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     

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)     

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)     

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     

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)     

Sexual HIV risk behaviour among men who have sex with both men and women

The aim of this study was to describe the sexual behaviour of men who had sex with both men and women in the preceding five years (behaviourally bisexual men), specifically to examine their needs in relation to HIV prevention. Anonymous telephone interviews were carried out with respondents recruited though advertisements in UK newspapers and magazines with (sexual) 'personal' or 'contact' sections. Data are reported from 745 respondents. Respondents report relatively high and approximately equal numbers of male and female sexual partners in the year preceding interview. There is a clear patterning of sexual activity by type of partner (regular or casual). A high proportion report anal intercourse with female and male partners. A third disclose their homosexual practices to regular female partners. Although self-reported HIV seroprevalence is low (less than 1%), the levels of unprotected sex with multiple sexual partners indicate substantial potential for transmission of sexually transmitted infections, including HIV. While low seroprevalence suggests that there is little overlap with existing core groups of HIV infection, the study provides information to judge the priority of targeting HIV prevention initiatives and suggests ways in which initiatives could be undertaken.     

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)     

Managing multiple-minority identities: African American men who have sex with men at predominately white universities.

This study examined how African American men who have sex with men (AAMSM) manage their multiple-minority identities, including being both racial and sexual minorities at predominately White educational institutions (PWI). Using a phenomenological paradigm, AAMSM college students participated in semistructured interviews. Results suggest that AAMSM at PWIs view race, gender, and religious beliefs as of primary importance, and sexual orientation and social class as less salient aspects of their identities. Further, AAMSM attending PWIs reported experiencing both discrimination and stereotyping based on their race and sexual orientation, and their appraised risk of rejection and acceptance influenced their perception of identity options. AAMSM’s construction of their identity influenced their interpersonal associations with the African American, gay, African American and gay, and campus communities at large. Implications for future research and higher education administrators and mental health professionals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.     

Sex, sex guilt, and contraceptive use.

The Mosher True–False Guilt Scale, the Mosher Sex Guilt Scale, and questionnaires about sexual activity and contraceptive use were administered to 109 female undergraduates in 1973 and 111 Ss in 1978. Comparisons revealed an increase in sexual activity and a decrease in the use of effective contraception between 1973 and 1978. The data confirmed the utility of the Mosher scales for predicting sexual activity and contraceptive use, while indicating that the level of sex guilt sufficient to inhibit sexual activity in 1973 was no longer sufficient in 1978. Clinical implications of these trends in contraceptive use among unmarried Ss and methodological implications for use of the Mosher Sex-Guilt Scale as a predictor of sexual activity are discussed. (25 ref) (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)     

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)     

HIV risk behaviors associated with the injection process: multiperson use of drug injection equipment and paraphernalia in injection drug user networks

This study examines drug acquisition and multiperson use of paraphernalia, drugs, and needles/syringes. Ethnographers observed 54 injection episodes in which IDUs were linked by HIV risk behaviors, and developed a typology of higher-risk, lower-risk, and nonsharing-risk networks. Multiperson use of injection paraphernalia or drug solution occurred in most injection events (94%). Serial use of syringes/needles occurred infrequently (14%) relative to "backloading" (37%) and reuse of paraphernalia (cookers 84%, cotton 77%, water 77%). Higher-risk injection networks were characterized by larger size and pooling of resources for drugs. Prevention messages must include avoiding reuse of injection paraphernalia and transfer of drug solution.     

Constructions of survival and coping by women who have survived childhood sexual abuse.

This qualitative study investigated personal constructs of survival and coping by 11 women who have survived childhood sexual abuse. In-depth interviews, a 10-week focus group, documentary evidence, and follow-up participant checks and collaborative analysis were used. Over 160 individual strategies were coded and analyzed, and a theoretical model was developed describing (a) causal conditions that underlie the development of survival and coping strategies, (b) phenomena that arose from those causal conditions, (c) context that influenced strategy development, (d) intervening conditions that influenced strategy development, (e) actual survival and coping strategies, and (f) consequences of those strategies. Subcategories of each component of the theoretical model were identified and are illustrated by narrative data. Implications for counseling psychology research and practice are addressed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

High rates of sexual contact with female sex workers, sexually transmitted diseases, and condom neglect among HIV-infected and uninfected men with tuberculosis in Abidjan, C?te d''Ivoire

We assessed mechanisms of acetylcholine- and bradykinin-induced relaxations in human omental resistance vessels. Ring segments (approximately 200 microns normalized ID) were dissected from omental biopsies obtained from women at laparotomy (nonpregnant) or at cesarean delivery (pregnant) and were studied under isometric conditions in a Mulvany-Halpern myograph. All arginine vasopressin-preconstricted vessels relaxed in a strictly endothelium-dependent manner to acetylcholine and bradykinin; maximal relaxations were not decreased by either NG-nitro-L-arginine or indomethacin. By contrast, bradykinin failed to relax vessels that had been preconstricted with potassium gluconate. In the combined presence of NG-nitro-L-arginine and indomethacin, addition of charybdotoxin, a selective antagonist of some calcium-sensitive potassium channels, did not inhibit maximal bradykinin-induced relaxation. By contrast, addition of 10 mmol/L tetraethylammonium chloride abolished relaxation in vessels from nonpregnant women but not in vessels from gravidas. We conclude that bradykinin relaxes these human resistance arteries in an endothelium-dependent but predominantly nitric oxide- and prostanoid-independent manner; relaxation likely depends on the action of an endothelium-derived hyperpolarizing vasodilator. Furthermore, in striking contrast to mechanistic insights from animal studies, human pregnancy appears to augment a mechanism of endothelium-dependent relaxation in these vessels that is insensitive to the inhibitors noted above. Whether a similar novel vasodilator mechanism in vivo contributes to the physiological vasodilation that characterizes human gestation or whether failure of such a mechanism might lead to preeclampsia remains the subject of future study.     

Sex, sex guilt, and contraceptive use revisited: The 1980s.

The Mosher True-False Sex-Guilt Inventory and questionnaires about sexual activity and contraceptive use were administered to a sample of 93 female college students in the 1983-1984 academic year. Comparison of this sample with comparable samples collected in the 1973-1974 and 1978-1979 academic years revealed an increase in sex guilt, a decrease in sexual activity, and an increase in the use of effective contraceptives between 1978-1979 and 1983-1984. These shifts indicate that both sexual behavior and contraceptive use returned to approximately the same level as in 1973-1974, whereas attitudes toward sex were more conservative than in either of two previous cohorts. Thus the current data provided the opportunity to test the emotional inhibition hypothesis of contraception during a period of relative sexual conservatism. The discussion deals with the relation between the personality disposition of sex guilt and trends in sexual values and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nuclear attitudes and reactions: Associations with depression, drug use, and quality of life.

Investigated attitudes and amount of distress associated with the ever-present threat of nuclear war and the possibility of accidents at nuclear power plants. A nuclear attitudes questionnaire consisting of 15 items was administered to 211 19–24 yr old males and 511 20–24 yr old females who grew up in the nuclear age. The items were found to reflect 4 latent factors (Nuclear Concern, Nuclear Support, Fear of the Future, and Nuclear Denial), all of which in turn represent 2nd-order construct of nuclear anxiety. Females reported significantly more nuclear concern, less nuclear support, more fear of the future, and less nuclear denial than did males. In latent-variable models, nuclear anxiety was significantly associated with less purpose in life, less life satisfaction, more powerlessness, more depression, and more drug use. It is concluded that the threat of nuclear war and accidents is significantly related to psychological distress and may disturb normal maturational development. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective associations among alcohol use-related sexual enhancement expectancies, sex after alcohol use, and casual sex.

Higher levels of alcohol use have consistently been related to higher rates of sexual risk taking; however, it is not clear whether this relationship is causal. This study examined the concurrent and predictive associations among alcohol use-related sexual enhancement expectancies, drinking alcohol before engaging in sex, and casual sex during the transition into emerging adulthood and whether these associations differed for men and women. Data came from 590 men and women who were interviewed 3 times at 6-month intervals after high school. Growth curve analyses indicated that alcohol-related sexual enhancement expectancies were related to casual sex indirectly through drinking before sex but did not predict change in either of these behaviors. However, increases in drinking before sex predicted increases in casual sex over time. The findings provide some support for prevention programs that focus on alcohol-related sexual expectancies to reduce sexually transmitted illnesses among emerging adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)