Sandfort Theodorus G M, Eshleman Susan H, Knox Justin, Breaud Autumn, Weaver Katie, Kerubo Emily, Panchia Ravindre, Hamilton Erica L, Cummings Vanessa, Clarke Bill
Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dive, Unit 15, New York, NY, 10032, USA.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AIDS Behav. 2025 Sep 13. doi: 10.1007/s10461-025-04832-6.
Research linking substance use with HIV risk behaviors and antiretroviral therapy adherence is typically based on self-reported data. However, studies in high-income countries show that men who have sex with men (MSM) often underreport substance use when compared to objective biological testing. Such comparisons have not been conducted among MSM in sub-Saharan Africa. We compared self-reported and objectively measured substance use among MSM participating in HPTN 075, a multi-site observational cohort study conducted in Kenya, Malawi, and South Africa. Urine samples (n = 734) from 382 participants were tested for the alcohol metabolite ethyl glucuronide and 43 other substances. These tests detect alcohol use in the prior 48-72 h and other substances up to 7 days earlier, depending on the drug. Of the 734 samples, 159 (21.7%) tested positive for ethyl glucuronide. Self-reported alcohol use was available for 97.5% of these cases and confirmed in 141 (91.0%) of them. Sixty samples (8.2%) tested positive for at least one of the 43 other substances. Self-report data were available for 95.0% of those, but use was acknowledged in only 19 (33.3%) cases. These findings suggest that alcohol use is generally reported accurately, while drug use is substantially underreported-likely due to legal prohibitions and social stigma. Incorporating objective substance testing alongside self-reports is recommended to improve the accuracy of substance use measurement in behavioral and clinical HIV research, especially in contexts where stigma or criminalization may inhibit disclosure.
将物质使用与艾滋病毒风险行为及抗逆转录病毒疗法依从性联系起来的研究通常基于自我报告的数据。然而，高收入国家的研究表明，与客观生物学检测相比，男男性行为者（MSM）往往少报物质使用情况。撒哈拉以南非洲的男男性行为者中尚未进行此类比较。我们比较了参与HPTN 075研究的男男性行为者自我报告的和客观测量的物质使用情况，HPTN 075是一项在肯尼亚、马拉维和南非开展的多地点观察性队列研究。对382名参与者的尿液样本（n = 734）进行了酒精代谢物乙基葡萄糖醛酸苷及其他43种物质的检测。这些检测可检测出之前48 - 72小时内的酒精使用情况以及其他物质，其他物质的检测时间可提前至7天，具体取决于药物。在734份样本中，159份（21.7%）乙基葡萄糖醛酸苷检测呈阳性。这些案例中有97.5%提供了自我报告的酒精使用情况，其中141份（91.0%）得到了证实。60份样本（8.2%）至少对43种其他物质中的一种检测呈阳性。这些案例中有95.0%提供了自我报告数据，但只有19份（33.3%）承认使用过。这些发现表明，酒精使用情况通常报告准确，而药物使用情况则被大量少报——可能是由于法律禁令和社会耻辱感。建议将客观物质检测与自我报告结合起来，以提高行为和临床艾滋病毒研究中物质使用测量的准确性，特别是在耻辱感或刑事定罪可能抑制信息披露的情况下。
