A Mixed-Methods Examination of HIV Risk in Men Who Have Sex With Men: Effects of Alcohol and Sexual Compulsivity

男男性行为者艾滋病毒风险的混合方法检查：酒精和性强迫症的影响

• 批准号: 10681431
• 负责人: Neil Gleason
• 金额: $ 4.77万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-16 至 2024-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10681431
• 关键词: Acute; Address; Adherence; Age; Alcohol consumption; Alcoholic Intoxication; Alcohols; Back; Clinical; Conflict (Psychology); Cross-Sectional Studies; Data; Data Set; Development; Esthesia; Event; Failure; Frequencies; Goals; HIV; HIV Infections; HIV diagnosis; HIV risk; Health Care Costs; Heavy Drinking; Individual; Intervention; Interview; Intoxication; Investigation; Knowledge; Measures; Mediating; Methods; Modeling; Morals; Motivation; Participant; Perception; Persons; Pharmaceutical Preparations; Predisposition; Prevention; Prevention strategy; Preventive treatment; Prophylactic treatment; Public Health; Qualitative Methods; Research; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Scientist; Sex Behavior; Surveys; Training; Training Support; United States; Update; Viral Load result; alcohol effect; alcohol myopia; alcohol risk; antiretroviral therapy; condomless anal sex; condoms; drinking; experience; experimental study; hazardous drinking; homonegativity; medication compliance; men who have sex with men; multilevel analysis; phenomenological models; pre-exposure prophylaxis; programs; restraint; risk mitigation; secondary analysis; sex; sexual minority health; sexual risk behavior; skills; theories; therapy adherence; timeline; uptake

PROJECT SUMMARY HIV is a significant public health concern in the United States, particularly among men who have sex with men (MSM). In the past decade, MSM have accounted for approximately 70% of new HIV diagnoses, resulting in billions of dollars in lifetime healthcare costs. Alcohol significantly contributes to HIV risk behavior among MSM. There is a robust association between acute alcohol intoxication and condomless anal sex (CAS), as well as failure to utilize and adhere to preventative treatments including Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and adherence to antiretroviral therapy (ART). However, event-level research provides more mixed results, indicating a variety of moderating factors. One potential moderating factor that has not yet been investigated is sexual compulsivity (SC), which is the inability to control frequent and intense sexual urges or impulses. SC is associated with HIV risk, alcohol use, and increased likelihood of alcohol use before sex, suggesting those high in SC may be more susceptible to alcohol’s effects on sexual risk. The inhibition conflict model (ICM) of alcohol myopia suggests that alcohol has the greatest impact on sexual risk behavior in situations where a person is conflicted due to simultaneously experiencing high sexual instigation and high sexual inhibition. Individuals high in SC have demonstrated elevated levels of both sexual instigation and inhibition factors, potentially making them particularly vulnerable to alcohol-induced sexual risk. The proposed research aims to investigate of the effects of alcohol use and SC, both individually and synergistically, on HIV risk behavior in three steps. First, the proposed project would examine the potential moderating role or SC on the relationship between alcohol use and CAS through secondary analysis of a 90- day timeline follow-back dataset. Next, a cross-sectional survey of MSM at elevated HIV risk will evaluate the effects of SC and alcohol use on other methods of HIV risk mitigation, including PrEP, PEP and ART use, update, and adherence. Finally, a qualitative interview study will provide rich idiographic data on the lived experience of those with elevated SC, alcohol use, and sexual risk behavior, as well as the interactive effects of SC and alcohol on HIV risk. This proposal is commensurate with the candidate’s desire to develop a research program in sexual minority health focused on HIV risk, alcohol use, and problematic sexual behavior and supports his training goals of becoming proficient in both quantitative and qualitative methods. Through the proposed research and training plan, the applicant will develop the skills and expertise necessary to make a substantive contribution to the field of alcohol and HIV risk behavior as an independent clinical scientist.

项目摘要 艾滋病毒是美国一个重大的公共卫生问题，特别是在男男性行为者中 （男男性行为者）。在过去十年中，MSM占新诊断的艾滋病毒的约70%， 数十亿美元的终身医疗费用。酒精对艾滋病毒的危险行为有很大的影响， 男男性接触者急性酒精中毒和无安全套肛交（CAS）之间存在强烈的联系， 以及未能利用和坚持预防性治疗，包括暴露前预防（PrEP）， 暴露后预防（PEP）和坚持抗逆转录病毒治疗（ART）。然而，事件级 研究提供了更复杂的结果，表明有各种各样的调节因素。一种潜在的调节剂 一个尚未被研究的因素是性强迫（SC），这是无法控制频繁的性行为。 和强烈的性冲动SC与HIV风险、酒精使用以及 性行为前饮酒，这表明SC含量高的人可能更容易受到酒精对性行为的影响。 风险酒精性近视的抑制冲突模型（ICM）表明，酒精对 在一个人由于同时经历高性生活而发生冲突的情况下， 煽动和高度性抑制。高SC的个体表现出高水平的性激素和性激素。 煽动和抑制因素，可能使他们特别容易受到酒精引起的性风险。 这项研究的目的是调查酒精使用和SC的影响，无论是单独的， 协同地，分三个步骤对艾滋病风险行为进行控制。首先，拟议的项目将审查 调节作用或SC对酒精使用和CAS之间的关系，通过二次分析的90- 日时间轴跟踪数据集。接下来，一项对艾滋病毒风险升高的男男性行为者的横断面调查将评估 SC和酒精使用对其他艾滋病毒风险缓解方法的影响，包括PrEP，PEP和ART的使用， 更新和遵守。最后，定性访谈研究将提供丰富的具体数据的生活 SC升高、饮酒和性风险行为的患者的经验，以及交互作用 SC和酒精对HIV风险的影响。这一提议与候选人希望发展一种 性少数群体健康研究项目，重点关注艾滋病毒风险、酒精使用和有问题的性行为 并支持他的培训目标，成为精通定量和定性方法。通过 建议的研究和培训计划，申请人将发展必要的技能和专业知识，使一个 作为一名独立的临床科学家，对酒精和艾滋病毒风险行为领域做出了实质性贡献。