The influence of state and trait affect on HIV risk behaviors: A daily diary study of MSM.

Objective: To characterize the influence of state and trait affect on HIV risk behaviors. Design: Men who have sex with men (N = 155) completed reports of trait affect and daily reports of affect and sexual behaviors each night for up to 30 days. Main Outcome Measures: Analyses focused on the role of state and trait positive activation (PA), negative activation (NA), anxious arousal (AA), and sexual activation (SA) on sexual risk taking, operationalized as having a sex partner, a partner-related risk composite, and an HIV risk behavior composite. Results: State SA was positively associated with having a sex partner and HIV risk behaviors; trait SA was positively associated with partner-related risk. State AA was negatively associated with having a sex partner and positively associated with HIV risk behaviors. Trait AA had a negative association with partner-related risk and moderated the effects of state AA. State PA was negatively associated with HIV risk behaviors, and trait PA had a main effect on having a sex partner. NA had no significant trait or state effects. Conclusion: These data suggest a role for multiple affective states in sexual risk taking. Models of HIV risk-taking behaviors should be extended to include affective processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial to reduce club drug use and HIV risk behaviors among men who have sex with men.

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p     

Sorting through chickens and eggs: A longitudinal examination of the associations between attitudes, norms, and sexual risk behavior.

Objective: Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true—that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions. Design: Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities—that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse. Results: Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior. Conclusions: These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of sexual arousal and sexual partner characteristics in HIV+ MSM's intentions to engage in unprotected sexual intercourse.

Objective: This study investigated the effects of sexual arousal and sexual partner characteristics as determinants of HIV+ men who have sex with men's (MSM) intentions to engage in unprotected sex. Design: In a computer-based controlled experiment, 67 HIV+ MSM underwent a sexual arousal manipulation and indicated their intentions to engage in unprotected sex with hypothetical partners who differed in terms of HIV serostatus, physical attractiveness, relationship type, and preference for condom use. Main Outcome Measures: Computer-delivered questions assessed HIV+ MSM's intentions to engage in various sexual acts with each hypothetical partner. Results: As predicted, sexually aroused HIV+ MSM indicated stronger intentions to engage in unprotected sex than nonaroused HIV+ MSM; and having a partner who was attractive, HIV+, long term, or who preferred not to use condoms, also led to riskier intentions. Several significant interactions among these factors were found, which were generally consistent with predictions and with theory and research on cognitive processing and decision making. Conclusions: These findings have implications for understanding risky sexual behavior among HIV+ individuals and for the development of interventions to reduce this risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of planning and self-efficacy in condom use among men who have sex with men: An application of the Health Action Process Approach model.

Objective: In Hong Kong, men who have sex with men (MSM) remain a high risk group for HIV infection. This study applied the Health Action Process Approach (HAPA) to study the motivational and behavioral patterns of local MSM in condom use. Design: Four hundred ten sexually active MSM completed the questionnaire on site at Time 1; 217 who remained sexually active were interviewed during a 1-month follow-up. Main Outcome Measures: Risk perception, outcome expectancy, action self-efficacy, intention, planning, maintenance self-efficacy, and recovery self-efficacy were measured at Time 1. Actual condom use was measured at both time points. Results: The HAPA model had a good fit to the data (χ2 = 300.71, df = 111, p     

Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: A randomized clinical trial.

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model’s stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of HIV-related thought suppression on risk behavior: Cognitive escape in men who have sex with men.

This study investigated the relationship between suppressing thoughts about HIV risk and several outcomes related to HIV risk, including sexual risk behavior and HIV prevention service use, in men who have sex with men (MSM). Synthesizing the ironic processing theory (D. M. Wegner, 1994) with a cognitive escape paradigm (D. J. McKiman, D. G. Ostrow, & B. Hope, 1996), it was hypothesized that thought suppression might increase risk by leading MSM to "escape" from sexual safety norms and engage in risky sex behaviors and, via a paradoxical process, increase future use of community prevention services. Results from a sample of MSM (N = 709) indicated that thought suppression was positively related to concurrent sexual risk behavior and to future use of prevention services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual compulsivity, state affect, and sexual risk behavior in a daily diary study of gay and bisexual men.

Researchers have identified a strong link between sexual compulsivity (SC) and risky sexual behavior among men who have sex with men (MSM). Meanwhile, affect/mood has also been connected with negative sexual health outcomes (sexually transmitted infection/human immunodeficiency virus [HIV] transmission, sexual risk, sex under the influence of drugs/alcohol). Given that SC is characterized by marked distress around one's own sexual behavior, affect may play a central role in SC and HIV risk behavior. Data were taken from the Pillow Talk Project, a pilot study conducted in 2008–2009 with 50 highly sexually active MSM (9 or more male sex partners, ≤ 90 days), of which half displayed SC symptoms and half did not. Forty-seven men completed a daily diary online for 30 days (n = 1,060 diary days), reporting on their sexual behavior and concurrent affect: positive activation, negative activation, anxious arousal, and sexual activation. We conducted HLM analyses using daily affect (Level 1, within subjects) and SC and HIV status (Level 2, between subjects) to predict sexual behavior outcomes. Increased negative activation (characterized by fear, sadness, anger, and disgust) was associated with reduced sexual risk behavior, but less so among sexually compulsive MSM. Sexual activation was associated with increased sexual risk taking, but less so among sexually compulsive MSM. Anxious arousal was associated with increased sexual behavior, but not necessarily sexual risk taking. Findings indicate that affect plays key roles in sexual behavior and sexual risk taking; however, the association between affect and behavior may be different for sexually compulsive and non-sexually compulsive MSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Treatment Advocacy Program: A randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men.

Objective: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM “peer advocates” in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). Method: We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. Results: At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, χ2(2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants. Conclusions: TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP—computer-based and individually tailored session content, delivered by peers, in the primary care setting—warrant further exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Virtual and physical venues as contexts for HIV risk among rural men who have sex with men.

Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship characteristics and sexual risk-taking in young men who have sex with men.

Objective: Young men who have sex with men (MSM), particularly young men of color, are experiencing the largest increase in HIV incidence of any risk group in the United States Epidemiological research suggests that the majority of transmissions among MSM are occurring in the context of primary partnerships, but little research has been done on the processes within these dyads that increase HIV risk behaviors. The aim of this study was to use longitudinal partnership-level data to explore the effects of partner and relationship characteristics on the frequency of unprotected sex within young MSM relationships. Method: One hundred twenty-two young MSM (age 16–20 at baseline) were assessed at three time-points six months apart, with 91% retention at the 12-month follow-up wave. Over 80% were racial/ethnic minorities. At each wave, participants reported on characteristics of the relationships and partners for up to three sexual partners. Hierarchical linear modeling was used for analyses. Results: The largest effect was for considering the relationship to be serious, which was associated with nearly an eightfold increase in the rate of unprotected sex. Other factors that increased risk behaviors included older partners, drug use prior to sex, physical violence, forced sex, and partnership lasting more than six months. Partners met online were not associated with significantly more sexual risk. Conclusions: These data provide insight into the relationship processes that should be addressed in prevention programs targeted at young MSM. Relationships may serve as a promising unit for HIV prevention interventions, although more formative research will be required to address potential logistical obstacles to implementing such interventions. The partner-by-partner analytic approach (i.e., evaluating situational variables associated with several partners for a given participant) holds promise for future HIV behavioral research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men.

Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age = 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation. Results: The final model demonstrated acceptable fit, χ2(123) = 157.05, p = .02, CFI = .95, TLI = .94, RMSEA = .04, SRMR = .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits. Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

Objective: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. Design: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. Main Outcome Measures: Rates of unprotected anal intercourse in the previous 3 months. Results: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. Conclusions: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men.

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City.

Objective: This study examined how disengagement coping with HIV risk mediated the association between internalized homophobia and unprotected anal intercourse (UAI) and how sexual encounters in public venues (public sex) and drug use moderated the association between disengagement coping and UAI among HIV-negative gay men. Disengagement coping included fatalistic beliefs about maintaining HIV-negative seronegative serostatus (fatalism), optimistic attitudes toward medical seriousness of HIV infection and reduced concern about HIV risk due to highly active anti-retroviral therapies (optimism), and negative affective states associated with sexual risk (anxiety). Design: A survey was conducted among 285 HIV-negative gay men at an HIV prevention counseling program in New York City. Main Outcome Measures: Sexual risk was defined as having had UAI with nonprimary partners in the past 6 months. Results: In addition to the positive association between internalized homophobia, disengagement coping, and UAI, fatalism mediated the association between internalized homophobia and UAI; and optimism mediated the association between anxiety and UAI. A significant moderation effect of public sex was found between fatalism and UAI. Conclusions: The findings highlight the importance of understanding disengagement coping as it affects sexual risk practices among HIV-negative gay men in the continuing epidemic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing STD and HIV risk behavior of substance-dependent adolescents: A randomized controlled trial.

A randomized controlled trial assessed 3 interventions designed to increase safer sex behaviors of substance-dependent adolescents. Participants (N = 161) received 12 sessions of either a health information intervention (I only), information plus skills-based safer sex training (I + B), or the same experimental condition plus a risk-sensitization manipulation (I + M + B). The I + B and I + M + B conditions, as compared with the I only condition, (a) produced more favorable attitudes toward condoms; (b) reduced the frequency of unprotected vaginal sex; and (c) increased behavioral skill performance, frequency of condom-protected sex, percentage of intercourse occasions that were condom protected, and number of adolescents who abstained from sex. The intervention that included the risk-sensitization procedures was more resistant to decay. An unexpected finding was that the I + B and I + M + B conditions produced substantial increased in sexual abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caretaking behaviors by adolescent children of mothers with and without a history of depression.

In a sample of 72 mothers with and without a history of depression and their adolescent children, maternal depression history, current maternal depressive symptoms, intrusive and withdrawn parental behavior, and adolescent caretaking behaviors were examined as predictors of adjustment in these youth. Two types of caretaking behaviors were examined: emotional (e.g., caring for a parent's emotional distress) and instrumental (e.g., looking after younger siblings). Although adolescents of mothers with and without a history of depression were comparable on levels of both types of caretaking, caretaking was associated with adolescents' reports of anxiety–depression and mothers' reports of social competence only for adolescents of mothers with a history of depression. Moreover, regression models showed that among children of mothers with a history of depression, emotional, but not instrumental, caretaking was related to adolescents' anxiety–depression symptoms and social competence after controlling for current parental depressive symptoms and stressful parenting behaviors. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of pain and depression with various health-promoting behaviors in African American elders.

Purpose/Objective: In this study, the authors investigated how presence of pain interferes with various health behaviors in a sample of urban African American elders, examining depression as a potential mediator. Research Method/Design: 74 African Americans over the age of 60 years and residing in Detroit participated in both self-report questionnaires and physical performance measures. Regression analyses were used to determine the effect of pain interference on health behaviors, and partial correlations were used to determine whether depression mediated the relations. Results: The authors found that pain interference was significantly related to physical functioning and frequency of aerobic exercise. The latter relation (pain interference and frequency of exercise) was partially mediated by depression. Conclusions/Implications: Given these findings, the effect of pain interference on health behaviors is neither simple nor direct, and depression may be a key variable. Identification and treatment of pain and depression in older persons may reduce physical impairment and health care costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The five-factor model of personality traits and organizational citizenship behaviors: A meta-analysis.

Using meta-analytic tests based on 87 statistically independent samples, we investigated the relationships between the five-factor model (FFM) of personality traits and organizational citizenship behaviors in both the aggregate and specific forms, including individual-directed, organization-directed, and change-oriented citizenship. We found that Emotional Stability, Extraversion, and Openness/Intellect have incremental validity for citizenship over and above Conscientiousness and Agreeableness, 2 well-established FFM predictors of citizenship. In addition, FFM personality traits predict citizenship over and above job satisfaction. Finally, we compared the effect sizes obtained in the current meta-analysis with the comparable effect sizes predicting task performance from previous meta-analyses. As a result, we found that Conscientiousness, Emotional Stability, and Extraversion have similar magnitudes of relationships with citizenship and task performance, whereas Openness and Agreeableness have stronger relationships with citizenship than with task performance. This lends some support to the idea that personality traits are (slightly) more important determinants of citizenship than of task performance. We conclude with proposed directions for future research on the relationships between FFM personality traits and specific forms of citizenship, based on the current findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depression ratings, reported sexual risk behaviors, and methamphetamine use: Latent growth curve models of positive change among gay and bisexual men in an outpatient treatment program.

Although the cessation of substance use is the principal concern of drug treatment programs, many individuals in treatment experience co-occurring problems such as mood disruptions and sexual risk behaviors that may complicate their recovery process. This study assessed relationships among dynamic changes tracked over time in methamphetamine use, depression symptoms, and sexual risk behaviors (unprotected anal intercourse) in a sample of 145 methamphetamine-dependent gay and bisexual males enrolled in a 16-week outpatient drug treatment research program. Participants were randomly assigned into 1 of 4 conditions: contingency management (CM), cognitive behavioral therapy (CBT; the control condition), combined CM and CBT, and a tailored gay-specific version of the CBT condition. Using latent growth curve models, the authors assessed the relationship of means (intercepts) and the slopes of the 3 measures of interest over time to test whether changes in methamphetamine use predicted declining rates of depression and risky sexual behavior in tandem. Participants with the greatest downward trajectory in methamphetamine use (urine verified) reported the greatest and quickest decreases in reported depressive symptoms and sexual risk behaviors. The control group reported the most methamphetamine use over the 16 weeks; the tailored gay-specific group reported a more rapidly decreasing slope in methamphetamine use than the other participants. Findings indicate that lowering methamphetamine use itself has a concurrent and synergistic effect on depressive symptoms and risky sexual behavior patterns. This suggests that some users who respond well to treatment may show improvement in these co-occurring problems without a need for more intensive targeted interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)