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

项目总结 在美国，艾滋病毒是一个重大的公共卫生问题，特别是在男男性行为者中 (MSM)。在过去的十年中，男男性接触者约占新增艾滋病毒诊断病例的70%，导致 数十亿美元的终身医疗成本。酒精对人群中的艾滋病毒危险行为有显著影响 MSM。急性酒精中毒和无套肛交(CAS)之间有很强的相关性，如 以及未能利用和坚持包括暴露前预防(PrEP)在内的预防性治疗， 暴露后预防(PEP)和坚持抗逆转录病毒治疗(ART)。但是，事件级别 研究提供了更多喜忧参半的结果，表明有多种调节因素。一种潜在的缓和 尚未被调查的因素是性强迫症(SC)，即无法控制频繁 以及强烈的性冲动或冲动。SC与HIV风险、酗酒和增加罹患 性行为前饮酒，表明性欲高的人可能更容易受到酒精对性行为的影响 风险。酒精近视的抑制冲突模型(ICM)表明，酒精对近视的影响最大 在一个人因同时经历高性行为而产生冲突的情况下的性危险行为 教唆和高度的性抑制。性欲高的个体表现出更高的性激素水平 教唆和抑制因素，潜在地使他们特别容易受到酒精诱导性风险的影响。 这项拟议的研究旨在调查酒精使用和SC的影响，包括单独和 协同作用，分三个步骤对艾滋病毒危险行为进行研究。首先，拟议的项目将审查潜在的 在酒精使用和CAS之间的关系上的调节作用或SC通过对90- 日时间线后续数据集。接下来，对感染艾滋病毒风险较高的男男性行为者进行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使用， 更新，并遵守。最后，定性访谈研究将提供关于生活的丰富的具体数据 SC升高、饮酒和性危险行为的人的经历以及交互影响 SC和酒精对艾滋病毒风险的影响。这项提议与候选人希望制定一项 性少数人群健康研究计划侧重于艾滋病毒风险、酒精使用和问题性行为 并支持他精通定量和定性方法的培训目标。通过 建议的研究和培训计划，申请者将发展必要的技能和专业知识，使 作为一名独立的临床科学家，在酒精和艾滋病毒危险行为领域做出了实质性贡献。

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.