Another study amongst migrant MSM in Beijing, China found that having a foreign MSM friend was significantly associated with HIV infection. It is possible that foreigners who have sex with Vietnamese MSM may have higher risks of HIV infection, since they may also have sex with other MSM in other countries where they travel. We also found that nearly half of MSM who had ever engaged in sex with a foreigner also had transactional sex with male or female clients. It has been reported in Hochiminh City and Hanoi that a foreigner pays much more for sex than local clients, and financial power influences decision-making about using condoms. In that same study, MSM thought that not using condoms was a way to show hospitality to foreign clients. Alcohol use was frequent among participants. Alcohol consumption immediately before having sex “sometimes” was significantly associated with a lower risk for HIV infection than “always”. In fact, heavy alcohol use has been shown to be a risk for HIV infection, since it often leads to unsafe sex and a disregard for safe sexual behavior. In this study, condom use was protective for HIV; however, only “frequent condom use” was a significant protective factor. The role of condom use in protecting MSM from HIV infection has been shown in a number of studies. However, consistent condom use in our study was only 43.5 %, which is similar to that in other provinces in Vietnam, suggesting a need to expand and strengthen condom programmes for MSM in Vietnam. Condom use helps prevent both HIV and STIs. Self-assessment of their risk of HIV infection was associated with HIV infection,grow racks with lights suggesting it is a good indicator for MSM at risk for HIV.
It is possible that MSM recognize that they are at risk of HIV if they use drugs, engage in unsafe sex, and have multiple partners. Therefore, HIV risk perception may be a useful way to prioritize which MSM to target for intervention. Strengthening HIV education and counseling programs for MSM to increase their knowledge and awareness of HIV transmission and related risk behaviors may be beneficial. STIs are recognized as a facilitating factor for HIV transmission, although the prevalence of STIs among MSM in this study was not high, though possibly underestimated, since chlamydia and gonorrhea were only tested for in urine samples, not from rectal specimens. In this study, the prevalence of syphilis was low, but it was highly correlated with HIV infection. Syphilis may increase the risk of HIV transmission, because it shares the same sexual route of transmission, or is facilitated by HIV infection. This study had certain limitations. The study population was very young and may not be representative of all MSM in the study area. Since “mapping” was used for the sampling frame, only those frequenting the mapped areas would be captured by mapping and be invited into the study. Perhaps the sampling strategy is why the majority of the participants identified as “bong kin” . As such, it would be hard to generalize to MSM in Vietnam more broadly unless the proportion in this study is similar to others. However, the results here could be extrapolated to the gay population in southern Vietnam. Moreover, we do not know the refusal rates, since peer educators distributed the invitation cards to participants at each hotspot.
It is possible that some MSM refused to participate and/or gave the invitation cards to other MSM who wanted to take part in the study. If the invitees and non-invitees differed in HIV prevalence and risk behaviors, the association could be under- or over-estimated. Moreover, sensitive topics such as drug use and anal sex might have been under-reported, and under-estimation of the association between these behaviors and HIV could have occurred. Last but not least, the cross-sectional design cannot define temporal relationships between exposures and HIV . Our findings suggest that recreational drug use is strongly associated with HIV infection among MSM in southern Vietnam. This is similar to findings among female sex workers in Vietnam, where drug use played a very important role in HIV transmission in this high-risk population. This study also supports the evidence of the protective role of condom use in preventing HIV transmission among MSM. Consumption of alcohol, HIV risk self-assessment, and other risk factors found in the study may be useful for recognizing MSM groups with a higher risk for HIV for implementation of interventions. HIV interventions among MSM should incorporate several components and address risk behaviors and having a STI. DIFFICULTY ADHERING TO LONG-TERM anti-retroviral regimens is a well-established and primary cause of treatment failure among individuals living with human immunodeficiency virus . Fundamentally, patient behaviors are paramount to effective HIV management such as establishing optimal lifelong adherence to medications , and consistent attendance at HIV clinic appointments . These adherence-related behavioral requirements often occur in the face of stigma-related distress and negative affect and/or aversive and unwanted side effects from the medications themselves . Indeed, the literature is rife with data indicating that ART side effects are strongly related to poor ART adherence .
In addition, there is substantial evidence that negative affect is also associated with ART non-adherence . Accordingly, an inability to tolerate negative affect may interfere with ART adherence and persistence. Given the enduring prevalence and clinical significance of sub-optimal ART adherence among HIV infected individuals , examination of malleable transdiagnostic processes related to indices of HIV management is critical from an intervention standpoint. Distress tolerance is one such potentially important transdiagnostic variable. Here, and throughout the literature, distress tolerance is defined as perceived and/or behavioral persistence in the presence of unpleasant stressors or emotional/physical states . Distress intolerance is characterized by the tendency to rapidly alleviate or escape negative emotional experiences when in crisis or distressing situations, which interferes with engaging in goal-oriented actions . Distress intolerance has been established within various models of problematic behaviors and psychopathology ; hence its consideration as a transdiagnostic psychological vulnerability factor. Accordingly, in the context of HIV management, one’s ability to effectively tolerate distress is crucial because discomfort and/or distress are part of the treatment process and cannot be altogether avoided . Attempts to avoid discomfort and distress may lead to sub-optimal ART adherence , with sub-optimal adherence defined as less than 95% adherence to older regimens and less than 80% adherence to newer regimens . Sub-optimal ART adherence may, in turn, lead to eventual increases in viral load and potential ART-resistant HIV strains . To illustrate, one may experience difficulty sustaining adequate medication adherence if unwilling to tolerate negative emotions resulting from being reminded of living with HIV when taking ART medications. Thus, low tolerance of unpleasant affective states or behavioral tasks may be a clinically addressable risk factor for poor ART adherence and HIV disease progression. In addition to recent work showing perceived distress intolerance to be associated with psychological symptoms among individuals with HIV , a study conducted by O’Cleirigh and colleagues revealed that greater perceived distress tolerance was associated with better self-reported ART adherence and HIV disease management. Although this work represents an important first step in the literature,rolling benches for growing there is a lack of data on the relation between distress tolerance and ART adherence using objective adherence measures or relying on a multi-method approach to DT assessment. As there is inherent difficulty in participants accurately identifying motives for their behavior, along with the potential for inflated correlations with shared method variance , reliance on only self-report methodologies for examining distress tolerance may be problematic. As such, it is recommended to include both self-report and behavioral measures when assessing distress tolerance .
To evaluate the explanatory role of distress tolerance as a transdiagnostic vulnerability factor potentially underlying several indices of HIV disease management, the present study sought to evaluate the relation between distress tolerance and ART adherence using objective measures of ART adherence, response to ART, and immunocompromise and two measures of distress tolerance . Behavioral distress tolerance measures evoke distress “in vivo” thereby capturing one’s objective capacity for tolerating distress, whereas self report measures capture one’s “perceived” capacity for tolerating aversive and unwanted psychological experiences . Given the evidence that poor distress tolerance is associated with negative affectivity , and negative affectivity and ART side effects are associated with ART nonadherence , we also sought to clarify the association between distress tolerance and ART adherence when controlling for negative affectivity and ART side-effect severity. We hypothesized that a multi-method model of distress tolerance would be positively related to objective indices of ART adherence, response to ART, and immuno compromise ; and the effect of distress tolerance would be observed above and beyond the contribution of negative affectivity and ART side effect severity. We also sought to explore whether the two employed measures of distress tolerance would differentially relate to the objective indices of adherence, ART response, and immunological status, given differential relations observed in past work .Data were collected as part of a larger cross sectional study of 180 individuals with HIV . To be included in this study, participants had to be HIV positive, currently prescribed at least one ART medication, and undergoing treatment at an HIV outpatient clinic. Participants were excluded from this study if they were not able to provide informed, voluntary, written consent to participate; or they were actively suicidal, which was ascertained during a structured clinical interview. Analyses for the present study were conducted among a sub-sample of 140 participants representing those who completed all measures of interest for this study. Some of the participants who were missing data skipped measures and others missed items, hence the decrease in sample size for those completing all items on all study measures. We observed no differences in demographics, HIV regimen variables, or primary study variables of negative affectivity, ART side-effect severity, distress tolerance, ART adherence, viral load, CD4 cell count, or marijuana use between the larger sample of 180 participants and the sample of 140 participants used in the current study . All participants provided informed consent. Approval for human subjects’ research was obtained from the relevant affiliated IRBs. The average age of this sample was 48.1 years and ranged from 25 to 65. In terms of ethnicity, 41.4% of participants identified as Black/ non-Hispanic, 27.9% as White/Caucasian, 11.4% as Black/Hispanic, 10.7% as Hispanic, 1.4% as Asian, and 7.1% as “Other.” The majority of the sample graduated high school and 20.4% completed either a 2- or 4-year college degree. Based on the structured clinical interview, 84 participants met criteria for current substance abuse or dependence, 64 met criteria for a current anxiety disorder, and 30 participants met criteria for a current mood disorder.Interested persons, responding to flyers posted in community outpatient HIV clinics, contacted the research team via telephone and were provided with a detailed description of the study. Participants were then initially screened for eligibility and, if eligible, scheduled for an appointment. Participants were instructed to bring all of their ART medications to the study appointment. Upon arrival to the laboratory, each participant provided written consent to participate in the research study. Participants were then administered the SCID-I-N/P by trained interviewers to assess for psychopathology and inclusionary/exclusionary criteria. Eligible participants then completed a battery of self-report measures, the computerized MTPT-C, and participated in a pill count. At the conclusion of this assessment, participants were compensated $50 for their time and effort. Following the appointment, information from the most recent viral load and CD4 cell count was obtained from each participant’s medical record.To our knowledge, this is the first study to examine both objective and perceived assessment of distress tolerance in relation to objective measures of ART adherence, ART response, and immuno compromise. Our hypotheses were mostly supported. Consistent with prediction, lower levels of distress tolerance were significantly related to lower ART adherence and greater likelihood of having a detectable viral load. These data suggest that HIV+ patients with sub-optimal adherence may have a propensity to escape or alleviate unpleasant emotional states and be less able or willing to persist in goal-directed efforts despite experiencing distress. Importantly, these associations were observed above and beyond level of negative affectivity and ART side-effect severity, which have been shown in previous studies to be predictors of poor adherence .