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

虽然有许多变量影响男性艾滋病患者坚持抗逆转录病毒治疗（ART）， 在男男性行为艾滋病毒感染者（MLWHSM）中，饮酒是最普遍和重要的因素之一。 事件水平研究已经确定了饮酒，特别是大量饮酒， 和ART不依从性，但尚未研究酒精使用和其他心理社会因素的相互作用。 ART不依从的因素。与酒精使用交叉的一个关键因素是亲密伴侣暴力 (IPV)这在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和艾滋病毒治疗效果差之间，迄今为止的研究依赖于交叉， 分段设计，并产生了混合的结果。横向研究也产生了数据， 表明在这一人群中不健康的酒精使用和IPV之间存在关联。迄今为止，没有任何研究 试图捕捉MLWHSM中酒精使用和IPV的事件级经验，这可能 阐明这些变量之间的时间关联以及酒精使用和IPV的交互作用 关于抗逆转录病毒疗法的不依从性可以使用识别ART不依从性之前的可改变的风险因素 指导旨在改善MLWHSM健康状况的干预措施。此外，人们对 个体差异，使一些MLWHSM在面对艾滋病毒感染风险因素时具有弹性 治疗结果。两个因素，可能有助于弹性和优点考试是应对方式和 社会抚养费使用因果建模分析方法，拟议的研究将检查时间 酒精使用，IPV（永久化和受害）和ART坚持之间的关联，100 MLWHSM。此外，我们还将检验保护性因素（应对方式和社会因素）的调节作用 支持），并将探讨其他近端和远端综合征因素（药物使用，心理健康， 性少数压力、艾滋病毒污名和儿童虐待）。我们提出了一种设计， 评估，然后是连续60天的每日日记。迫切需要加强我们的 了解酒精使用、IPV及其相互作用如何影响MLWHSM中的ART不依从性。 横截面数据可用于确定干预的候选变量。然而，事件级数据 关键是要查明最常见的变量之前，ART不遵守，并可能代表总理 干预目标是改善MLWHSM的健康状况。此外，在文献中有一些引人注目的例子， 当数据是全球和横断面与前瞻性时，ART不依从性的预测因素不一致， 事件级数据。这项拟议中的研究将是第一次对酒精与时间的关联进行实证检验。 MLWHSM中的使用、IPV、其他发病因素、保护因素和ART依从性。这行 研究将用于为未来的干预发展提供信息，以减少与综合征相关的危害。 提高抗逆转录病毒治疗的依从性。

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.