HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida.

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics (“syndemics”) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0–3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2–9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

与仅与男性发生性行为的男性（MSMO）相比，与男性和女性都发生性行为的男性（MSMW）一直报告两种艾滋病病毒（HIV）风险行为的发生率更高：性交易（TS）以及同时使用毒品和发生性行为（CSS）。在MSMW群体中，协同性流行病（“共病”）如何影响性交易和同时使用毒品与发生性行为，人们知之甚少。我们利用在南佛罗里达州的一个使用毒品的男男性行为者样本（n = 515），比较了MSMO和MSMW中的性交易和同时使用毒品与发生性行为情况；检验了在MSMW（n = 86）群体中，性交易和同时使用毒品与发生性行为是否能预测与艾滋病病毒血清不一致/感染状况不明的伴侣发生无保护的肛交（SU - UAI）；并测试了共病是否能预测性交易和同时使用毒品与发生性行为。MSMW报告参与性交易和同时使用毒品与发生性行为的比率更高（调整比值比 = 1.7；95%置信区间为1.0 - 3.0）。在MSMW群体中，参与性交易和同时使用毒品与发生性行为可预测无保护的肛交（调整比值比 = 3.3；95%置信区间为1.2 - 9.6）；共病可预测性交易和同时使用毒品与发生性行为的参与情况（p < 0.01）。使用毒品的MSMW可能会从针对性交易、同时使用毒品与发生性行为以及潜在共病的干预措施中受益。