Alcohol Use, Intimate Partner Violence, and ART Adherence among Men Living with HIV who Have Sex with Men

虽然有许多变量会影响艾滋病患者对抗逆转录病毒疗法(ART)的坚持 在艾滋病男男性行为者(MLWHSM)中，饮酒是最普遍和重要的因素之一。 事件水平的研究已经确定了饮酒，特别是酗酒， 和ART的不依从性，但没有检查酒精使用和其他心理社会的交互影响 影响ART不依从性的因素。与饮酒有关的一个关键因素是亲密伴侣的暴力行为 (IPV)，在MLWHSM中非常普遍。虽然现存的文献指出了一种潜在的关系 在MLWHSM中IPV和糟糕的HIV治疗结果之间，到目前为止的研究依赖于交叉- 分段设计，并产生了好坏参半的结果。横断面研究也产生了数据， 表明在这一人群中，不健康的饮酒与IPV之间存在关联。到目前为止，还没有研究表明 尝试捕获MLWHSM中酒精使用和IPV的事件级体验，这可能 阐明这些变量之间的时间关联以及饮酒和IPV的交互作用 论艺术的不执着。可以使用在ART不遵守之前识别可修改的风险因素 指导旨在改善MLWHSM健康状况的干预措施。此外，人们对此知之甚少 个体差异，使一些MLWHSM在面对贫穷艾滋病毒的风险因素时具有弹性 治疗结果。可能有助于韧性和功绩考核的两个因素是应对方式和 社会支持。使用因果模型分析方法，拟议的研究将检查时间 在100人中，酒精使用、IPV(持续和受害)和艺术坚持之间的关系 MLWHSM。此外，我们还将考察保护性因素(应对方式和社交)的调节作用 支持)，并将探讨其他近端和远端合并症因素(药物使用、心理健康、 性少数群体压力、艾滋病毒污名和儿童期虐待)。我们提出了一个由基线组成的设计 评估，随后是连续60天的每日日记。我们迫切需要提高我们的 了解酒精使用、IPV及其相互作用如何影响MLWHSM之间的ART不依从性。 横断面数据可用于确定干预的候选变量。但是，事件级数据是 确定最常出现在ART不遵守之前且可能代表质数的变量的关键 旨在改善MLWHSM健康状况的干预目标。此外，在文学作品中也有一些引人注目的例子 当数据是全局性的、横截面的和前瞻性的时，ART不依从性的不一致预测因子， 事件级数据。这项拟议的研究将是第一次对酒精之间的时间关联进行实证测试 使用、IPV、其他共性因素、保护因素、以及MLWHSM之间的艺术依从性。这一行 研究将被用来为未来的干预发展提供信息，以减少与Syndemic相关的危害 因素和提高艺术的坚持性。

While there are many variables that impact adherence to antiretroviral therapy (ART) among men living with HIV who have sex with men (MLWHSM), alcohol use is one of the most prevalent and significant factors. Event-level studies have identified a temporal association between alcohol use, particularly heavy drinking, and ART nonadherence but have not examined the interactive effects of alcohol use and other psychosocial factors on ART nonadherence. One key factor that intersects with alcohol use is intimate partner violence (IPV), which is highly prevalent among MLWHSM. While the extant literature points to a potential relationship between IPV and poor HIV treatment outcomes among MLWHSM, research thus far has relied on cross- sectional designs and has produced mixed results. Cross-sectional research has also produced data that suggest an association between unhealthy alcohol use and IPV in this population. No research to date has attempted to capture event-level experiences of both alcohol use and IPV among MLWHSM, which could elucidate both temporal associations among these variables and the interactive effect of alcohol use and IPV on ART nonadherence. Identification of modifiable risk factors that precede ART nonadherence could be used to guide interventions aimed at improving the health of MLWHSM. Further, little is understood about the individual differences that enable some MLWHSM to be resilient in the face of risk factors for poor HIV treatment outcomes. Two factors that may contribute to resilience and merit examination are coping style and social support. Using a causal modeling analytic approach, the proposed study will examine temporal associations among alcohol use, IPV (perpetuation and victimization), and ART adherence among 100 MLWHSM. In addition, we will examine the moderating effect of protective factors (coping style and social support) and will explore the impact of other proximal and distal syndemic factors (drug use, mental health, sexual minority stress, HIV stigma, and childhood abuse). We propose a design consisting of a baseline assessment, followed by 60 consecutive days of daily diaries. There is an urgent need to sharpen our understanding of how alcohol use, IPV, and their interaction impact ART nonadherence among MLWHSM. Cross-sectional data can be used to identify candidate variables for intervention. However, event-level data are key to pinpointing the variables that most commonly precede ART nonadherence and could represent prime intervention targets to improve the health of MLWHSM. Further, there are striking examples in the literature of discrepant predictors of ART nonadherence when data are global and cross-sectional versus prospective, event-level data. The proposed study will be the first empirical test of temporal associations among alcohol use, IPV, other syndemic factors, protective factors, and ART adherence among MLWHSM. This line of research will be used to inform future intervention development to reduce the harms associated with syndemic factors and improve ART adherence.