Substance use and sexual risk behavior among MSM in South African townships

描述（由申请人提供）：生活在南非乡镇、城郊或农村住宅区的男男性行为者（MSM）吸毒和酗酒的负担很重，这些地区在种族隔离时期是为非白人保留的，今天仍然是数百万南非黑人的居住区。我们对生活在这些乡镇的男男性行为者滥用药物和酒精的决定因素的了解有限。定性数据表明，毒品和酒精主要是在社交场合使用的，一起喝酒是男男性接触者互动的有限方式之一。因此，除个体危险因素外，探讨社会网络特征对药物和酒精滥用的影响具有重要意义。吸毒和酗酒的一个潜在有害影响是性危险行为，这在乡镇的男同性恋者中尤为重要，因为他们的艾滋病毒传播率很高。到目前为止，对城镇男同性恋者中药物使用与性危险行为之间关系的研究报告了不一致的结果。需要对这些问题进行进一步的研究。本项目旨在通过探索这些共同发生的风险行为的个人和环境原因，并通过并置两种不同的时间视角来调查它们，从而更全面地了解南非城镇男同性恋者中物质使用与性风险行为之间的关系。该项目将使用来自美国国立卫生研究院资助的研究“南非乡镇非洲男同性恋者的艾滋病毒和性风险”的数据来实现这一目标。本研究采用受访者驱动的抽样方法，从茨瓦内大都市区的四个南非乡镇招募了480名黑人男男性行为者。在这些男性中进行了一项调查，使用先前有效的措施来评估药物使用、酒精使用和性危险行为。将遵循一项详细的培训计划，以获得方法技能、实质性知识和跨学科专业知识，以实现以下目标：1)评估社会网络特征是否能预测超出个人风险因素的药物滥用；2)评估过去一年的药物使用是否预测性风险行为，然后测试药物使用与性风险行为之间的关系是否被药物使用的原因、对药物使用对性行为的影响的预期或从事安全性行为的意图所修正；3)在考虑了个体、情境和伙伴层面的因素后，评估在确定的性接触中使用药物或酒精是否会预测性风险行为

DESCRIPTION (provided by applicant): A heavy burden of drug and alcohol use has been observed among men who have sex with men (MSM) living in South African townships, peri-urban or rural residential areas that were reserved for non-Whites under Apartheid and which are still residential communities for millions of black South Africans today. Our understanding of the determinants of drug and alcohol abuse among MSM living in these townships is limited. Qualitative data suggests that drugs and alcohol are mostly used in social situations and that drinking together is one of a limited number of ways in which MSM interact. Therefore, it is important to explore the influence of social network characteristics on drug and alcohol abuse, in addition to individual risk factors. One potentially harmful effect of drug and alcohol use is sexual risk behavior, which is of heightened importance among MSM in townships as they have high rates of HIV transmission. Thus far, studies that have looked at the relationship between substance use and sexual risk behavior among MSM in townships have reported inconsistent findings. Further research on these topics is needed. This project aims to achieve a more comprehensive understanding of the relationship between substance use and sexual risk behavior among MSM in South African townships by exploring the individual and contextual causes of these co-occurring risk behaviors, and by juxtaposing two distinct temporal perspectives to investigate them. This project will achieve this using data drawn from the NIH-funded study, "HIV and Sexual Risk in African MSM in South African Townships." This study used respondent-driven sampling to recruit 480 black MSM from four South African townships in the metropolitan area of Tshwane. A survey using previously validated measures to assess drug use, alcohol use, and sexual risk behavior was administered among these men. A detailed training plan will be followed in order to acquire the methodological skills, substantive knowledge and cross-disciplinary expertise to address the following aims: 1) assess whether social network characteristics predict substance abuse beyond individual risk factors; 2) assess whether substance use predicts sexual risk behavior over the past year, then test whether the relationship between substance use and sexual risk behavior is modified by reasons for substance use, expectations about the effect of substance use on sexual behavior, or intentions to engage in safe sex; 3) assess whether drug or alcohol use during a defined sexual encounter predict sexual risk behavior, after accounting for individual-, situational-, and partnership-level characteristics. A greater understanding of substance use among MSM in South African townships, as well as the link between substance use and sexual risk behavior, will inform the development of interventions to reduce substance abuse and sexual risk behavior among this critical population. Given that South Africa has a high prevalence of hazardous drinking, a growing problem with drug use, and the highest burden of HIV in the world, identifying and addressing factors that contribute to substance abuse and the spread of HIV in South Africa is of critical importance.