HIV Care Continuum Disparities Among Black Bisexual Men and the Mediating Effect of Psychosocial Comorbidities.
HIV Care Continuum Disparities Among Black Bisexual Men and the Mediating Effect of Psychosocial Comorbidities.
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DOI：
10.1097/qai.0000000000001631
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发表时间：
2018-04-15
期刊：
影响因子：
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通讯作者：
Stall R
中科院分区：
文献类型：
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作者：
Friedman MR;Sang JM;Bukowski LA;Matthews DD;Eaton LA;Raymond HF;Stall R
在艾滋病毒护理连续体中，与男性和女性发生性行为的男性（MSMW）和仅与男性发生性行为的男性（MSMO）之间的差异在最近的文献中逐渐出现，但尚未在黑人MSM中得到全面的记录。尽管MSMW的艾滋病毒患病率低于MSMO，但他们更有可能是艾滋病毒阳性而不知道，并且病毒未受到抑制。这些差异的解释因素以前没有被评估过。2014-2016年间，我们调查了美国6个城市黑人同性恋骄傲活动中性活跃的≥18岁黑人MSM (n=3881)，其中1229人自我报告hiv阳性或现场检测hiv阳性。我们比较了HIV阳性MSMW （n=196）和HIV阳性MSMO （n=1033）的HIV阳性不知情状态、HIV护理吸收和病毒载量抑制。我们进行了多变量logistic回归，并建立了一个结构方程模型，评估心理社会共病（暴力受害、抑郁、多种药物使用）对MSMW状态与未抑制病毒之间关系的中介作用。MSMW比MSMO更有可能在不知情的情况下呈hiv阳性（aOR=2.17; 95% CI: 1.58, 3.00）。在那些意识到HIV阳性的人中（n=720）， MSMW更有可能报告从未接受过HIV护理（aOR=2.74; 95% CI: 1.05, 7.16）和报告可检测的病毒载量（aOR=2.34; 95% CI: 1.31, 4.19）。心理社会共病显著介导MSMW状态与未抑制病毒之间的关系（p= 0.01）。黑人MSMW比黑人MSMO更不可能接受生物医学护理和二级预防。如果社会心理合并症也得到解决，针对艾滋病毒阳性黑人MSMW的生物行为干预发展将是最成功的。
Differences across the HIV care continuum between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) are emerging in recent literature but have not been comprehensively documented among Black MSM. Although MSMW have lower HIV prevalence than MSMO, they are more likely to be HIV-positive unaware and be virally unsuppressed. Explanatory factors for these differences have not previously been assessed. Between 2014—2016, we surveyed sexually active Black MSM ≥18 years old at Black Gay Pride events in six U.S. cities (n=3881), 1229 of whom either self-reported HIV-positive status or tested HIV-positive onsite. We compared HIV-positive MSMW (n=196) with HIV-positive MSMO (n=1033) by HIV-positive unaware status, HIV care uptake, and viral load suppression. We conducted multivariable logistic regressions and built a structural equation model assessing mediating effects of psychosocial co-morbidities (violence victimization, depression, polydrug use) on the relationship between MSMW status and unsuppressed virus. MSMW were more likely than MSMO to be HIV-positive unaware (aOR=2.17; 95% CI: 1.58, 3.00). Among those who were HIV-positive aware (n=720), MSMW were more likely to report never receiving HIV care (aOR=2.74; 95% CI: 1.05, 7.16) and to report detectable viral loads (aOR=2.34; 95% CI: 1.31, 4.19). Psychosocial co-morbidities significantly mediated (p=.01) the relationship between MSMW status and unsuppressed virus. Black MSMW were less likely than Black MSMO to uptake biomedical care and secondary prevention. Bio-behavioral intervention development specific to HIV-positive Black MSMW will be most successful if psychosocial co-morbidities are also addressed.