Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, USA.
Department of Psychology, State University of New York at Oneonta, Oneonta, NY, USA.
AIDS Behav. 2018 Sep;22(9):2815-2829. doi: 10.1007/s10461-018-2147-9.
Methamphetamine use poses increased risk for HIV and other sexually transmitted infections. There is robust evidence that methamphetamine use increases sexual risk behavior, like condomless sex, primarily among men who have sex with men but also among heterosexual women and men. Gender differences have been found among women and men who use meth, and there is a high degree of interconnectedness between meth use, depression, and condomless sex. The aims of the current study are to evaluate the efficacy of a theory-based, tri-focal intervention designed to reduce depression, meth use, and condomless sex among women and men, and to examine gender as a moderator of efficacy. A total of 432 HIV-negative women and men who use meth participated in a two-arm randomized controlled trial and completed baseline and follow-up assessments at 4, 8, and 12 months. We used latent growth curve modeling techniques to analyze the data. Results showed that while all participants exhibited reductions in depression, meth use, and condomless sex, the intervention and comparison groups did not differ in changes over time. However, we did find a significant gender moderation effect, such that among men, those in the intervention arm reported greater reductions in meth use relative to those in the comparison group; reduced meth use was associated with reduced condomless sex, but not depression. In contrast, women in the intervention condition did not differ from women in the comparison condition in changes in any of the three outcome variables. Interventions targeting heterosexual women and men who use meth must be gender-specific, and take into account the unique vulnerabilities and experiences of women, including the perceived positive aspects of using meth, gendered power dynamics, higher depression, and violence.
甲基苯丙胺的使用会增加感染艾滋病毒和其他性传播感染的风险。有充分的证据表明，甲基苯丙胺的使用会增加性风险行为，例如无保护的性行为，主要发生在男男性行为者中，但也发生在异性恋女性和男性中。在使用甲基苯丙胺的女性和男性中发现了性别差异，并且甲基苯丙胺的使用、抑郁和无保护的性行为之间存在高度的相互关联。本研究的目的是评估一种基于理论的、三重焦点干预措施的疗效，该措施旨在减少女性和男性的抑郁、甲基苯丙胺的使用和无保护的性行为，并研究性别作为疗效的调节因素。共有 432 名 HIV 阴性的甲基苯丙胺使用者参加了一项双臂随机对照试验，并在基线和 4、8 和 12 个月时完成了随访评估。我们使用潜在增长曲线建模技术来分析数据。结果表明，虽然所有参与者的抑郁、甲基苯丙胺的使用和无保护的性行为都有所减少，但干预组和对照组在随时间的变化上没有差异。然而，我们确实发现了一个显著的性别调节效应，即对于男性，干预组报告的甲基苯丙胺使用减少量相对于对照组更大；减少甲基苯丙胺的使用与减少无保护的性行为相关，但与抑郁无关。相比之下，干预组的女性在三种结果变量中的任何一种变化上都与对照组的女性没有差异。针对异性恋女性和男性甲基苯丙胺使用者的干预措施必须是针对性别的，并且要考虑到女性的独特脆弱性和经验，包括对使用甲基苯丙胺的积极看法、性别权力动态、更高的抑郁和暴力。
