A Life Course Perspective Model of HIV Risk and Substance Use Patterns among MSM

MSM 中 HIV 风险和药物使用模式的生命历程透视模型

• 批准号: 7686286
• 负责人: James Anthony Swartz
• 金额: $ 15.7万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686286
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Affect; Age; Alcohol consumption; Alcohol or Other Drugs use; Anus; Behavior; Behavioral; Classification; Cocaine; Cohort Studies; Cross-Sectional Studies; Data; Data Analyses; Data Set; Development; Drug usage; Fatigue; Functional disorder; Goals; Growth; HIV; HIV Infections; HIV Seropositivity; Health; Health Status; Heroin; Highly Active Antiretroviral Therapy; Human; Incidence; Individual; Infection; Ketamine; Lead; Length; Life Cycle Stages; Link; Measurement; Methamphetamine; Modeling; Nature; Participant; Patient Self-Report; Pattern; Pharmaceutical Preparations; Population; Prevention; Procedures; Public Health; Relative (related person); Research Personnel; Risk; Risk Behaviors; Safe Sex; Sampling; Sexually Transmitted Diseases; Site; Testing; Time; Work; base; club drug; cohort; contextual factors; data modeling; ecstasy; high risk sexual behavior; innovation; men; men who have sex with men; parallel processing; psychologic; public health relevance; sex; sex risk; sildenafil; social; social capital; time interval

DESCRIPTION (provided by applicant): The proposed study will test and extend the findings from a cross-sectional study that found men who have sex with men (MSM) can be reliably classified into 4 groups based on their pattern of substance use and that the patterns of substance use were associated with both HIV status and with the level of behavioral risk for HIV infection. Men evidencing heavier drug use either through the combined and regular (i.e., weekly or greater) use of club-drugs, poppers, and methamphetamine or the regular use of harder drugs such as heroin and cocaine were more likely to be HIV positive and to evidence higher levels of HIV risk behaviors, such as unprotected receptive anal intercourse, than men who did not use these drugs or used them less frequently. These findings represent one of the first attempts to classify MSM according to their overall pattern of substance use and to test the classification associations with HIV risk behaviors and status through use of latent class analysis. The proposed study builds on this work and the work of other researchers that has found relationships between substance use and risky sexual behaviors for MSM, but using more limited longitudinal or cross-sectional data. Through the application of concepts derived from the life-course perspective (heterotypic continuity, human agency, and social capital), which attempts to explain consistency and changes in health-related behaviors over the lifetime, the proposed study will use the MACS dataset to extend the 4-class model of substance to determine how the pattern of substance use among MSM has changed over time in relation to the trajectory of HIV risk behaviors. Additionally, the study will seek to statistically model the longitudinal associations of individual level factors such as HIV status, health status, and safe-sex fatigue as well as social-contextual factors such as age cohort and the advent of Highly Active Antiretroviral Therapy (HAART), as they affect the dual trajectories of HIV risk behaviors and substance use. Advanced analytic procedures such as growth mixture modeling with parallel processes will be used to analyze the MACS data longitudinally across all measurement points. It is our hope that the findings will lead to a deeper understanding of the inter-relationships among substance use and HIV risk as they change over time, more so than has been possible with temporally limited or cross- sectional data sets. Ultimately our goal is to inform the development of more effective prevention efforts for decreasing substance use, HIV risk behaviors, and the incidence of HIV infection among MSM. Public Health Relevance Statement despite decades of progress in treatment and prevention efforts, HIV/AIDS infections among MSM remains a significant and vexing public health problem, marked by a recent and surprising increase in HIV infection rates as well as the infection rates for other sexually transmitted infections (STIs). The proposed study seeks to enhance understanding of the individual and social-contextual reasons, including patterns of substance use, that underly the recent increase in HIV risk behavior in the MSM population, thereby leading to the development of more effective, contextually sensitive prevention efforts.

描述（由申请人提供）：拟议的研究将测试并扩展一项横断面研究的结果，该研究发现男男性行为者 (MSM) 可以根据其物质使用模式可靠地分为 4 组，并且物质使用模式与 HIV 状况和 HIV 感染行为风险水平相关。与不使用这些药物或使用频率较低的男性相比，通过联合和定期（即每周或更多）使用俱乐部毒品、波普斯和甲基苯丙胺或定期使用海洛因和可卡因等烈性药物而表现出较重吸毒的男性更有可能感染艾滋病毒，并且表现出更高水平的艾滋病毒危险行为，例如无保护的接受性肛交。这些发现代表了根据 MSM 的总体物质使用模式对 MSM 进行分类的首次尝试之一，并通过使用潜在类别分析来测试分类与 HIV 风险行为和状态的关联。拟议的研究建立在这项工作和其他研究人员的工作基础上，这些研究人员发现了 MSM 的物质使用和危险性行为之间的关系，但使用了更有限的纵向或横截面数据。通过应用源于生命历程视角（异型连续性、人类能动性和社会资本）的概念，试图解释一生中健康相关行为的一致性和变化，拟议的研究将使用 MACS 数据集扩展物质的 4 类模型，以确定 MSM 中的物质使用模式如何随着时间的推移而改变，与 HIV 危险行为的轨迹相关。此外，该研究还将寻求对个体水平因素（如艾滋病毒状况、健康状况和安全性疲劳）以及社会背景因素（如年龄组和高效抗逆转录病毒疗法（HAART）的出现）的纵向关联进行统计建模，因为它们影响艾滋病毒危险行为和药物使用的双重轨迹。先进的分析程序（例如具有并行过程的生长混合物建模）将用于纵向分析所有测量点的 MACS 数据。我们希望这些发现能够使人们更深入地了解物质使用和艾滋病毒风险之间的相互关系，因为它们会随着时间的推移而变化，这比使用暂时有限的或横截面数据集所能实现的更深入。我们的最终目标是为制定更有效的预防措施提供信息，以减少 MSM 中的药物使用、艾滋病毒危险行为和艾滋病毒感染发生率。公共卫生相关性声明 尽管治疗和预防工作取得了数十年的进展，MSM 中的艾滋病毒/艾滋病感染仍然是一个重大且令人烦恼的公共卫生问题，其特点是最近艾滋病毒感染率以及其他性传播感染 (STI) 的感染率令人惊讶地增加。拟议的研究旨在加强对个人和社会背景原因的理解，包括物质使用模式，这些因素是近期 MSM 人群中艾滋病毒危险行为增加的原因，从而导致制定更有效、对具体情况敏感的预防工作。