The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
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DOI：
10.1186/s12889-016-3149-z
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发表时间：
2016-07-07
影响因子：
4.5
通讯作者：
Sonnenberg P
中科院分区：
文献类型：
--
作者：
Mercer CH;Prah P;Field N;Tanton C;Macdowall W;Clifton S;Hughes G;Nardone A;Wellings K;Johnson AM;Sonnenberg P
到目前为止，对男男性行为者(MSM)的研究主要集中在他们的性健康需求和从面向同性恋的场所招募的男性。国家概率调查数据提供了一个难得的机会来检查更广泛的男男性人口、行为和健康概况，男男性接触者的定义是，在过去5年中报告了≥1男性性伴侣(S)的男性，因此无论他们的性别身份如何，与在此期间报告只与女性发生性行为的男性(MSEW)相比，以及健康不平等聚集的程度。英国第三次全国性性态度和生活方式调查(Natsal-3)是一项概率抽样调查，在2010-2012年间访问了15,162名年龄在16-74岁之间的人(6,293名男性)，使用计算机辅助个人访谈和计算机辅助自我访谈。我们使用多元回归来比较MSM和MSEW在各自和集体报告变量方面的差异，这些变量分别对应于三个领域：身体健康、心理健康和性健康。在所有男性中，2.6%(n = 190)被定义为男男性接触者，其中52.5%(95%CI：43.6%-61.2%)被确定为同性恋。MSM(n = 5,069)与MSEW(N MSEW)一样认为自己的健康状况“不好”/“非常糟糕”，尽管MSM更有可能报告长期患病/残疾/虚弱(调整后的优势比：1.46，95%CI：1.02-2.09)、抑郁症治疗/过去一年(2.75，1.69-4.47)和药物使用(例如，娱乐用药/过去一年：3.46，2.22-5.40)。男男性接触者更有可能报告有害的性健康行为，例如，过去一年与≥2性伴侣发生无套性行为(3.52，2.13-5.83)，以及不良的性健康结局，包括性传播感染诊断/性服务(5.67，2.67-12.04)，性功能较差(2.28，1.57-3.33)，以及有过尝试非意志性行为(6.51，4.22-10.06)。MSM也比MSEW更有可能报告在所考虑的三个健康领域内和跨健康领域的不良健康行为和结果。在所有MSM中，8.4%的人在所有三个领域-身体、心理和性健康-都经历了糟糕的健康结果，相比之下，所有MSEW的这一比例为1.5%。男男性接触者不成比例地受到各种有害健康行为和不良健康结果的影响。尽管经常观察到少数男男性接触者的健康不平等，但许多健康不平等现象被结合在一起，因此旨在改善男男性接触者健康和福祉的政策和做法需要采取全面的方法，而不考虑临床专业。
To date, research on men who have sex with men (MSM) has largely focused on their sexual health needs and on men recruited from gay-orientated venues. National probability survey data provide a rare opportunity to examine the broader sociodemographic, behavioural, and health profiles of MSM, defined as men who reported ≥1 male sexual partner(s) in the past 5 years, and thus regardless of their sexual identity, in comparison to men reporting sex exclusively with women (MSEW) during this time, and also the extent that health inequalities cluster. Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey, interviewed 15,162 people aged 16–74 years (6,293 men) during 2010–2012 using computer-assisted personal-interviewing with a computer-assisted self-interview. We used multivariable regression to compare MSM relative to MSEW in their reporting of variables, individually and collectively, corresponding to three domains: physical, mental, and sexual health. Among all men, 2.6 % (n = 190) were defined as MSM, of whom 52.5 % (95 % CI: 43.6 %–61.2 %) identified as gay. MSM were as likely as MSEW (n = 5,069) to perceive their health was ‘bad’/’very bad’, despite MSM being more likely to report a long-standing illness/disability/infirmity (adjusted odds ratio, AOR: 1.46, 95 % CI:1.02–2.09), treatment for depression/past year (2.75, 1.69–4.47), and substance use (e.g., recreational drug use/past year: 3.46, 2.22–5.40). MSM were more likely to report harmful sexual health behaviours, e.g., condomless sex with ≥2 partners/past year (3.52, 2.13–5.83), and poor sexual health outcomes, including STI diagnosis/es (5.67, 2.67–12.04), poorer sexual function (2.28, 1.57–3.33), both past year, and ever-experience of attempted non-volitional sex (6.51, 4.22–10.06). MSM were also more likely than MSEW to report poor health behaviours and outcomes both within and across the three health domains considered. Of all MSM, 8.4 % had experienced poor health outcomes in all three domains – physical, mental, and sexual health - in contrast to 1.5 % of all MSEW. MSM are disproportionately affected by a broad range of harmful health behaviours and poor health outcomes. Although often observed for a minority of MSM, many health inequalities were seen in combination such that policies and practices aimed at improving the health and well-being of MSM require a holistic approach, regardless of clinical specialty.