急性酒精摄入直接增加艾滋病毒传播风险：一项随机对照实验。
Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment.
作者信息
Shuper Paul A, Joharchi Narges, Monti Peter M, Loutfy Mona, Rehm Jürgen
机构信息
*Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; †Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ‡Department of Behavioral and Social Sciences, Brown University Center for Alcohol and Addiction Studies, Brown University, Providence, RI; §Women's College Hospital, Toronto, Canada; ‖Department of Medicine, University of Toronto, Toronto, Canada; ¶Maple Leaf Medical Clinic, Toronto, Canada; #Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada; **Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ††Centre for Addiction and Mental Health, PAHO/WHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada; ‡‡Epidemiological Research Unit, Technische Universität Dresden, Dresden, Germany; §§Klinische Psychologie and Psychotherapie, Dresden, Germany; and ‖‖Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Toronto, Canada.
出版信息
J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):493-500. doi: 10.1097/QAI.0000000000001549.
BACKGROUND
Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative.
METHODS
In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target blood alcohol concentration = 0.080%), placebo alcohol (target blood alcohol concentration = 0.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/nonaroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex.
RESULTS
A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274) = 9.43, P = 0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274) = 1.86, P = 0.174).
CONCLUSIONS
The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts.
背景
饮酒常被认为是无保护性行为和艾滋病毒传播的一个驱动因素，但迄今为止，缺乏关于饮酒对艾滋病毒阳性人群因果性冒险行为影响的实验证据。本实验旨在确定急性饮酒是否对男男性行为者（MSM）中艾滋病毒阳性者的无保护性行为意图有直接因果影响，并评估艾滋病毒阳性与阴性的男男性行为者之间酒精的影响是否存在差异。
方法
在一项随机对照酒精给药实验中，将艾滋病毒阳性和阴性的男男性行为者带入一个专门的酒吧实验室，并随机分配到饮料消费条件组：酒精（目标血液酒精浓度 = 0.080%）、安慰剂酒精（目标血液酒精浓度 = 0.000%）或水（对照组）。参与者随后接受基于视频的性唤起操纵（性唤起/未唤起），并在标准化范式中表明他们进行有保护和无保护性行为的意图。主要结果涉及进行无保护接受性和无保护插入式肛交的意图。
结果
共有282名男男性行为者（141名艾滋病毒阳性；141名艾滋病毒阴性）完成了实验程序。与接受安慰剂酒精或水的男男性行为者相比，接受酒精的男男性行为者报告的无保护性行为意图明显更强（F(1,274) = 9.43，P = 0.002）。艾滋病毒阳性和阴性的男男性行为者之间酒精的影响没有差异（F(1,274) = 1.86，P = 0.174）。
结论
本研究是首个以风险为重点、涉及艾滋病毒阳性样本的酒精给药实验，结果表明饮酒对可能导致艾滋病毒传播的性行为意图有独立的因果影响。研究结果强烈表明，应以酒精为重点的举措应纳入艾滋病毒预防工作中。
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