Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners.

The present study interviewed gay (n?=?473) and bisexual men (n?=?146) as part of an HIV prevention program and investigated social cognitive factors associated with HIV risk. Results indicated that HIV risk in homosexual men was associated with sexual openness and connections to gay communities, factors not associated with risk for bisexual men. Compared with men at lower risk, those who practiced high-risk sex scored lower on measures of perceived safer sex norms, safer sex self-efficacy, and social skills. Bisexual men with primary female partners often had not disclosed their bisexuality to female partners (75%), and 64% had not modified their behavior to protect female partners. Bisexual men who engage in high-risk behaviors therefore pose a risk to female partners who may be unaware of their involvement with men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with Hispanic women's HIV-related communication and condom use with male partners

To determine factors influencing Hispanic women's HIV-related communication and condom use with their primary male partner, 189 Dominican, Puerto Rican, and Mexican women were interviewed regarding sexual behaviour and condom use, relationship characteristics, perceived risk for HIV, and HIV-related communication with the primary male partner. Level of HIV-related communication with the primary male partner was associated with the woman's perceived risk for HIV and her rating of the openness with which she could communicate with her primary partner. Mexican women were less likely than Puerto Rican or Dominican women and women with multiple partners were less likely than those with one partner to communicate about HIV-related issues with their primary partner. Women reporting more condom use with their primary partner were younger, had discussed HIV-related issues more with the primary partner, and were less likely to expect negative reactions to requests for condom use than those reporting less condom use. These results suggest that prevention programmes that increase both general and HIV-specific communication between members of a couple may facilitate safer sex practices by the couple. Prevention programmes that encourage women to insist on condom use should consider the woman's expectations about her partner's reaction as a potential barrier to the initiation of safer sex practices.     

HIV serostatus disclosure among gay and bisexual men in four American cities: general patterns and relation to sexual practices

The present study examined patterns of serostatus disclosure among previously untested HIV-seropositive and HIV-seronegative gay and bisexual men recruited from four American cities (n = 701). Six months after learning their HIV serostatus, 97% of study participants had disclosed their test results to at least one other individual. Consistent with earlier studies, test results were most frequently shared with friends and the respondent's primary partner. HIV serostatus was disclosed less frequently to family members, co-workers, and non-primary sex partners. Compared with HIV-seronegative men, HIV-seropositive men were more likely to have disclosed their status to a health care provider and less likely to have shared this information with family members. Of seropositive men, 11% did not disclose their serostatus to their primary partner and 66% did not disclose to a non-primary sex partner. Of HIV-seropositive men with one or more non-primary partners, 16% of those who did not disclose their serostatus reported inconsistent condom use during anal intercourse with these partners. No significant differences in self-reported sexual practices were observed for HIV-seropositive disclosers versus non-disclosers. Compared with HIV-seronegative men who did not disclose, seronegative men who shared information about their serostatus were more likely to have had receptive anal intercourse with their primary partner (p < 0.05) and to have engaged in mutual masturbation (p < 0.005), receptive oral sex (p < 0.005) and insertive anal intercourse (p < 0.05) with non-primary partners. No significant differences were observed between disclosers and non-disclosers with regard to condom use. Implications of the findings for future research and HIV prevention programmes are discussed.     

Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes.

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be "casual" sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information-motivation-behavioral skills model of preventive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual relationships, sexual behavior, and HIV infection: HIV-seropositive gay and bisexual men seeking prevention services.

The authors evaluated sexual practices, sexually tempting situations, and risk avoidance coping strategies among HIV-seropositive men who have sex with men and who were seeking HIV prevention services. HIV-seropositive men who practiced unprotected anal intercourse in the previous 4 weeks reported stronger temptations to engage in high-risk sex than men who were sexually safe. Being in a positive mood and being with desirable partners were particularly tempting risk situations for seropositive men, who also possessed less coping capacity to deal with risky situations than safer men. Prevention interventions must address the needs of men infected with HIV and must remove barriers to enrolling in prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desired change in couples: Gender differences and effects on communication.

Using a sample (N = 453) drawn from a representative sampling frame of couples who are married or living together and have a 3 to 7 year-old child, this study investigates (a) the amount and specific areas of change desired by men and women, (b) the relation between relationship adjustment and desired change; and (c) the ways in which partners negotiate change. On the Areas of Change Questionnaire, women compared with men, wanted greater increases in their partners’ emotional and companionate behaviors, instrumental support, and parenting involvement; men wanted greater increases in sex. Using the Actor–Partner Interdependence Model (Kenny, 1996), both men’s and women’s relationship adjustment predicted desired change (i.e., actor effects), over and above the effects of their partners’ adjustment (i.e., partner effects); partner effects were not significant. Each couple was also observed discussing the man’s and the woman’s top desired change area. Both men and women behaved more positively during the partner-initiated conversations than during their own-initiated conversations. Women, compared with men, were more negative in their own and in their partners’ conversations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual communication in the age of AIDS: the construction of risk and trust among young adults

Sexually transmitted diseases are extremely prevalent among youth, and it is only by understanding the processes involved in negotiating sexual relationships that effective prevention and intervention programs can be designed. This study explores sexual communication among young adults, how gender and sexual orientation influence negotiation for safer sex, the strategies employed for risk reduction, and the barrier to safer sex. It assumes sexual behavior as a communicative form, both reflective and reflexive, subject to interpretation, and created interactively within and between sexual partners. Data from in-depth interviews with 30 undergraduates at the University of California, Berkeley were triangulated with questionnaires (n = 159), secondary sources and informal interviews with university officials. Participants were representative of arts and science students, ethnically diverse and of varying sexual orientations. Interviews focused on the normative influences of family, school and friends regarding sexuality; and how relationships and sex were negotiated. They investigated how strategies for risk reduction, attitudes about HIV and testing, and contraceptive practices were managed differently by gender and sexual orientation and what the barriers to safer sex were in various situations. Interviews focused on the normative influences of family, school and friends regarding sexuality; how relationships were negotiated, and how trust and risk were constructed within relationships; how strategies for risk reduction, attitudes about HIV and testing, and contraceptive practices were managed differently be gender and sexual orientation; and what the barriers were to safer sex. Friends, the social culture at university, and the interaction of the two with the developmental tasks characteristic of the period between adolescence and adulthood were more important influences than parents or high school sex education classes in how sexual relationships were managed. How and whether friends talked about sex and practiced safe sex were strong normative influences in predicting safer sex among individuals. Negotiating for safer sex contains elements of impression management, requires assertiveness and takes constant effort, even among those who have made the most progress in incorporating it. Practicing safer sex involves a complicated process of sexual negotiation, requiring a degree of open communication about sexual desire and intent that is not widely available in this culture, and still less among young people. Risk and thus how sex is negotiated is assessed differently by gender, and varies further according to the degree of intimacy in the relationship or the sex act being contemplated. How sex is negotiated depends on the construction of risk and trust which differ by the type of relationship or sexual encounter being contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)     

Associations among experiential avoidance, couple adjustment, and interpersonal aggression in returning Iraqi war veterans and their partners.

Objective: The purpose of the present study was to examine the role of experiential avoidance (EA) in relationship adjustment, psychological aggression, and physical aggression among military couples. Method: The sample was composed of 49 male soldiers who recently returned from deployment to Iraq and their female partners. As part of a larger study, participants completed self-report measures of emotional avoidance (EA; Acceptance and Action Questionnaire–II), relationship adjustment (Dyadic Adjustment Scale), and conflict (Conflict Tactics Scale–2). Data from men and women were simultaneously modeled with the actor–partner interdependence model. Results: Men's EA was associated with decreases in relationship adjustment and increases in physical aggression perpetration and victimization. For women, relationship adjustment was not associated with EA, but greater EA among women was associated with decreased relationship adjustment for male partners. Associations among EA and psychological aggression were nonsignificant. Conclusions: These data provide evidence that EA may play a critical role in the relationships of couples following deployment and highlight the importance of targeting EA in couple therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Factors predicting continued high-risk behavior among gay men in small cities: Psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of negative racial stereotypes and Afrocentricity on Black couple relationships.

This questionnaire study investigated the relationship between internalized negative stereotypes, Afrocentricity, and dyadic trust and adjustment for 73 Black couples. Internalized negative stereotypes alone generally did not predict relationship problems; however, the combination of internalized negative stereotypes and high Afrocentricity for the men was associated with decreased perceptions of partner dependability, an aspect of relationship trust, and decreased dyadic adjustment for both partners. Contrary to predictions, Afrocentricity was associated with less perceived partner dependability and satisfaction for the couples. Controlling for socioeconomic status failed to alter these associations. Findings imply that racial perspectives are important predictors of Black couple outcomes and that complex and conflicting racial attitudes held by Afrocentric Black men may cause deterioration in Black couple relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men.

This study surveyed 430 men at an urban gay pride celebration to assess fatalism, current life satisfaction, and perceived expected years of life among men who have sex with men. Analyses showed that men who engaged in unprotected anal intercourse outside of exclusive relationships reported a greater fatalistic outlook, were more dissatisfied with life, and perceived a shorter life for themselves than men who practiced only safer sex and men who were in exclusive relationships. Gay men in exclusive relationships scored higher than nonexclusively partnered gay men on the measure of current life satisfaction. These results suggest that efforts to prevent HIV infection among gay men should include building personal self-worth, support of long-term relationships, and future goal orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men.

The availability of improved HIV treatments may prompt reduced concern about HIV and sexual risk. Gay and bisexual men (N?=?554, 17% HIV-positive) completed measures of treatment attitudes, sexual risk, and assumptions regarding the infectiousness of sexual partners. A substantial minority reported reduced HIV concern related to treatment advances. Reduced HIV concern was an independent predictor of sexual risk, particularly among HIV-positive men. In response to hypothetical scenarios describing sex with an HIV-positive partner, participants rated the risk of unprotected sex to be lower if the partner was taking combination treatments and had an undetectable viral load, relative to scenarios with a seropositive partner not taking combination treatments. Prevention efforts must address attitudinal shifts prompted by recent treatment successes, stressing the continued importance of safer sex, and that an undetectable viral load does not eliminate infection risks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An outbreak of foal yersiniosis in Poland: pathological and bacteriological examination

This study surveyed 430 men at an urban gay pride celebration to assess fatalism, current life satisfaction, and perceived expected years of life among men who have sex with men. Analyses showed that men who engaged in unprotected anal intercourse outside of exclusive relationships reported a greater fatalistic outlook, were more dissatisfied with life, and perceived a shorter life for themselves than men who practiced only safer sex and men who were in exclusive relationships. Gay men in exclusive relationships scored higher than nonexclusively partnered gay men on the measure of current life satisfaction. These results suggest that efforts to prevent HIV infection among gay men should include building personal self-worth, support of long-term relationships, and future goal orientations.     

Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partners: New opportunities for prevention.

This study examined whether preventive counseling of HIV-positive men (N?=?255) was associated with self-disclosure of serostatus to sex partners. Men who reported being counseled at posttest and at their current HIV clinic to disclose their serostatus to partners were more likely to have done so than men counseled only at posttest, only at the HIV clinic, or not counseled at either site. Disclosure increased with the number of times counseled at the HIV clinic. These patterns held for HIV-negative partners, but not for HIV-positive or HIV-unknown partners. Disclosure to HIV-negative partners was associated with safer sexual practices. The findings suggest that counseling interventions for HIV-positive men, when delivered by multiple sources, may provide an effective means of increasing disclosure to sexual partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction.

This study examined whether the association between protective buffering and psychological distress was moderated by relationship satisfaction. Protective buffering is defined as hiding worries, denying concerns, and yielding to one's partner in an effort to avoid disagreement and reduce one's partner's upset and burden. Two hundred thirty-five women diagnosed with early stage breast cancer and their partners completed measures of protective buffering, psychological distress, and relationship satisfaction at 3 time points over an 18-month period after cancer diagnosis. The authors hypothesized that protective buffering would result in more distress among patients and partners reporting higher relationship satisfaction than among patients and partners reporting lower levels of relationship satisfaction. Patients' protective buffering predicted more distress among patients rating their relationships as more satisfactory, whereas the patients' buffering did not predict distress among patients rating their relationships as less satisfactory. Partner relationship satisfaction also moderated the association between patients' buffering and partners' distress. These findings elucidate conditions under which protective buffering may have detrimental effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple sexual partners and their psychosocial correlates: The population-based AIDS in Multiethnic Neighborhoods (AMEN) Study.

In this study we examined multiple partners in a household probability sample of heterosexuals. Thirty-seven percent reported 2 or more partners in the past year, and 6% reported 5 or more partners. Significant interactions among gender, ethnicity, and relationship status revealed complex relations. African American men without a primary partner were the most likely to have multiple partners; ethnic minority women with primary partners were the least likely. Psychosocial factors associated with multiple partners were examined with the AIDS Risk Reduction Model (ARRM). Situational factors influenced how ARRM variables related to multiple partners. Perceived risk, commitment to monogamy, and communication were all important correlates. Prevention efforts must focus on increasing awareness of the risks of heterosexual transmission of HIV for people in dating relationships and on strengthening sexual communication skills with new partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High HIV prevalence, low condom use and gender differences in sexual behaviour among patients with STD-related complaints at a Nairobi primary health care clinic

Of 22,274 patients > or = 12 years old attending a Nairobi primary health care (PHC) clinic, 1076 (4.8%) had STD-related complaints, of whom 980 underwent assessment of risk factors for human immunodeficiency virus (HIV) infection and infrequent condom use. Gonorrhoea, chancroid, syphilis seroactivity, trichomoniasis, or objective signs of STD were found in 78%, and HIV seropositivity in 15% of men and 19% of women. Most women were married, living with a spouse; while most men were single, or married, but living separated from a spouse. Among married men, last sex was with a female sex worker (FSW) or casual partner for 60% not living with a spouse and 26% living with a spouse (P<0.005). Two or more partners during the past year were reported by 82% of men and 25% of women (P <0.001), and 55% of men and 11% of women reported the last partner was high risk. HIV seropositivity among both genders was associated with numbers of partners, and among women, with being widowed or divorced. Only 3% reported use of a condom with the last partner. Among men whose last sex was with a FSW, 74% said the reason for not using a condom was not having one. Thus, infrequent condom use, low condom availability, and gender differences in behaviour necessitate modifying development policies that separate families; and better coordination between family planning, PHC, and AIDS/STD programmes, with improved supply, social marketing and community-based distribution of condoms in high-risk settings for STD/HIV prevention.     

The Interpersonal Process Model of Intimacy: The Role of Self-Disclosure, Partner Disclosure, and Partner Responsiveness in Interactions Between Breast Cancer Patients and Their Partners.

This study evaluated H. Reis and P. Shaver's (1988) interpersonal process model of intimacy in a sample of 98 women with breast cancer and their partners. Couples engaged in two discussions and rated self- and partner disclosure, perceived partner responsiveness, and intimacy experienced. A mediational model was tested in which partner responsiveness mediated the association between disclosure and intimacy. For patients, perceived responsiveness partially mediated the association between partner disclosure and intimacy, but self-disclosure was not significantly associated with responsiveness or intimacy. For partners, perceived responsiveness mediated the association between self-disclosure and perceived partner disclosure and intimacy. For breast cancer patients, partner disclosure predicted patient feelings of intimacy, because this type of disclosure was associated with greater feelings of acceptance, understanding, and caring. These findings may have implications for interventions to improve relationship closeness among couples coping with breast cancer. (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)     

HIV risk correlates among non-injection cocaine dependent men in treatment

Guided by the AIDS Risk Reduction Model (ARRM), psychosocial correlates of HIV risk behavior were examined among noninjection cocaine dependent, heterosexual men (NI-CD-HM) in treatment. Subjects (N = 111) completed a structured interview to measure ARRM mediating variables and HIV risk behaviors. The results indicated that greater perceived susceptibility to contracting HIV, lower sexual self-efficacy, higher lifetime incidence of sexually transmitted diseases, and being under the influence of alcohol or other drugs during sex predicted having more sexual partners in the month prior to admission. Despite adequate knowledge of safer sex guidelines, subjects remained misinformed regarding certain aspects of HIV transmission. Men who perceived that their partners viewed condoms more positively and who exchanged drugs for sex were more likely to use condoms, yet condom use skills were typically inadequate to ensure effective prevention. These results suggest that HIV prevention interventions among NI-CD-HM should focus on improving knowledge, enhancing beliefs in the capacity to enact safer sex behaviors for preventing HIV and other STDs, building relevant skills (e.g., condom use, open sexual communication between partners), and emphasizing psychoactive substance abstinence. Couple interventions, in which partners actually rehearse safer sex negotiations, may be particularly effective in this regard.