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

描述（由申请人提供）：在南非城镇、城市周边或农村居民区的男男性行为者（MSM）中观察到吸毒和酗酒的沉重负担，这些居民区在《种族隔离法》下为非白人保留，今天仍然是数百万南非黑人的居住社区。我们对生活在这些乡镇的男男性行为者中药物和酒精滥用的决定因素的理解是有限的。定性数据表明，毒品和酒精主要用于社交场合，一起喝酒是MSM互动的有限方式之一。因此，重要的是要探讨社会网络的特点对药物和酒精滥用的影响，除了个人的危险因素。毒品和酒精使用的一个潜在有害影响是性风险行为，这在城镇的男男性行为者中尤为重要，因为他们的艾滋病毒传播率很高。到目前为止，研究了物质使用和性风险行为之间的关系，在城镇的男男性接触者报告了不一致的结果。需要对这些主题进行进一步研究。本项目旨在通过探索这些共同发生的风险行为的个体和背景原因，并通过并列两个不同的时间视角来调查它们，从而更全面地了解南非乡镇MSM之间的物质使用和性风险行为之间的关系。该项目将利用美国国立卫生研究院资助的研究“南非城镇非洲男男性行为者的艾滋病毒和性风险”中的数据来实现这一目标。“这项研究使用响应者驱动的抽样方法，从Tshwane大都市区的四个南非乡镇招募了480名黑人MSM。在这些男性中进行了一项使用先前验证的措施来评估药物使用，酒精使用和性风险行为的调查。将遵循详细的培训计划，以获得方法技能、实质性知识和跨学科专门知识，以实现以下目标：1）评估社会网络特征是否可预测超出个人风险因素的药物滥用; 2）评估物质使用是否预测过去一年的性风险行为，然后测试物质使用和性风险行为之间的关系是否被物质使用的原因、对物质使用对性行为的影响的预期或从事安全性行为的意图所改变; 3）在考虑了个人、情境和伙伴关系水平后，评估在确定的性接触期间使用药物或酒精是否能预测性风险行为。 特色更好地了解南非城镇MSM之间的物质使用，以及物质使用和性风险行为之间的联系，将为制定干预措施提供信息，以减少这一关键人群中的物质滥用和性风险行为。鉴于南非危险饮酒的流行率很高，吸毒问题日益严重，艾滋病毒的负担也是世界上最高的，查明和解决导致南非药物滥用和艾滋病毒传播的因素至关重要。

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.