Sex role segregation and mixing among men who have sex with men: implications for biomedical HIV prevention interventions.

Sex role segregation and mixing among men who have sex with men: implications for biomedical HIV prevention interventions.
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DOI:
10.1371/journal.pone.0070043
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发表时间:
2013
期刊:
影响因子:
3.7
通讯作者:
Schneider JA
Schneider JA
中科院分区:
综合性期刊3区
文献类型:
--
作者:
Armbruster B;Roy S;Kapur A;Schneider JA

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在一些国际环境中,男男性行为者(MSM)实行角色隔离-仅插入或接受性姿势,而不是多功能角色-候选的生物医学艾滋病毒预防干预措施(例如,包皮环切术,肛门杀微生物剂)将进行测试。这些职位的具体干预措施对艾滋病毒发病率的影响进行建模。我们使用2003-2010年的数据开发了一个确定性房室模型来预测印度MSM中的HIV发病率。该模型的性别混合矩阵来自印度MSM(n = 4604)的网络数据。  我们的模型捕捉到了性别角色分布随时间的变化。我们对杀微生物剂和包皮环切术在异性恋者中的效果进行了模拟试验。越来越多的多才多艺的男男性接触者导致艾滋病毒发病率在20年内几乎没有变化。肛门杀菌剂和包皮环切术将使10年时的HIV感染率分别从15.6%降至12.9%和12.7%。肛门杀微生物剂将提供类似的保护,包皮环切术在人口水平,尽管较低的模拟疗效(54%和60%的风险降低,分别)。干预措施的组合是累加的:在5年内,组合的艾滋病毒流行率下降(-3.2%)几乎是其各自艾滋病毒流行率下降(-1.8%和-1.7%)的总和。男男性接触者性别角色的隔离和混合,不同于性别角色分布的变化,可能是重要的,在国际环境中评估艾滋病毒预防干预措施。一些针对特定位置的预防干预措施,如包皮环切术和肛门杀微生物剂之间的协同作用值得进一步研究。
Men who have sex with men (MSM) practice role segregation – insertive or receptive only sex positions instead of a versatile role - in several international settings where candidate biomedical HIV prevention interventions (e.g., circumcision, anal microbicide) will be tested. The effects of these position-specific interventions on HIV incidence are modeled. We developed a deterministic compartmental model to predict HIV incidence among Indian MSM using data from 2003–2010. The model’s sex mixing matrix was derived from network data of Indian MSM (n = 4604). Our model captures changing distribution of sex roles over time. We modeled microbicide and circumcision efficacy on trials with heterosexuals. Increasing numbers of versatile MSM resulted in little change in HIV incidence over 20 years. Anal microbicides and circumcision would decrease the HIV prevalence at 10 years from 15.6% to 12.9% and 12.7% respectively. Anal microbicides would provide similar protection to circumcision at the population level despite lower modeled efficacy (54% and 60% risk reduction, respectively). Combination of the interventions were additive: in 5 years, the reduction in HIV prevalence of the combination (−3.2%) is almost the sum of their individual reductions in HIV prevalence (−1.8% and −1.7%). MSM sex role segregation and mixing, unlike changes in the sex role distribution, may be important for evaluating HIV prevention interventions in international settings. Synergies between some position-specific prevention interventions such as circumcision and anal microbicides warrant further study.
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