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)     

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)     

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)     

Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression.

Objective: Social-cognitive models have been used to explain health risk behaviors in numerous populations, including people with HIV. However, these models generally do not account for the influence of clinically significant psychological problems such as major depression. Design: This study examined whether a social-cognitive model would explain recent sexual transmission risk behavior among sexually active HIV-infected men who have sex with men (MSM) who meet or do not meet screening criteria for major depression. Main Outcome Measures: Participants (n = 403) completed self-report assessments of negative expectancy, social models, and self-efficacy (SE) related to condom use, as well as recent STRB and a screening measure for major depression. Multiple group modeling was used to examine whether condom use SE explained associations of negative expectancy and social models for condom use with recent STRB among participants who screened positive (n = 47) or negative (n = 356) for major depression. Results: The multiple group model fit the data well (χ2(36) = 30.55, p = .73; CFI = 1.00; RMSEA     

Influences of sexual sensation seeking, alcohol consumption, and sexual arousal on women's behavioral intentions related to having unprotected sex.

This experimental study examined effects of alcohol consumption and sexual sensation seeking on unprotected sex intentions, taking into account sexual arousal, indirectly discouraging sex, and condom insistence. Women (N = 173; mean age = 25.02) were randomly assigned to a control, placebo, low-dose beverage (target blood alcohol level = .04), or high- dose beverage (target blood alcohol level = .08) condition. Participants projected themselves into a hypothetical sexual interaction with a man in which no condom was available. Structural equation modeling demonstrated that both sexual sensation seeking and alcohol dose directly increased sexual arousal early in the interaction, but later sexual arousal indirectly increased unprotected sex intentions by decreasing endorsement of indirect discouragement and, in turn, condom insistence. These findings help to clarify the role of alcohol consumption and sensation seeking in women's sexual decision making and point to the importance of examining it as a multistage process. (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 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)     

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     

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)     

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)     

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)     

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)     

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)     

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)     

The effects of acute alcohol intoxication, partner risk level, and general intention to have unprotected sex on women's sexual decision making with a new partner.

Women account for a quarter of all new HIV/AIDS cases, with approximately 65% having contracted the infection via heterosexual contact. Few experimental studies have examined interactions among background, partner, and situational characteristics in predicting women's sexual decisions. The Cognitive Mediation Model provides a useful theoretical framework for assessing likelihood of unprotected sex. Female social drinkers (n = 230) who had answered questions related to their general intention to have unprotected sex were randomly assigned to an experimental condition based on partner risk level (unknown, low, high) and beverage (control, placebo, low dose, high dose). Participants projected themselves into a story depicting a sexual situation with a man and answered questions about their cognitive appraisals, assertive condom request, and likelihood of unprotected sex. Alcohol effects on appraisal of sexual potential differed by partner risk condition. In the unknown and low risk conditions, placebo and alcohol participants appraised the situation as having greater sexual potential than controls whereas in the high risk condition, only those who consumed alcohol did so. Sexual potential appraisals in turn predicted impelling cognitions about having sex, which in turn predicted assertive condom request and unprotected sex intentions. General intention for unprotected sex independently predicted cognitive appraisals and outcomes. These findings highlight the need for prevention programs that focus on teaching women how to pay attention and consider sexual risk cues presented by potential partners, particularly when under the influence of alcohol. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Alcohol and erectile response: The effects of high dosage in the context of demands to maximize sexual arousal.

Although drinking often precedes men's sexual activity, basic questions about alcohol's effects on men's sexual arousal remain unanswered. Inconsistencies in findings from studies examining subjective and physiological effects on erectile functioning suggest these effects are context specific, for example, dependent on whether a man wants to maximize or suppress his arousal. To address unresolved questions about alcohol and erectile functioning, the authors evaluated the effects of high blood alcohol concentrations (BACs) and arousal instructional demands on indices of penile circumference change and self-reported sexual arousal. In Study 1, a target BAC of .10% (vs. .00%) attenuated peak circumference change from a neutral baseline but did not affect mean change, latency to arousal onset (a 5% increase in circumference from baseline), latency to peak achieved arousal, or subjective arousal, which correlated moderately with physiological indices. In Study 2, instructions to maximize (vs. suppress) arousal increased peak and mean circumference change and interacted with a target BAC of .08% (vs. .00%) to influence latency to arousal onset. Sober men instructed to maximize showed a shorter latency to arousal onset than did those instructed to suppress arousal; however, intoxicated men did not show a differential pattern. Moreover, compared with intoxicated counterparts, sober men instructed to maximize arousal showed a marginally shorter latency to arousal onset. Overall, alcohol and arousal instructions had small but discernible effects. Findings highlight the importance of contextual factors in alcohol's impact on erectile functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol Use and High-Risk Sexual Behavior Among Men Who Have Sex With Men: The Effects of Consumption Level and Partner Type.

Alcohol use may increase HIV sexual risk behavior, although findings have varied across study populations and methods. Using event-level data from 1,712 seronegative men who have sex with men, the authors tested the hypothesis that social context would moderate the effect of alcohol consumption on unprotected anal sex (UAS). For encounters involving a primary partner, rates of UAS did not vary as a function of alcohol use. However, consumption of 4 or more drinks tripled the likelihood of UAS for episodes involving a nonprimary partner. Thus, the effects of alcohol vary according to the context in which it is used. Interventions to reduce substance-related risk should be tailored to the demands of maintaining sexual safety with nonprimary partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of alcohol and alcohol expectancies on male perception of female sexual arousal in a date rape analog.

The impact of alcohol and alcohol expectancies on men's perception of female sexual arousal and men's ability to discriminate accurately female sexual intentions in a dating situation was examined. In a 2 (alcohol)?×?2 (expectancy) balanced placebo design, men were exposed to an audiotape of a date rape and asked to signal when the man should stop making sexual advances. On 4 occasions during the vignette, participants rated how sexually aroused the woman on the tape was at that moment. Relative to controls, participants who consumed alcohol or expected to consume alcohol took significantly longer to identify the inappropriateness of the man's sexual behavior toward his date. Similarly, alcohol participants also rated the woman's sexual arousal level significantly higher at the first 2 refusals. Implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)