Closson Elizabeth F, Mitty Jennifer A, Malone Jowanna, Mayer Kenneth H, Mimiaga Matthew J
a The Fenway Institute , Fenway Health , Boston , MA , USA.
b Department of Social and Environmental Health , The London School of Hygiene and Tropical Medicine , London , UK.
AIDS Care. 2018 Feb;30(2):191-198. doi: 10.1080/09540121.2017.1360992. Epub 2017 Aug 22.
The use of recreational drugs while having sex is associated with increased HIV incidence among men who have sex with men (MSM). Taking a daily antiretroviral pill, or pre-exposure prophylaxis (PrEP) is a biomedical intervention to prevent HIV. However, the efficacy of PrEP is closely tied with high levels of adherence. While PrEP has the potential to reduce HIV acquisition, the use of recreational drugs may impede adherence. We explored perceptions of PrEP utilization and regimen preferences among 40 HIV-negative, MSM who reported concurrent recreational drug use and condomless anal sex with a man. Semi-structured qualitative interviews were conducted and the data were analyzed using a qualitative descriptive approach. Participants perceived that it would be challenging to take PrEP while high on crystal meth, crack, powder cocaine, ecstasy and/or GHB. However, men identified strategies for using PrEP when they were not high on these drugs, including taking the pill when they started their day and integrating PrEP into an established routine, such as when taking other medications or preparing for sex. PrEP regimen preferences seemed to be shaped by the frequency in which participants used drugs and their ability to plan for sex. Taking PrEP everyday was appealing for those who regularly engaged in sexualized recreational drug use. Accounts depict these sexual interactions as frequent but unpredictable. A daily regimen would allow them to be prepared for sex without having to plan. An event-driven regimen was acceptable to men who occasionally used recreational drugs in the context of sex. For this group, sex usually occurred was generally prearranged. Patterns of sex and recreational drug use figured largely into participants' framings of how they would use PrEP. These behaviors will likely play a role in the uptake of and adherence to PrEP among this population.
在发生性行为时使用消遣性药物与男男性行为者（MSM）中艾滋病毒感染率上升有关。每日服用抗逆转录病毒药物，即暴露前预防（PrEP），是一种预防艾滋病毒的生物医学干预措施。然而，PrEP的疗效与高依从性密切相关。虽然PrEP有降低感染艾滋病毒风险的潜力，但使用消遣性药物可能会妨碍依从性。我们探讨了40名艾滋病毒阴性的男男性行为者对PrEP使用的看法和用药方案偏好，这些人报告同时使用消遣性药物并与男性进行无保护肛交。我们进行了半结构化定性访谈，并采用定性描述方法对数据进行了分析。参与者认为，在吸食冰毒、快克、粉末可卡因、摇头丸和/或γ-羟基丁酸酯处于兴奋状态时服用PrEP具有挑战性。然而，男性确定了在未处于这些药物兴奋状态时使用PrEP的策略，包括在一天开始时服药，并将PrEP融入既定的日常安排中，比如在服用其他药物或准备性行为时。PrEP用药方案的偏好似乎受到参与者使用药物的频率及其计划性性行为能力的影响。对于那些经常进行与性相关消遣性药物使用的人来说，每天服用PrEP很有吸引力。描述显示这些性互动频繁但不可预测。每日用药方案可以让他们无需计划就能为性行为做好准备。对于偶尔在性行为中使用消遣性药物的男性来说，事件驱动的用药方案是可以接受的。对于这个群体，性行为通常是预先安排好的。性行为和消遣性药物使用模式在很大程度上影响了参与者对如何使用PrEP的构想。这些行为可能会在这一人群对PrEP的接受和依从方面发挥作用。
