Substance use and sexual risk behavior among MSM in South African townships

描述(申请人提供)：观察到在南非城镇、城市周边或农村居民区的男男性行为者(MSM)吸毒和酗酒的负担很重，这些居民区在种族隔离制度下为非白人保留，至今仍是数百万南非黑人的居民区。我们对居住在这些城镇的MSM中吸毒和酗酒的决定因素的了解是有限的。定性数据表明，毒品和酒精主要用于社交场合，一起喝酒是男男性接触者为数不多的互动方式之一。因此，除了个体危险因素外，探索社会网络特征对药物和酒精滥用的影响也是重要的。吸毒和酗酒的一个潜在有害影响是性行为风险，这在乡镇MSM中非常重要，因为他们的艾滋病毒传播率很高。到目前为止，关于乡镇MSM中物质使用和性危险行为之间关系的研究报告了不一致的结果。需要对这些主题进行进一步的研究。该项目旨在通过探索这些共同发生的危险行为的个人和背景原因，并通过并列两个不同的时间视角来调查它们，从而更全面地了解南非城镇MSM中药物使用和性危险行为之间的关系。该项目将使用美国国立卫生研究院资助的研究数据来实现这一点，该研究名为“南非城镇中非洲男男性接触者中的艾滋病毒和性风险”。这项研究使用受访者驱动的抽样方法，从茨瓦内大都市地区的四个南非城镇招募了480名黑人男男性接触者。在这些男性中进行了一项调查，使用之前经过验证的方法来评估药物使用、酒精使用和性行为风险行为。为了获得方法技能、实质性知识和跨学科专业知识，将遵循详细的培训计划，以解决以下目标：1)评估社会网络特征是否可以预测个人风险因素之外的药物滥用；2)评估过去一年中药物使用是否预测性风险行为，然后测试药物使用和性风险行为之间的关系是否被药物使用的原因、对药物使用对性行为的影响的预期或从事安全性行为的意图所改变；3)评估在确定的性行为中使用药物或酒精是否预测性风险行为，在考虑到个人、情景和伙伴关系水平后 特点。更好地了解南非城镇男男性接触者中的药物使用情况，以及药物使用与性危险行为之间的联系，将有助于制定干预措施，以减少这一关键人群中的药物滥用和性危险行为。鉴于南非危险饮酒盛行，吸毒问题日益严重，艾滋病毒负担是世界上最高的，找出和解决导致药物滥用和艾滋病毒在南非传播的因素至关重要。

DESCRIPTION (provided by applicant): A heavy burden of drug and alcohol use has been observed among men who have sex with men (MSM) living in South African townships, peri-urban or rural residential areas that were reserved for non-Whites under Apartheid and which are still residential communities for millions of black South Africans today. Our understanding of the determinants of drug and alcohol abuse among MSM living in these townships is limited. Qualitative data suggests that drugs and alcohol are mostly used in social situations and that drinking together is one of a limited number of ways in which MSM interact. Therefore, it is important to explore the influence of social network characteristics on drug and alcohol abuse, in addition to individual risk factors. One potentially harmful effect of drug and alcohol use is sexual risk behavior, which is of heightened importance among MSM in townships as they have high rates of HIV transmission. Thus far, studies that have looked at the relationship between substance use and sexual risk behavior among MSM in townships have reported inconsistent findings. Further research on these topics is needed. This project aims to achieve a more comprehensive understanding of the relationship between substance use and sexual risk behavior among MSM in South African townships by exploring the individual and contextual causes of these co-occurring risk behaviors, and by juxtaposing two distinct temporal perspectives to investigate them. This project will achieve this using data drawn from the NIH-funded study, "HIV and Sexual Risk in African MSM in South African Townships." This study used respondent-driven sampling to recruit 480 black MSM from four South African townships in the metropolitan area of Tshwane. A survey using previously validated measures to assess drug use, alcohol use, and sexual risk behavior was administered among these men. A detailed training plan will be followed in order to acquire the methodological skills, substantive knowledge and cross-disciplinary expertise to address the following aims: 1) assess whether social network characteristics predict substance abuse beyond individual risk factors; 2) assess whether substance use predicts sexual risk behavior over the past year, then test whether the relationship between substance use and sexual risk behavior is modified by reasons for substance use, expectations about the effect of substance use on sexual behavior, or intentions to engage in safe sex; 3) assess whether drug or alcohol use during a defined sexual encounter predict sexual risk behavior, after accounting for individual-, situational-, and partnership-level characteristics. A greater understanding of substance use among MSM in South African townships, as well as the link between substance use and sexual risk behavior, will inform the development of interventions to reduce substance abuse and sexual risk behavior among this critical population. Given that South Africa has a high prevalence of hazardous drinking, a growing problem with drug use, and the highest burden of HIV in the world, identifying and addressing factors that contribute to substance abuse and the spread of HIV in South Africa is of critical importance.