Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies.
Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies.
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DOI：
10.1097/qad.0000000000001139
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发表时间：
2016-07-31
期刊：
影响因子：
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通讯作者：
NHBS Study Group
中科院分区：
文献类型：
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作者：
Paz-Bailey G;Mendoza MC;Finlayson T;Wejnert C;Le B;Rose C;Raymond HF;Prejean J;NHBS Study Group
评估男男性行为者（MSM）最后一次性交时无安全套肛交的变化，并评估这些变化是否与采用血清分选和生物医学预防有关。国家艾滋病毒行为监测是2005年、2008年、2011年和2014年在多达21个城市进行的一项横断面调查。MSM通过基于场所的抽样招募。在报告至少有一个男性伴侣的男性中，我们评估了与（1）HIV一致（血清学分类的代表）或（2）HIV不一致（不一致/未知）状态的伴侣进行最后一次性交时无避孕套肛交的变化。我们假设，如果一致的无安全套性行为增加，而不一致的稳定/下降，增加可能是由于更多的男性试图血清分离。我们使用广义估计方程，假设泊松分布和稳健的方差估计，以探讨是否随时间变化的结果所选择的特征。我们还评估了艾滋病毒阳性男男性行为者使用抗逆转录病毒治疗（ART）后无安全套肛交的变化。在5371例HIV阳性MSM中，一致性（2005年为19%，2014年为25%，P < 0.001）和不一致性行为（15%至19%，P < 0.001）增加。使用抗逆转录病毒疗法的增加没有差异。在30547名HIV阴性MSM中，一致性（21%至27%，P < 0.001）和不一致无避孕套性行为（8%至13%，P < 0.001）增加。我们的数据表明，男男性行为者中避孕套的使用减少，血清分选或ART不能解释这种趋势。推广避孕套和增加接触前预防的机会对于确保ART在减少艾滋病毒传播方面的益处不被破坏至关重要。
Evaluate changes in condomless anal sex at last sex among men who have sex with men (MSM) and assess if these changes are associated with the adoption of serosorting and biomedical prevention. The National HIV Behavioral Surveillance is a crosssectional survey done in up to 21 cities in 2005, 2008, 2011 and 2014. MSM were recruited through venue-based sampling. Among men reporting at least one male partner, we evaluated changes in condomless anal sex at last sex with a partner with (1) HIV-concordant (proxy for serosorting) or (2) HIV-discordant (discordant/unknown) status. We hypothesized that if concordant condomless sex was increasing while discordant was stable/declining, the increases could be driven by more men attempting to serosort. We used generalized estimating equations assuming a Poisson distribution and robust variance estimator to explore whether temporal changes in the outcomes varied by selected characteristics. We also assessed changes in condomless anal sex by antiretroviral therapy (ART) use among HIV-positive MSM. Among 5371 HIV-positive MSM, there were increases in concordant (19% in 2005 to 25% in 2014, P < 0.001) and discordant condomless sex (15 to 19%, P < 0.001). The increases were not different by ART use. Among 30 547 HIV-negative MSM, concordant (21 to 27%, P < 0.001) and discordant condomless sex (8 to 13%, P < 0.001) increased. Our data suggest that condom use decreased among MSM and that the trends are not explained by serosorting or ART. Promotion of condoms and increased access to preexposure prophylaxis are vital to ensure that the benefits of ART in reducing transmission of HIV are not undermined.