Understanding the effects of substance use on male couples risk for HIV

 描述（由申请人提供）：尽管美国有三分之一到三分之二的男男性行为者（MSM）从他们的主要4个同性关系伴侣（即，虽然大多数艾滋病毒预防工作都是在个人和社区层面针对男男性行为者开展的。物质使用也是一个重要的公共卫生问题，影响艾滋病毒6的获得和男男性行为者之间的传播;物质通常被用来增强快感和维持7性行为的参与，包括无避孕套肛交（CAS）。对男性夫妇进行的少数研究8的结果表明，他们在性生活中使用物质会对他们的关系9动态和与艾滋病毒预防相关的行为产生负面影响，包括与临时MSM伴侣的CAS和较差的治疗依从性。虽然这些研究结果表明需要进行干预以预防，但对于男性夫妇中的主要伴侣如何影响彼此使用物质，他们使用物质的不同背景以及他们的使用如何直接影响他们感染艾滋病毒的风险以及这种关系的动态，我们知之甚少。为此，我们建议进行一项为期4年的混合方法研究，从理论上讲，14研究男性夫妇使用药物如何影响他们的关系以及感染艾滋病毒和/或传播艾滋病毒的风险。我们将使用场地时间抽样招募225物质使用的男性夫妇，16个不同的艾滋病毒状态和关系长度，从社区和互联网场所在南佛罗里达。17我们将在6个月的时间内收集定性和定量的纵向二元数据，以检查一般的自我、人际和背景因素之间的18种关联，以及与事件水平19物质使用之间的关联。参与者将在3个时间点（基线、3个月和6个月）完成面对面ACASI，并在第2个月和第5个月期间完成20次每日生态瞬时评估（EMA）。每三个报告的物质使用21事件将补充一个深入的电话采访。所有数据将独立收集每22对夫妇的合作伙伴，夫妇的物质使用和艾滋病毒血清状态将在基线，3和6 23个月进行验证。从ACASI和EMA获得的纵向定量数据将使用24个混合/多水平模型进行分析，包括演员合作伙伴的影响。定性内容分析，特别是潜在和显性内容分析，将用于确定和描述从电话访谈数据中出现的主要主题和次主题。我们将使用标准的混合方法来整合定量和27定性结果，以阐明主要合作伙伴如何影响彼此使用物质和28艾滋病毒的风险，以及他们的使用如何影响他们关系的动态。在米切尔的指导下，他和他的29名高级合作研究人员将传播这些发现，并将其应用于开发一个以30对夫妇为重点的艾滋病毒和药物使用预防干预措施，供未来项目使用。

 DESCRIPTION (provided by applicant): Despite between one- and two-thirds of US men who have sex with men (MSM) acquire HIV from their primary 4 same-sex relationship partner (i.e., male couples), most HIV prevention efforts have targeted MSM at the 5 individual- and community-levels. Substance use is also an important Public Health issue that affects HIV 6 acquisition and transmission among MSM; substances are often used to enhance pleasure and sustain 7 engagement in sexual behaviors including condomless anal sex (CAS). Findings from the few studies 8 conducted with male couples indicate their use of substances with sex negatively impacts their relationship 9 dynamics and behaviors related to HIV prevention, including CAS with casual MSM partners and poor 10 treatment adherence. Although these findings suggest the need to intervene for prevention, less is known 11 about how primary partners within the male couple influence one another's use of substances, the different 12 context(s) in which they use substances, and how their usage directly affects their risk for HIV and dynamics of 13 the relationship. To that calling, we propose to conduct a 4-year mixed method study that is theoretically 14 grounded to examine how male couples' use of substances affects their relationship and risk for acquisition 15 and/or transmission of HIV. We will use venue-time sampling to recruit 225 substance-using male couples, 16 diverse in terms of HIV status and relationship length, from community and Internet venues in South Florida. 17 We will collect qualitative and quantitative longitudinal dyadic data over a 6-month period to examine the 18 associations between intrapersonal, interpersonal and contextual factors in general and with event level 19 substance use. Participants will complete in-person ACASI at 3 time points (baseline, 3 and 6 months), and 20 daily ecological momentary assessments (EMA) during months 2 and 5. Every third reported substance use 21 event will be supplemented with an in-depth phone interview. All data will be collected independently from each 22 partner of the couple, and couples' substance use and HIV serostatus will be verified at baseline, 3 and 6 23 months. Longitudinal quantitative data obtained from the ACASI and EMA will be analyzed using 24 mixed/multilevel models, including actor-partner effects. Qualitative content analysis, specifically latent and 25 manifest content analysis, will be used to identify and describe the major themes and sub-themes that emerge 26 from the phone interview data. We will use standard mixed methodology to integrate the quantitative and 27 qualitative findings to elucidate how primary partners' influence one another's use of substances and risk for 28 HIV, and how their usage affects dynamics of their relationship. Under the direction of Mitchell, he and his 29 team of senior co-investigators will disseminate these findings, and apply them toward development of a 30 couples-focused HIV and substance use preventive intervention for use in a future project.