Understanding the effects of substance use on male couples' risk for HIV

 描述(由申请人提供)：尽管三分之一至三分之二的美国男男性行为者(MSM)从其主要的4个同性关系伙伴(即男性伴侣)那里感染艾滋病毒，但大多数艾滋病毒预防工作都是在5个个人和社区层面针对MSM。物质使用也是一个重要的公共卫生问题，影响男男性接触者中艾滋病毒6的感染和传播；物质经常被用来增加快感和维持性行为，包括无套肛交(CAS)。对男性夫妇进行的少数几项研究8的结果表明，他们使用与性行为有关的物质对他们的关系产生了负面影响9与艾滋病毒预防有关的动态和行为，包括与临时MSM伴侣的CAS和较差的治疗依从性。尽管这些发现表明有必要进行干预以进行预防，但关于男性夫妇中的主要伴侣如何影响彼此的物质使用，他们使用物质的不同背景(S)，以及他们的使用如何直接影响他们感染艾滋病毒的风险和这种关系的动态，人们知之甚少。为此，我们建议进行一项为期4年的混合方法研究，理论上以14为基础，以考察男性夫妇使用药物如何影响他们的关系以及感染和/或传播艾滋病毒的风险。我们将使用场地时间抽样从南佛罗里达州的社区和互联网场所招募225对使用药物的男性夫妇，其中16对在艾滋病毒状况和关系持续时间方面存在差异。17我们将在6个月的时间里收集定性和定量的纵向二元数据，以检验个人内部、人际和背景因素之间的18种联系，以及与事件水平19物质使用的关系。参与者将在3个时间点(基线、3个月和6个月)完成面对面的ACASI，并在2个月和5个月期间完成20次每日生态瞬时评估(EMA)。每报告21次物质使用事件，将补充一次深入的电话采访。所有数据将从夫妇中的每个22个伴侣那里独立收集，夫妇的药物使用和艾滋病毒血清状况将在基线、3个月和6个23个月时进行核实。从ACASI和EMA获得的纵向量化数据将使用24个混合/多水平模型进行分析，其中包括行动者-伙伴效应。定性内容分析，特别是潜在内容分析和显性内容分析，将用于确定和描述从电话访谈数据中出现的主要主题和副主题26。我们将使用标准的混合方法来整合定量和27个定性的结果，以阐明主要伴侣如何影响彼此使用物质和感染28例艾滋病毒的风险，以及他们的使用如何影响他们关系的动态。在米切尔的指导下，他和他的29个高级联合调查团队将传播这些发现，并将其应用于开发30对夫妇为重点的艾滋病毒和药物使用预防性干预措施，用于未来的一个项目。

 DESCRIPTION (provided by applicant): Despite between one- and two-thirds of US men who have sex with men (MSM) acquire HIV from their primary 4 same-sex relationship partner (i.e., male couples), most HIV prevention efforts have targeted MSM at the 5 individual- and community-levels. Substance use is also an important Public Health issue that affects HIV 6 acquisition and transmission among MSM; substances are often used to enhance pleasure and sustain 7 engagement in sexual behaviors including condomless anal sex (CAS). Findings from the few studies 8 conducted with male couples indicate their use of substances with sex negatively impacts their relationship 9 dynamics and behaviors related to HIV prevention, including CAS with casual MSM partners and poor 10 treatment adherence. Although these findings suggest the need to intervene for prevention, less is known 11 about how primary partners within the male couple influence one another's use of substances, the different 12 context(s) in which they use substances, and how their usage directly affects their risk for HIV and dynamics of 13 the relationship. To that calling, we propose to conduct a 4-year mixed method study that is theoretically 14 grounded to examine how male couples' use of substances affects their relationship and risk for acquisition 15 and/or transmission of HIV. We will use venue-time sampling to recruit 225 substance-using male couples, 16 diverse in terms of HIV status and relationship length, from community and Internet venues in South Florida. 17 We will collect qualitative and quantitative longitudinal dyadic data over a 6-month period to examine the 18 associations between intrapersonal, interpersonal and contextual factors in general and with event level 19 substance use. Participants will complete in-person ACASI at 3 time points (baseline, 3 and 6 months), and 20 daily ecological momentary assessments (EMA) during months 2 and 5. Every third reported substance use 21 event will be supplemented with an in-depth phone interview. All data will be collected independently from each 22 partner of the couple, and couples' substance use and HIV serostatus will be verified at baseline, 3 and 6 23 months. Longitudinal quantitative data obtained from the ACASI and EMA will be analyzed using 24 mixed/multilevel models, including actor-partner effects. Qualitative content analysis, specifically latent and 25 manifest content analysis, will be used to identify and describe the major themes and sub-themes that emerge 26 from the phone interview data. We will use standard mixed methodology to integrate the quantitative and 27 qualitative findings to elucidate how primary partners' influence one another's use of substances and risk for 28 HIV, and how their usage affects dynamics of their relationship. Under the direction of Mitchell, he and his 29 team of senior co-investigators will disseminate these findings, and apply them toward development of a 30 couples-focused HIV and substance use preventive intervention for use in a future project.