Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications
Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications
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DOI：
10.1007/s11524-014-9930-3
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发表时间：
2015-08-01
影响因子：
6.6
通讯作者：
Hembling, John
中科院分区：
文献类型：
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作者：
Peacock, Erin;Andrinopoulos, Katherine;Hembling, John
男男性行为者 (MSM) 和变性女性 (TW) 的大量饮酒率较高，与感染艾滋病毒的可能性增加和心理健康状况不佳有关。虽然解释性少数群体饮酒水平升高的理论已经被提出，但很少有调查使用经验数据评估潜在途径，特别是明确关注低收入和中等收入国家的 MSM 和 TW 中的自我耻辱。本研究采用受访者驱动抽样方法招募了萨尔瓦多圣萨尔瓦多的 MSM 和 TW (n = 670) 样本，研究了与耻辱相关的压力（特别是自我耻辱和隐瞒性取向）与酗酒之间的关系。参与者的饮酒水平很高：只有 39% 的样本不饮酒或不酗酒，而 34% 的人至少每周都会酗酒。在 MSM 中，高度自我耻辱与至少每周酗酒有关（调整后相对风险比 (aRRR) = 2.1，p < 0.05）。与少于每周一次的酗酒没有发现这种关系。在 MSM 和 TW 中，拥有女性伴侣与少于每周一次的酗酒有关（aRRR = 3.3，p < 0.05）和至少每周一次的酗酒（aRRR = 3.4，p < 0.05），而向多种类型的人透露性取向与少于每周的酗酒有关（对于一到两类人的披露，aRRR = 2.9，p < 0.01；aRRR = 4.0 对于三九类人的披露，p < 0.01）。至少每周一次的酗酒并没有发现这种关系。至少每周酗酒与许多性健康结果略有相关，包括终生伴侣数量较多（调整后比值比 (aOR) = 1.7，p < 0.10）、与非固定伴侣不一致使用安全套（aOR = 0.5，p < 0.10）以及在未来 12 个月内检测 HIV 的意愿下降（aOR = 0.6，p < 0.10）。除了与非固定性伴侣不一致地使用安全套外（aOR = 0.4，p < 0.05），少于每周的酗酒与性危险行为增加无关，实际上与未来 12 个月内检测 HIV 的意愿增加相关（aOR = 2.8，p < 0.01）。这些发现支持将耻辱相关压力与饮酒联系起来的多种途径。具体来说，那些具有高度自我污名和身份隐藏的人可能会使用酒精作为一种适应不良的应对和情绪调节策略，而那些向多种类型的人透露自己性取向的人可能会更多地参与性少数群体的活动，可能是在酒吧和其他盛行酒精使用规范的场所。这种酗酒的频率似乎与性危险行为的增加无关（甚至可能与未来 12 个月内检测 HIV 的意愿增加有关），这进一步支持了这样的观点：这些具有健康自我概念的人（如高水平的披露和低水平的危险性行为所表明的）可能由于社会环境的影响而参与酗酒。需要进一步研究来建立将耻辱相关压力与酗酒联系起来的途径，以便确定干预点。
High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one's sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling. Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one-two types of people, p < 0.01; aRRR = 4.0 for disclosure to three-nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01). These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified.