From the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA.
Department of Health Policy and Management.
Sex Transm Dis. 2022 Mar 1;49(3):216-222. doi: 10.1097/OLQ.0000000000001568.
Methamphetamine use, sexual risk behaviors, and depression contribute to ongoing human immunodeficiency virus (HIV) and sexually transmitted infection (STI) disparities among men who have sex with men (MSM). The relative contributions of these effects longitudinally are not well understood.
This analysis used visit-level data from a longitudinal cohort of MSM, half with HIV, in Los Angeles, CA. From August 2014 to March 2020, participants completed follow-up visits every 6 months and underwent testing for rectal gonorrhea/chlamydia (GC/CT) and completed questionnaires including depressive symptoms, number of receptive anal intercourse (RAI) partners, and methamphetamine use. Path analysis with structural equation modeling using concurrent and lagged covariates was used to identify relative contributions of methamphetamine use and depression on number of RAI partners and rectal GC/CT across time.
Five hundred fifty-seven MSM with up to 6 visits (3 years) were included for a total of 2437 observations. Methamphetamine use and depressive symptoms were positively associated with number of RAI partners (β = 0.28, P < 0.001; β = 0.33, P = 0.018, respectively), which was positively associated with rectal GC/CT (β = 0.02, P < 0.001). When stratified by HIV status, depressive symptoms were positively associated with RAI partners for HIV-negative MSM (β = 0.50, P = 0.007) but were not associated for MSM living with HIV (β = 0.12, P = 0.57). Methamphetamine use was positively associated with RAI partners in both strata.
Factors and patterns, which contribute to risk behaviors associated with rectal GC/CT, may differ by HIV status. Our findings demonstrate the importance of combined treatment and prevention efforts that link screening and treatment of stimulant use and depression with STI prevention and treatment.
冰毒使用、性风险行为和抑郁是导致男男性行为者（MSM）中艾滋病毒（HIV）和性传播感染（STI）持续存在差异的原因。这些影响在纵向方面的相对贡献尚不清楚。
本分析使用了加利福尼亚州洛杉矶的一个纵向 MSM 队列的访视水平数据，其中一半为 HIV 感染者。从 2014 年 8 月至 2020 年 3 月，参与者每 6 个月完成一次随访，并进行直肠淋病/衣原体（GC/CT）检测，并完成包括抑郁症状、接受性肛交（RAI）伴侣数量和冰毒使用的问卷。使用同期和滞后协变量的结构方程模型路径分析用于确定冰毒使用和抑郁对 RAI 伴侣数量和直肠 GC/CT 的相对贡献。
共有 557 名 MSM 参加了最多 6 次访视（3 年），共进行了 2437 次观察。冰毒使用和抑郁症状与 RAI 伴侣数量呈正相关（β=0.28，P<0.001；β=0.33，P=0.018），而 RAI 伴侣数量与直肠 GC/CT 呈正相关（β=0.02，P<0.001）。按 HIV 状况分层时，抑郁症状与 HIV 阴性 MSM 的 RAI 伴侣呈正相关（β=0.50，P=0.007），但与 HIV 阳性 MSM 不相关（β=0.12，P=0.57）。冰毒使用与两个层次的 RAI 伴侣呈正相关。
与直肠 GC/CT 相关的风险行为的促成因素和模式可能因 HIV 状况而异。我们的研究结果表明，需要综合治疗和预防措施，将兴奋剂使用和抑郁的筛查和治疗与性传播感染的预防和治疗联系起来。
