Patterson Thomas L, Semple Shirley J
Department of Psychiatry, University of California, San Diego, La Jolla 92093, USA.
J Urban Health. 2003 Dec;80(4 Suppl 3):iii77-87. doi: 10.1093/jurban/jtg085.
According to the US Centers for Disease Control, the majority of new HIV infections are the direct result of unprotected sexual relations between serodiscordant individuals. Thus, the development of behavioral interventions to increase the safer sex practices of HIV-positive individuals has the potential to reduce the number of new infections. Currently, less than 1% of the total US population is infected with HIV. Targeting behavioral interventions to this smaller group of HIV-positive individuals has the potential for making cost-effective reductions in the number of new infections. Despite reports that some HIV-positive individuals continue to engage in high-risk behaviors, interventions designed to prevent secondary transmission of HIV are rare. In this era of highly active antiretroviral therapy (HAART), interventions for HIV-positive individuals are more critical than ever to address the unique challenges and issues they face regarding disclosure and partner notification, use of HAART and sexual risk behavior, and HIV-related stigma. Although a growing number of reports document the efficacy of sexual risk reduction interventions for HIV-positive individuals, to date none of these studies have focused on drug-using populations. This article focuses on sexual risk reduction interventions for HIV-positive men who have sex with men (MSM), the largest group of HIV-positive individuals in the United States. It reviews factors associated with high-risk behaviors and discusses some findings from research with HIV-positive methamphetamine users, including (1) data from a small qualitative study and its implications for the development of new interventions, and (2) baseline data from an ongoing large-scale study of the efficacy of a theory-based sexual risk reduction intervention for HIV-positive methamphetamine-using MSM. The article concludes with a discussion of future research issues, including, for example: Can sexual risks be reduced in the context of active drug use? Are different patterns of drug use, or specific drugs, associated with increased risk behavior? How do gender, race, and culture relate to the efficacy of specific interventions?
根据美国疾病控制中心的数据，大多数新的艾滋病毒感染是血清学不一致的个体之间无保护性行为的直接结果。因此，开发行为干预措施以增加艾滋病毒阳性个体的安全性行为有可能减少新感染的数量。目前，美国总人口中感染艾滋病毒的比例不到1%。针对这一较小的艾滋病毒阳性个体群体进行行为干预，有可能在新感染数量上实现具有成本效益的减少。尽管有报告称一些艾滋病毒阳性个体继续从事高风险行为，但旨在预防艾滋病毒二次传播的干预措施却很少见。在这个高效抗逆转录病毒疗法（HAART）的时代，针对艾滋病毒阳性个体的干预措施比以往任何时候都更加关键，以应对他们在披露和通知伴侣、使用HAART和性风险行为以及与艾滋病毒相关的耻辱感方面面临的独特挑战和问题。尽管越来越多的报告记录了针对艾滋病毒阳性个体的性风险降低干预措施的有效性，但迄今为止，这些研究都没有关注吸毒人群。本文重点关注针对男男性行为者（MSM）的艾滋病毒阳性男性的性风险降低干预措施，这是美国最大的艾滋病毒阳性个体群体。它回顾了与高风险行为相关的因素，并讨论了对艾滋病毒阳性甲基苯丙胺使用者的研究结果，包括（1）一项小型定性研究的数据及其对新干预措施开发的影响，以及（2）一项正在进行的关于基于理论的性风险降低干预措施对艾滋病毒阳性使用甲基苯丙胺的男男性行为者有效性的大规模研究的基线数据。文章最后讨论了未来的研究问题，例如：在积极吸毒的情况下能否降低性风险？不同的吸毒模式或特定药物是否与增加的风险行为有关？性别、种族和文化如何与特定干预措施的有效性相关？
