Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Int J STD AIDS. 2023 May;34(6):416-422. doi: 10.1177/09564624231155998. Epub 2023 Feb 24.
Studies show that stressful life events (SLE) (e.g., discrimination, financial problems) can lead to psychosocial problems and exacerbate condomless anal sex (CAS) without protection via pre-exposure prophylaxis (PrEP) among men who have sex with men. However, few studies have examined this relationship among men who have sex with men in India, and none have examined this longitudinally.
As a part of an HIV-prevention intervention, 608 MSM from Chennai and Mumbai, India, completed behavioral surveys at baseline, 4, 8, and 12 months. We used longitudinal generalized estimating equations (GEE) modeling to examine the relationship between SLE and its severity and subsequent psychosocial problems, CAS, and history of diagnosed sexually transmitted infection (STI). All models are adjusted for age, sexual identity, intervention arm, human immunodeficiency virus status, and recruitment city.
The number of SLE and their corresponding perceived impact score remained consistent at each time point. In multivariable GEE models, the number of SLE was predictive of CAS, depression, and harmful drinking. Similarly, the ratio of the impact of SLE was predictive of CAS, depression, and diagnosed STI. However, harmful drinking was not predictive in this model.
These findings provide evidence that can inform future interventions, which can be used to enhance self-acceptance, coping skills, and other forms of resiliency.
研究表明，生活应激事件（SLE）（例如歧视、经济问题）可导致心理社会问题，并使男男性行为者（MSM）在无保护措施的情况下（通过暴露前预防 PrEP）发生无保护肛交性行为（CAS）的风险增加。然而，在印度，很少有研究调查了这一关系，也没有研究对此进行纵向调查。
作为一项艾滋病毒预防干预的一部分，来自印度钦奈和孟买的 608 名 MSM 在基线、4、8 和 12 个月时完成了行为调查。我们使用纵向广义估计方程（GEE）模型来检验 SLE 及其严重程度与随后的心理社会问题、CAS 和已确诊的性传播感染（STI）史之间的关系。所有模型均调整了年龄、性身份、干预组、人类免疫缺陷病毒状态和招募城市。
SLE 的数量及其相应的感知影响评分在每个时间点都保持一致。在多变量 GEE 模型中，SLE 的数量与 CAS、抑郁和有害饮酒有关。同样，SLE 影响的比例与 CAS、抑郁和已确诊的 STI 有关。然而，在这个模型中，有害饮酒并没有预测作用。
这些发现为未来的干预措施提供了证据，可以利用这些措施来增强自我接受、应对技能和其他形式的适应能力。
