Validating the Syndemic Threat Surrounding Sexual Minority Men's Health in a Population-Based Study With National Registry Linkage and a Heterosexual Comparison
Validating the Syndemic Threat Surrounding Sexual Minority Men's Health in a Population-Based Study With National Registry Linkage and a Heterosexual Comparison
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DOI：
10.1097/qai.0000000000001697
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发表时间：
2018-08-01
影响因子：
3.6
通讯作者：
Pachankis, John E.
中科院分区：
文献类型：
--
作者：
Branstrom, Richard;Pachankis, John E.
背景资料：对性少数群体男子面临的流行病健康威胁的研究表明，这一人群中艾滋病毒风险的增加与其他心理社会健康差异同时发生。本研究的目的是进行一项基于人口的检查同性恋和双性恋之间的艾滋病毒感染的临床评估的综合征预测因子，与异性恋，mans.Setting和方法：样本包括成年男子在斯德哥尔摩公共卫生队列。共有29，328人（91.9%）自我认定为异性恋，535人（1.7%）为同性恋，396人（1.2%）为双性恋。结果：男同性恋者感染艾滋病毒的风险比异性恋者高得多（>150倍）。与异性恋者相比，男同性恋者患抑郁症、自杀和暴力袭击的风险也更高。双性恋男性感染艾滋病毒的风险是异性恋男性的16倍。在男同性恋者中，心理社会综合症的数量与艾滋病毒感染显著相关（调整后的比值比[AOR] = 1.67; 95%置信区间[95%CI]：1.18 - 2.36），但在双性恋和异性恋男性中并非如此（AOR = 0.51; 95% CI：0.07 - 3.59; AOR = 1.92; 95% CI：0.96 - 3.84）。在男同性恋者中，并发的综合性疾病与艾滋病毒感染几率之间存在协同作用（即，大于相加）。结论：这项研究证实了影响性少数男性的综合症健康威胁的新证据，发现了同性恋者与双性恋男性相比更强有力的综合症证据，并表明需要采取艾滋病毒预防干预措施，全面解决共同发生的问题，并协同延续，影响这一人群的差异。
Background: Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared with heterosexual, men.Setting and Methods: The sample comprised adult men in the Stockholm Public Health Cohort. A total of 29,328 (91.9%) self-identified as heterosexual, 535 (1.7%) as gay, and 396 (1.2%) as bisexual. We linked survey responses to national health registry data.Results: Gay men had vastly elevated risk of HIV infection (>150 times) compared with heterosexuals. Gay men also had an elevated risk of depression, suicidality, and violent assaults compared with heterosexuals. Bisexual men had 16 times higher risk of being HIV-positive than heterosexual men. The number of psychosocial syndemic conditions was significantly associated with HIV infection among gay men (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [95% CI]: 1.18 to 2.36), but not among bisexual and heterosexual men (AOR = 0.51; 95% CI: 0.07 to 3.59; AOR = 1.92; 95% CI: 0.96 to 3.84). Among gay men, the association between co-occurring syndemic conditions and odds of HIV infection was synergistic (ie, more than additive).Conclusions: This study confirms emerging evidence of the syndemic health threats affecting sexual minority men, finds stronger evidence for syndemics among gay compared with bisexual men, and suggests the need for HIV-prevention interventions that comprehensively address the co-occurring, and synergistically perpetuating, disparities affecting this population.