HIV Infection and Sexual Risk among Men Who Have Sex with Men and Women (MSMW): A Systematic Review and Meta-Analysis

ObjectivesTo estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively.MethodsFollowing PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses.ResultsWe estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples.ConclusionsThis represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden.研究目的 本研究旨在估算美国境内与男性和女性均发生性行为的男性（men who have sex with men and women）中的HIV感染者数量，并对比三类人群的HIV感染率：与男性和女性均发生性行为的男性、仅与男性发生性行为的男性，以及仅与女性发生性行为的男性。 研究方法 本研究遵循PRISMA（系统综述与元分析优先报告条目）指南，针对涉及HIV感染率与与男性和女性均发生性行为的男性的相关报告开展系统综述与元分析。我们在PubMed及Ovid PsycINFO数据库中检索了以美国为研究场景、经同行评议的、报告与男性和女性均发生性行为的男性HIV感染率的文献，并进行了事件发生率、效应量、调节效应及敏感性分析。 研究结果 本研究估算显示，美国境内有1.0%的男性存在双性性行为，其中121800名双性性行为男性为HIV感染者。与仅与男性发生性行为的男性相比，与男性和女性均发生性行为的男性的HIV感染率不足其一半（16.9% vs. 33.3%；比值比OR=0.41，95%置信区间CI：0.31~0.54）；而与仅与女性发生性行为的男性相比，其HIV感染率则为后者的五倍以上（18.3% vs. 3.5%；OR=5.71，95%CI：3.47~9.39）。此外，与仅与男性发生性行为的男性相比，与男性和女性均发生性行为的男性发生无保护被动肛交的比例更低（15.9% vs. 35.0%；OR=0.36，95%CI：0.28~0.46）。在种族/族裔少数群体占比高的研究样本中，与男性和女性均发生性行为的男性的HIV感染率显著高于种族/族裔少数群体占比低的样本中的同类人群。 研究结论 本研究是美国境内首次针对与男性和女性均发生性行为的男性与仅与男性发生性行为的男性的HIV感染率开展的元分析研究。为更精准地量化并改善该人群的HIV疾病负担，亟需针对与男性和女性均发生性行为的男性开展针对性的数据收集、相关研究以及HIV预防与诊疗服务。