Friedman M Reuel, Coulter Robert W S, Silvestre Anthony J, Stall Ron, Teplin Linda, Shoptaw Steve, Surkan Pamela J, Plankey Michael W
a Department of Infectious Diseases and Microbiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , PA , USA.
AIDS Care. 2017 Apr;29(4):469-480. doi: 10.1080/09540121.2016.1211614. Epub 2016 Jul 25.
Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.
尽管功能性社会支持已被证明在其他人群中是抑制艾滋病毒载量的一个保护因素，但在美国，针对男男性行为者（MSM）之间这种关系的研究却很少。我们评估了社会支持的特征、社会支持对艾滋病毒载量的影响，以及社会支持对协同流行（共病）的心理社会指标与艾滋病毒载量之间关系的调节作用。我们分析了2002年至2009年期间参与多中心艾滋病队列研究的接受抗逆转录病毒治疗的艾滋病毒阳性男男性行为者的纵向数据（n = 712）。首先，我们对一项社会支持测量指标进行了信度评估。然后，我们进行了一系列广义纵向混合模型来评估我们的研究问题。使用交互项评估调节作用。一个三级（低/中/高）社会支持变量显示出高信度（组内相关系数 = 0.72；95%置信区间：0.70，0.75）。黑人和西班牙裔男男性行为者报告的社会支持低于白人同行（p <.0001）。近期血清转换与更高的社会支持相关（p <.05）。更多的共病指标（抑郁、多种物质使用和无保护肛交）与更低的社会支持相关（p <.0001）。中等和高社会支持水平与更大程度的病毒载量抑制和更低的病毒载量均值相关（p <.0001）。社会支持调节了共病与艾滋病毒载量之间的关系（p <.05）。艾滋病毒阳性男男性行为者，尤其是有色人种，可能会从能够成功增强功能性社会支持的干预措施中大大受益。开展基于优势的干预措施对心理社会负担最重的艾滋病毒阳性男男性行为者可能也有特别高的影响。
