1 Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), New York University , New York, New York.
2 Center for Drug Use and HIV Research, New York University , New York, New York.
LGBT Health. 2017 Dec;4(6):434-441. doi: 10.1089/lgbt.2016.0163. Epub 2017 Nov 20.
Substance use has been linked to the sexual transmission of HIV among gay, bisexual, and other men who have sex with men (MSM) across the lifespan. Among older, HIV-positive, MSM populations, cognitive dysfunction associated with age and HIV disease progression also may play a role in sexual risk-taking. People aged 50 years and older represent a growing proportion of the overall HIV-positive population. This study aimed to explore relationships between substance use and cognitive function, and their impact on condomless anal sex (CAS) among HIV-positive gay, bisexual, and other MSM aged 50 years and older.
Data from a cross-sectional study of HIV-positive MSM, aged 50 and older (N = 169) were gathered using a computer-assisted survey, researcher-administered behavioral and neurocognitive measures.
More than 50% of the men used substances and had one or more cognitive impairments. However, only 25% were at higher risk for dementia (i.e., two or more cognitive impairments). Multivariable modeling indicated that use of alcohol to intoxication and date of HIV diagnosis were the strongest predictors of CAS in both a model that included dementia risk and a model that included impaired executive function risk. Current illicit substance use was a significant predictor of CAS only in the model that included dementia risk. Those with better cognitive and executive function had higher odds of CAS. However, only executive function was a significant cognitive predictor of CAS.
Further research is needed to clarify the impact of cognitive function and substance use on sexual risk behaviors as these HIV-positive men achieve normal life expectancies, while continuing to use substances and engage in CAS. Furthermore, addiction treatment remains a critical need for this group even as they transition into later adulthood.
在同性恋、双性恋和其他男男性行为者（MSM）中，物质使用与艾滋病毒的性传播有关。在年龄较大、艾滋病毒呈阳性的 MSM 人群中，与年龄和艾滋病毒疾病进展相关的认知功能障碍也可能在性冒险中发挥作用。50 岁及以上的人群在艾滋病毒阳性人群中的比例不断增加。本研究旨在探讨物质使用与认知功能之间的关系，以及它们对 50 岁及以上艾滋病毒阳性的男同性恋、双性恋和其他 MSM 无保护肛交（CAS）的影响。
使用计算机辅助调查和研究人员管理的行为和神经认知措施，收集了年龄在 50 岁及以上的艾滋病毒阳性 MSM 的横断面研究数据（N=169）。
超过 50%的男性使用物质且存在一种或多种认知障碍。然而，只有 25%的人有更高的痴呆风险（即两种或更多的认知障碍）。多变量模型表明，酒精致醉和艾滋病毒诊断日期是 CAS 的最强预测因素，包括痴呆风险模型和执行功能风险模型。目前非法药物的使用仅是在包括痴呆风险模型中，是 CAS 的一个显著预测因素。认知和执行功能较好的人 CAS 的可能性更高。然而，只有执行功能是 CAS 的一个显著认知预测因素。
需要进一步研究以阐明认知功能和物质使用对性风险行为的影响，因为这些艾滋病毒阳性男性的预期寿命正常，同时继续使用物质并进行 CAS。此外，即使他们进入成年后期，成瘾治疗仍然是这一群体的关键需求。
