Violence and viral suppression among men living with HIV

项目总结/摘要 越来越多的证据表明，男男性行为者（MSM）经历艾滋病毒和艾滋病的双重流行， 亲密伴侣暴力（IPV），但了解这两种流行病之间的协同作用， 不发达。同性恋、双性恋和其他男男性行为者（GBMSM）仍然是风险群体 在美国受艾滋病影响最严重的人。与此同时， 男男性接触者的比例从12%到78%不等。新的证据表明IPV的经验之间的关联 艾滋病毒感染的风险或参与增加艾滋病毒风险的危险行为（即， 药物使用），但IPV的经验，男男性行为者艾滋病病毒感染者和艾滋病临床 关怀更少被理解。绝大多数将IPV与次优艾滋病毒护理联系起来的证据来自 异性恋女性的研究。最近的一项荟萃分析表明，女性的IPV经验是 自我报告的依从性降低55%，病毒抑制降低36%。的 四项研究关注了男性艾滋病毒感染者的临床护理和IPV之间的关系， 受方法学限制的阻碍：以临床为基础的人群的横断面研究设计， 能够得出结论，说明IPV如何影响艾滋病毒感染者伴侣参与艾滋病毒护理。 我们提出了一个创新的24个月的艾滋病毒阳性男男性行为者队列研究，加上嵌套定性数据， 确定美国男男性接触者的IPV和HIV护理之间的干预途径和点。拟议研究 活动包括招募300名艾滋病毒阳性的男男性行为者（>18岁）的前瞻性24个月队列 通过在亚特兰大，佐治亚州和底特律，密歇根州的在线和基于场地的招聘方法相结合。的 队列研究将采用专门开发的IPV测量方法，以捕获MSM经历的IPV， 将考虑IPV的经验（受害，犯罪和双向IPV），严重程度和 IPV频率是参与艾滋病毒护理的驱动因素。病毒载量和抗逆转录病毒药物依从性的生物标志物将在 收集所有参与者。拟议活动的总体目标是提供关于如何 IPV的受害或实施塑造了艾滋病毒护理的参与，并与实现以下目标的能力有关： 并维持病毒抑制

PROJECT SUMMARY/ABSTRACT There is increasing evidence that men who have sex with men (MSM) experience dual epidemics of HIV and intimate partner violence (IPV), yet understanding of the synergies between these two epidemics is underdeveloped. Gay, bisexual and other men who have sex with men (GBMSM) continue to be the risk group most severely affected by HIV in the United States. In parallel, estimated prevalence for receipt of IPV among MSM range from 12% to 78%. Emergent evidences demonstrates associations between the experience of IPV among MSM and the risk of HIV acquisition or participation in risk behaviors that heighten the risk of HIV (i.e. substance use), but the relationship between the experience of IPV for MSM living with HIV and HIV clinical care is less understood. The overwhelming majority of evidence linking IPV and sub-optimal HIV care comes from studies of heterosexual women. A recent meta-analysis showed that women's experience of IPV was associated with 55% lower odds of self-reported adherence and 36% decreased odds of viral suppression. The four studies that have looked at associations between clinical care and IPV for men living with HIV have all been hampered by methodological limitations: cross-sectional study designs with clinic-based populations that limit the ability to draw conclusions as to how IPV affects engagement in HIV care for partnered men living with HIV. We propose an innovative 24-month cohort study of HIV-positive MSM, coupled with nested qualitative data, to identify the pathways and points of intervention between IPV and HIV care for US MSM. The proposed research activities include a prospective 24-month cohort of 300 HIV-positive partnered MSM (>18 years) recruited through a combination of online and venue-based recruitment methods in Atlanta, GA and Detroit, MI. The cohort study will employ a measure of IPV developed specifically to capture IPV as experienced by MSM, and will consider the experience of IPV (victimization, perpetration and bidirectional IPV), and severity and frequency of IPV as drivers of engagement in HIV care. Biomarkers of viral load and adherence to ARV will be collected from all participants. The overall aim of the proposed activities is to provide new knowledge of how victimization or perpetration of IPV shapes engagement in HIV care and is associated with the ability to achieve and maintain viral suppression.