Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men
Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men
复制标题
DOI：
10.1136/sextrans-2013-051318
复制
发表时间：
2014-05-01
影响因子：
3.6
通讯作者：
Ayala, George
中科院分区：
文献类型：
--
作者：
Santos, Glenn-Milo;Do, Tri;Ayala, George
目的探讨慢性乙型肝炎与其他疾病的关系（定义为一组相互关联的心理社会健康状况）、性行为和自我报告的艾滋病毒感染之间的关系。方法我们使用广义估计方程逻辑回归模型与强大的SE来评估累积数量的共患病状况之间的关系，包括抑郁症、物质使用、暴力、性耻辱和无家可归和无保护的肛交（UAI）和HIV感染，而占集群内的国家在全球横断面调查的3934 MSM在151个countries.Results我们观察到平行的，显着的剂量-反应协会之间的一些症状和UAI，以及一些症状和HIV感染。与无症状的受试者相比，有1、2和3个或更多症状的受试者中UAI的调整OR（aOR）分别为1.44（Bonferroni调整的95%CI 1.23至1.68）、1.89（1.51至2.36）和2.03（1.43至2.89）。有1、2、3个或3个以上疫情者与无疫情者相比，HIV感染的aOR为1.67（1.24至2.26）、2.02（1.44至2.85）和2.35（1.31至4.21），结论本分析提供了证据的交织综合征，可能协同作用，以增加全球男男性接触者的艾滋病毒风险。为了有效地遏制艾滋病毒和促进MSM的健康，必须同时使用针对个体和结构性风险因素的多层次方法来解决多种情况。
Objective We evaluated the relationship among syndemic conditions (defined as a cluster of interconnected psychosocial health conditions), sexual behaviours and self-reported HIV infection in a global sample of men who have sex with men (MSM).Methods We used generalised estimating equations logistic regression models with robust SEs to assess the relationships among cumulative number of syndemic conditions-including depression, substance use, violence, sexual stigma and homelessness-and unprotected anal intercourse (UAI) and HIV infection, while accounting for clustering within-country in a global cross-sectional survey of 3934 MSM across 151 countries.Results We observed parallel, significant dose-response associations between the number of syndemic conditions and UAI, as well as number of syndemic conditions and HIV infection. Compared with participants without syndemics, the adjusted OR (aOR) for UAI among those with 1, 2 and 3 or more syndemic conditions were 1.44 (Bonferroni-adjusted 95% CI 1.23 to 1.68), 1.89 (1.51 to 2.36) and 2.03 (1.43 to 2.89), respectively. Compared with participants without syndemics, the aOR for HIV infection among those with 1, 2 and 3 or more syndemic conditions were 1.67 (1.24 to 2.26), 2.02 (1.44 to 2.85) and 2.35 (1.31 to 4.21), respectively.Conclusions This analysis provides evidence of intertwining syndemics that may operate synergistically to increase HIV risk among MSM globally. To curb HIV effectively and advance the health of MSM, multiple conditions must be addressed concurrently using multi-level approaches that target both individual and structural risk factors.