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

描述(由申请人提供)：这项拟议的研究将测试和扩展一项横断面研究的结果，该研究发现，男男性行为者(MSM)可以根据他们的药物使用模式可靠地分为4组，药物使用模式与HIV状况和HIV感染的行为风险水平都相关。与不使用这些药物或较少使用这些药物的男性相比，通过联合和定期(即每周或更多)使用俱乐部毒品、毒品和甲基苯丙胺或经常使用海洛因和可卡因等较硬毒品而出现更严重的药物使用的男性更有可能是艾滋病毒阳性，并表现出更高水平的艾滋病毒危险行为，如无保护的接受性肛交。这些发现是第一次尝试根据MSM的总体药物使用模式对其进行分类，并通过使用潜在类别分析来测试分类与HIV危险行为和状态的关联。这项拟议的研究建立在这项工作和其他研究人员的工作的基础上，这些研究发现了MSM的物质使用和危险的性行为之间的关系，但使用了更有限的纵向或横断面数据。通过应用从生命过程角度(异型连续性、人类中介和社会资本)得出的概念，试图解释与健康相关的行为在一生中的一致性和变化，拟议的研究将使用MACS数据集来扩展物质的四类模型，以确定MSM中的物质使用模式如何随着时间的推移而相对于HIV危险行为的轨迹发生变化。此外，这项研究将寻求对个人水平因素(如艾滋病毒状况、健康状况和安全性行为疲劳)以及社会背景因素(如年龄队列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。将使用先进的分析程序，如生长混合建模和并行过程，对所有测量点的MACS数据进行纵向分析。我们希望，这些发现将使人们更深入地了解药物使用和艾滋病毒风险之间的相互关系，因为它们随着时间的推移而变化，比使用时间有限或横截面的数据集更有可能。最终，我们的目标是为制定更有效的预防工作提供信息，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的发生率。公共卫生相关性声明尽管在治疗和预防工作方面取得了几十年的进展，但男男性接触者中的艾滋病毒/艾滋病感染仍然是一个严重而令人头疼的公共卫生问题，其特点是艾滋病毒感染率以及其他性传播感染的感染率最近惊人地上升。拟议的研究旨在加强对个人和社会背景原因的了解，包括物质使用模式，这是最近男男性接触者中艾滋病毒风险行为增加的根本原因，从而导致制定更有效、更具背景敏感性的预防努力。

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.