Carrico Adam W, Woolf-King Sarah E, Neilands Torsten B, Dilworth Samantha E, Johnson Mallory O
University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
Drug Alcohol Depend. 2014 Jun 1;139:174-7. doi: 10.1016/j.drugalcdep.2014.03.025. Epub 2014 Mar 30.
Research conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM).
In total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load.
After controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n=371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load.
Partner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples-based interventions targeting stimulant use as a potential driver of detectable HIV viral load.
迄今为止开展的研究主要集中在确定刺激物使用和艾滋病毒疾病管理的个体层面心理决定因素。本横断面研究调查了男男性行为者（MSM）中作为刺激物使用和艾滋病毒疾病管理相关因素的关系因素。
共有266对男性伴侣完成了一项队列研究的基线评估，该研究考察关系因素在艾滋病毒治疗中的作用。进行了基于计算机的关系因素评估、自我报告的酒精和物质使用情况评估以及自我报告的抗逆转录病毒疗法（ART）依从性评估。所有艾滋病毒呈阳性的参与者还提供了一份血样以测量病毒载量。
在控制了人口统计学特征和关系因素后，与使用刺激物的伴侣处于主要关系中的男性在过去三个月中报告使用任何刺激物的几率高出六倍多。在接受抗逆转录病毒治疗的艾滋病毒呈阳性参与者（n = 371）中，有一个使用刺激物的伴侣与报告30天完美抗逆转录病毒疗法依从性的几率降低67%以及显示可检测到的艾滋病毒病毒载量的几率高出两倍多独立相关。相比之下，伴侣层面更多的酒精使用与报告3天完美抗逆转录病毒疗法依从性的几率增加以及显示可检测到的艾滋病毒病毒载量的几率降低独立相关。
伴侣层面的刺激物使用是男男性行为者个体层面刺激物使用和艾滋病毒疾病管理困难的重要危险因素。为了优化作为预防手段的艾滋病毒治疗效果，需要开展临床研究来制定针对刺激物使用的基于伴侣的干预措施，因为刺激物使用可能是可检测到的艾滋病毒病毒载量的一个驱动因素。
