Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.     

GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing–based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.     

Psychological and socio-demographic variables associated with sexual risk behavior for sexually transmitted infections/HIV

New diagnoses of sexually transmitted infections (STIs) and HIV are rising in the adult population. The main objective of this study was to analyze whether knowledge of STIs/HIV, worry about STIs/HIV and pregnancy, and self-efficacy to refuse sex are predictors of sexual risk behaviors among Spanish young and adults. The study sample was composed of 1,106 young and adults of both sexes aged between 17 and 55 years. Results showed that being single, homosexual, having been tested for HIV, having previously contracted an STI, having a college education and earning a monthly income of €900 or more were the characteristics associated with higher scores in knowledge of STIs/HIV. Self-efficacy to refuse sex predicted most vaginal and anal sexual behaviors (i.e., age at vaginal and anal sex initiation and the number of couples that have remained vaginal sex). We also found that participants with greater knowledge of STIs/HIV reported older age at vaginal sex initiation and higher condom use in the first vaginal sexual contact. We consider that these findings can be useful for the development of STI/HIV prevention programs.     

Social anxiety and problematic alcohol consumption: the mediating role of drinking motives and situations

Social anxiety is inconsistently associated with alcohol use variables. To elucidate factors that contribute to the relationship between social anxiety and problematic alcohol use, the present study investigated drinking motives and drinking situations in an undergraduate sample (N = 293). Social anxiety was significantly correlated with endorsement of enhancement drinking motives (i.e., drinking to enhance positive experiences or emotions) but not social or coping motives. Social anxiety was also correlated with endorsement of drinking in the following high-risk situations: unpleasant emotions, conflict with others, social pressure, and testing personal control. Importantly, enhancement motives and each of these drinking situations mediated the relationship between social anxiety and alcohol-related problems. Findings suggest that alcohol use to enhance positive affect or in response to these specific situations may account for the risk for alcohol-related problems among those with social anxiety.     

Self-Assessed Risk of HIV and Other STIs Among Young Adults in Norway and Croatia

The purpose of the present study is to explore how sexually active young Norwegian and Croatian adults assess the risk of being infected with HIV and other STIs. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18–24 in Croatia (n = 1,005) and Norway (n = 871). A majority of sexually active young adults in Croatia and Norway assessed the risk of becoming infected with HIV or other STIs as low or negligible. Among non-condom users, 85–98% determined they had low or no risk of getting infected with HIV. The corresponding figures for STIs were 77–79%. In both countries a higher HIV risk self-assessment was observed among those who had had same-sex sexual experience, those who reported a higher number of sex partners during the past year, and those who were single. When investigating the patterns of HIV/STI risk assessment, gender and country-related differences appeared. Condom use associated with higher risk assessment was significant only among Croatian men. The strong perception of condom use as being a male responsibility in Croatia may be the reason for a higher risk assessment for unwanted pregnancy and HIV/STIs when protection fails. The risk assessment for HIV/STIs was not associated with partner turnover in Croatian men. New campaigns need to develop gender-sensitive messages, particularly targeting men who believe that a great number of sexual partners is a sign of manliness and women who shy away from their responsibility to use protection.     

The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents

Adolescents, particularly African American adolescents, are at high risk for sexually transmitted infections (STIs). The association between psychosocial factors and risky sexual behavior has been well established. However, only a small number of studies have examined the relationship between depressive symptomatology among African American female adolescents, specifically over time. The present study examined depressive symptoms as a predictor of risky sexual behavior, sexual communication, and STIs longitudinally among African American female adolescents between the ages 15 and 21. Binary generalized estimating equation models were conducted assessing the impact of depressive symptoms at baseline on risky sexual behavior and STIs over six- and 12-months follow-up. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high levels of depressive symptoms predicted no condom use during last sexual encounter and multiple sexual partners over six-months follow-up. Depressive symptoms also predicted having a main partner with concurrent partners, high fear of communication about condoms, and sex while high on alcohol or drugs over six- and 12-months follow-up. These findings could be used to inform HIV/STI prevention intervention programs and clinicians providing regular health care maintenance to African American female adolescents engaging in risky sexual behavior.     

Mental health correlates of HIV risk behaviour and STIs/HIV infection among university students from 22 low,middle and high income countries

The aim of this study was to determine mental health correlates of HIV risk behaviour and self-reported STIs/HIV infection among university students in 22 low, middle and high income countries. Data on mental health and HIV risk were collected from 16 567 undergraduate university students (mean age 20.9, SD = 2.9) from 23 universities in 22 countries across Asia, Africa and the Americas. Results indicate that overall 16.8% of the students had two or more sexual partners in the past 12 months, and among the sexually active, 73.7% had inconsistently used a condom in the past three months with their primary sexual partner, 3.2% had ever been diagnosed with a sexually transmitted infection (STI) and 0.6% had been diagnosed with HIV. In multivariate logistic regression poorer mental health and child abuse (physical and sexual) were associated with HIV risk behaviour, and child abuse (physical and sexual) was associated with STI and HIV positive diagnoses.     

Verbal Sexual Coercion Experiences,Sexual Risk,and Substance Use in Women

Research has linked sexual assault, substance use, and sexually transmitted infection (STI) risk in women. Sexual assault by means of verbal sexual coercion (VSC) is more common than sexual assault by means of physical tactics, but VSC is rarely assessed independently. In addition, past work has established global connections among substance use, sexual assault history, and STI risk; however, assessing substance use during sexual behavior is less common. This study examined the relations among VSC, STI risk behavior, and substance use and attitudes. We hypothesized that women with larger numbers of VSC experiences would report more frequent sexual risk behaviors and substance use and attitudes. Participants with larger numbers of VSC experiences reported larger numbers of anal sex partners, more frequent penile–vaginal sex and sexual activity after substance use, and stronger sex-related alcohol expectancies. These findings suggest that VSC is associated with higher levels of STI risk in women.     

Condoms,Sex, and Sexually Transmitted Diseases: Exploring Sexual Health Issues Among Asian-Indian College Students

Sexually transmitted infections (STIs) continue to pose a serious risk to college students in the US. According to the Centers for Disease Control, the highest rates of STIs are among college students and adolescents. Specifically regarding Asian-Indian students, more research is needed to thoroughly understand the knowledge, attitudes and sexual behaviors of this population. A comprehensive review of the literature found a paucity of studies involving Asian-Indian involvement in sexual activity. Therefore, the present study was undertaken to fill gaps in the research. The present study examined Asian-Indian college students’ involvement in sexual behaviors, overall STI knowledge, condom use rate, perceived benefits and barriers to condom use, and history of STIs and STI testing. A five page survey was completed by 122 Asian-Indian college students. Results indicated that overall STI knowledge was low. Females, students who perceived fewer barriers to condom use and students who had lived in the US for at least 3 years held significantly higher STI knowledge levels than their counterparts. Such findings could be used by community and university-based health educators to more effectively serve the needs of Asian-Indian students.     

Transmission risk behaviors in a subset of HIV-positive individuals: The role of narcissistic personality features

Most people living with HIV/AIDS (PLWHA) take steps to protect their sexual partners. However, a minority of PLWHA continue to engage in sexual risk behaviors that might contribute to the transmission of HIV. Psychiatric conditions, including certain pathological traits, are associated with sexual risk behaviors. Research examining the association between narcissistic traits as they relate to HIV transmission risk is limited. In the present study, 303 PLWHA were recruited from an infectious disease clinic and completed questionnaires assessing narcissistic characteristics, substance use, sexual risk behavior, and intentions to use condoms in the future. Narcissistic traits predicted unprotected sex with partners who are HIV-negative or whose HIV status was unknown as well as lower intentions to use condoms, after controlling for demographic factors and substance use. Interventions focused on reducing the transmission of HIV should take into account associations between sexual risk behavior and narcissism.     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Social support,self-esteem and depression: Relationship with risk for sexually transmitted infections/HIV transmission

Sexually transmitted infections (STIs) and HIV are important health problems that affect adolescents. The aim of the present study was to analyze the relationship between 1) depression, self-esteem and perceived social support and 2) sexual risk behaviors according to gender. The sample used in this ex post facto study was composed of 1,005 adolescents of both sexes aged between 14 and 18 years. Participants completed several questionnaires in the classrooms of their secondary education schools. The questionnaires assessed depression, self-esteem and perceived social support and recorded information on sexual behavior and socio-demographic issues. Results showed that, among males, self-esteem predicted higher vaginal risk, depression was related to higher vaginal, anal and oral sexual risk, and perceived support from the family predicted lower vaginal and anal sexual risk. Among females, self-esteem was found to be associated with lower anal sexual risk and perceived support from friends predicted lower anal and oral sexual risk. The study highlights the importance of considering family and friends as well as gender differences in the prevention of STIs/HIV.     

Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis.

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.     

Neighborhood Environment, Sexual Risk Behaviors and Acquisition of Sexually Transmitted Infections Among Adolescents Diagnosed with Psychological Disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.     

Sexual Health Risk Behaviors Among Older Men Who Have Sex With Men: Implications for Interventions

Sexual health risk behaviors, HIV and sexually transmitted infection (STI) transmission, substance use, stigma, and loneliness among older men who have sex with men are discussed. Implications for interventions are provided, including (a) assessment of health‐related risk behaviors, (b) brief interventions, (c) HIV and STI screening, and (d) relevant developmental and contextual factors.     

Unpacking Social Avoidance and Substance Use in Social Anxiety: Does Extraversion Explain Behavior Variability?

Social anxiety is characterized by heightened fear and anxiety associated with social situations, resulting in the use of avoidance behaviors. Contemporary models suggest that some individuals with social anxiety may choose to completely avoid social situations, while others may seek social connections and interactions and utilize avoidance behaviors such as substance use as a means of distress tolerance, while engaging in these situations. Our aim is to test a theoretical model whereby extraversion could help to explain the heterogenous nature of social anxiety in relation to these behaviors. Lower levels of extraversion have been commonly associated with withdrawal behaviors and higher levels of extraversion have been associated with behaviors commonly enacted in social situations. Understanding factors which predict the use of one behavior over another is imperative to the conceptualization and successful treatment of patients with social anxiety. A sample of 195 college students completed self-report measures and a 10-day experience sampling diary with five diary signals each day. Participants were asked to rate their current negative emotions and behaviors during each diary signal. Using a multilevel modeling approach, we tested the association between social anxiety symptoms and negative affect predicting engagement in substance use or social avoidance and tested whether extraversion moderated this association. Negative affect was included as a covariate given the established associations between elevations in negative affect predicting both behaviors. Results indicated that higher levels of social anxiety symptoms and negative affectivity increased the probability of social avoidance and substance use, and extraversion was a significant predictor for only substance use. Moderation analysis indicated that extraversion moderated the relationship between social anxiety and substance use, suggesting a stronger positive relationship between substance use and social anxiety for individuals higher in extraversion. However, extraversion was not a significant moderator between social anxiety and social avoidance. Overall, the findings suggest that extraversion could be a key factor predicting the use of substances amongst individuals with social anxiety and may need further consideration in treatment.

     

Family‐Based HIV and Sexually Transmitted Infection Risk Reduction for Drug‐Involved Young Offenders: 42‐Month Outcomes

This study tested a family‐based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug‐involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two‐site community‐based trial was conducted with 154 youth and their parents. Drug‐involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42‐month follow‐ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family‐based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42‐month follow‐up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9‐month follow‐ups. These intervention differences were evident through the 42‐month follow‐up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group‐based and family intervention in detention and following release may reduce sexual risk among substance‐involved young offenders, and a family‐based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.     

Nationwide survey of contraceptive and sexually transmitted infection knowledge,attitudes and skills of university students in Portugal

Sexually transmitted infections and (STIs) unintended pregnancies are contemporary public health concerns. Understanding factors (e.g. knowledge, attitudes and skills) influencing sexual behaviours of university students are critical to develop targeted and tailored risk-reduction interventions for this vulnerable population. Thus, the goals of this study were to describe sexual behaviours and analyze differences between genders for sexual behaviours; to identify whether differences exist between genders and age groups regarding knowledge, attitudes and skills concerning contraceptive methods and STIs, and to evaluate the association of knowledge with attitudes and skills with sexual behaviour among university students in Portugal. The sample included 3278 students. Results show that the majority were sexually active and use condoms and oral contraceptives. In general, university students have high knowledge, positive attitudes and skills about contraception and STIs. Gender analyses indicated that women had greater knowledge, and more favourable attitudes, and higher skills toward contraceptive and STI preventive behaviour College students, in particular, face new challenges in sexual health and would benefit from more comprehensive education aimed at promoting healthy decision-making about family planning and STI prevention.     

Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors

Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention models may not address psychological complexities among adolescents with mental illnesses. This study examined contextual factors related to HIV/STI risk among heterosexually active Black adolescents with mental illnesses to inform the development of targeted HIV/STI prevention strategies. Black adolescent males and females (aged 14–17) were recruited from outpatient mental health programs in Philadelphia, PA to complete a computer-assisted personalized interview on sociodemographics, sexual behaviors, and emotion regulation (N?=?53). Two sample t-tests, Wilcoxon Rank Sum tests and regression modeling were used to examine differences in the study measures by gender and relationship status. Reports of sexual partner concurrency were high—both while already in a sexual relationship (67.3%) and multiple sexual partners in the same day (42.3%). Boys reported significantly more risk behaviors than girls. Sadness dysregulation predicted currently being in a relationship, older age at first oral sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters. Coping difficulties predicted a greater number of vaginal and oral sexual partners, and a lower age at first vaginal sex. Increasing depression severity was related to older age at first vaginal sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters in the past 3 months. This formative work suggests that coping mechanisms should be addressed in HIV/STI prevention research through the inclusion of activities targeted toward emotion regulation and decreasing sexual risk behaviors. Psycho-education and skills building may mitigate the psychopathology that contributes to HIV/STI risk in the target demographic.     

Is it Too Soon to Meet? Examining Differences in Geosocial Networking App Use and Sexual Risk Behavior of Emerging Adults

Location-based geosocial networking smartphone applications (GSN apps) have become a popular way to meet romantic and casual sex partners. Although first used primarily by men who have sex with men (MSM), GSN apps are now commonly used in the population at large, particularly among emerging adults. Although, these apps may potentially contribute to increases in STI/HIV incidence, previous research linking GSN app use to sexual risk behavior has been mixed, with some suggesting app users report greater sexual risk behavior and others suggesting less. The present paper details findings of two studies with independent samples of emerging adults. The first, a pilot study, examined GSN app use among young MSM (n = 64) to identify possible within-group factors relating dating app use to sexual risk behavior. Results indicated that the time app users spent talking to each other through the app before meeting in person (time before meeting) was related to engagement in sexual risk behavior. Those who talked less before meeting in person engaged in more sexual risk behaviors than those who spent more time talking before meeting in person. The second study sought to expand upon this finding in a more representative sample of GSN app users (n = 129) and compared sexual risk behavior and impulsivity to non-users (n = 88). There were no differences in sexual risk behavior between GSN app users and non-users. However, when examining app users by time before meeting, those with a shorter time before meeting were more impulsive and more likely to report sexual risk behavior. These findings highlight the importance of understanding GSN app use in the spread of STIs/HIV among emerging adults.