title: Stimulant use and HIV disease management among men in same-sex relationships.
abstract: BACKGROUND
  Research conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM).
  
  
  METHODS
  In total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load.
  
  
  RESULTS
  After controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n=371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load.
  
  
  CONCLUSIONS
  Partner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples-based interventions targeting stimulant use as a potential driver of detectable HIV viral load.
authors.affiliation: University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States. Electronic address: adam.carrico@ucsf.edu.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.affiliation: University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Woolf-King
authors.affiliation: University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.affiliation: University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Dilworth
authors.affiliation: University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States; University of California, San Francisco, School of Pharmacy, United States.
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D000697:Central Nervous System Stimulants; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011581:Psychological Tests; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D000697:Central Nervous System Stimulants
keywords: Adherence; Cocaine; HIV; Methamphetamine; Treatment as prevention; Viral load
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