Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
Arch Sex Behav. 2020 Aug;49(6):2005-2018. doi: 10.1007/s10508-019-01531-x. Epub 2019 Dec 20.
People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, β = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (β = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.
HIV 感染者(PLWH)在向新性伴侣披露其 HIV 状况时面临艰难的决策。饮酒和其他药物使用可能会影响这些决策过程和随后的性风险行为。我们旨在研究物质使用、HIV 披露和 PLWH 及其首次 HIV 阴性或未知状态性伴侣使用避孕套之间的事件级关系。成年 PLWH 是从美国东南部一个城市的护理环境中招募的。参与者通过短信提示报告了他们 28 天的性行为。我们采用因果系统中的多层次协变量来检查物质使用与避孕套使用之间的事件级关系。我们假设这种关系将通过 HIV 披露来介导,并受到病毒抑制状态的调节。共有 243 名参与者(83%为男性,93%为黑人)报告了与首次 HIV 阴性/未知状态性伴侣发生的 509 次性行为。在病毒载量受抑制的 PLWH 中,性行为时的物质使用与披露呈负相关(OR 0.29,β=-1.22,95%CI[-2.42,-0.03],p=0.045),但与病毒载量可检测与不可检测的 PLWH 中避孕套的使用呈不同关系。在病毒抑制的 PLWH 中,与从不披露 HIV 状况的参与者相比,始终披露其 HIV 状况的参与者更有可能使用避孕套(β=1.84,95%CI[0.35,3.53],p=0.017),但不规律披露者在披露后使用避孕套的可能性较低(OR 0.22,95%CI[0.07,0.68],p=0.008)。事件级分析提供了对 PLWH 中 HIV 传播风险行为的更细微的近端(物质使用、HIV 披露)和个人水平(物质使用、病毒载量)决定因素的理解。
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