were significantly less likely to have unprotected anal intercourse after alcohol or drug use, based on a series of paired analysis (OR = 0.27; 95% CI = 0.15-0.48). However, when we stratified by type of sexual partner, men were significantly more likely to have unprotected anal intercourse with their nonsteady sexual partners after drinking than when sober (OR = 4.33; 95% CI = 1.37-13.7), but were significantly less likely to have unprotected anal intercourse with steady partners (OR = 0.27; 95% CI = 0.15-0.48). The patterns observed as already mentioned for drinking were also found for substance use in general. Men who were more likely to have unprotected anal intercourse after substance use were significantly more likely to have a drinking problem (OR = 7.65; 95% CI = 2.34-24.59). These results suggest that the role of alcohol and unsafe sex in young gay men is complex, with the role of situational factors of paramount importance. Alcohol and substance use interventions designed to reduce HIV risk need to specify the role of substance use in the sexual context to be successful.
本研究的目的是评估男男性行为的年轻男性中饮酒、吸毒与无保护肛交之间的关系。对1993年至1994年从波士顿的酒吧、大学校园和芬威社区健康中心招募的508名年轻男同性恋者的前瞻性队列首次就诊数据进行了横断面分析。主要结局指标为饮酒后和清醒时的任何无保护肛交情况，按过去6个月以及最近一次性接触中性伴侣类型（固定或非固定）进行分层。该队列的平均年龄为23.3岁；77.6%为白人，76.4%为大学生。这些年轻男性一生中男性性伴侣的中位数为10.5个，入组前6个月有3个性伴侣。134人（26%）报告在过去6个月中有过无保护肛交。与未进行无保护肛交的个体相比，进行无保护肛交的个体更有可能存在饮酒问题（优势比[OR]=1.95；95%置信区间[CI]=1.26 - 3.01）且饮酒量更多（20.4毫升/天对13.9毫升/天；p≤0.01）。总体而言，根据一系列配对分析，男性在饮酒或吸毒后进行无保护肛交的可能性显著降低（OR = 0.27；95% CI = 0.15 - 0.48）。然而，当我们按性伴侣类型分层时，男性在饮酒后与非固定性伴侣进行无保护肛交的可能性显著高于清醒时（OR = 4.33；95% CI = 1.37 - 13.7），但与固定伴侣进行无保护肛交的可能性显著降低（OR = 0.27；95% CI = 0.15 - 0.48）。如前所述的饮酒模式在一般物质使用方面也有发现。物质使用后更有可能进行无保护肛交的男性存在饮酒问题的可能性显著更高（OR = 7.65；95% CI = 2.34 - 24.59）。这些结果表明，酒精和不安全性行为在年轻男同性恋者中的作用是复杂的，情境因素的作用至关重要。旨在降低艾滋病毒风险的酒精和物质使用干预措施若要取得成功，需要明确物质使用在性情境中的作用。
