HIV-seropositive men who engage in high-risk sexual behaviour: Psychological characteristics and implications for prevention

Abstract

A minority of people who test HIV seropositive continue to engage in sexual behaviour that places their partners at high risk for HIV infection. However, little is known about factors that contribute to sexual risk behaviour among. HIV-seropositive men. In this study, HIV-seropositive men participating in substance abuse support groups and HIV prevention programmes (n = 223) completed measures of demographic characteristics, sexual behaviour history, sensation-seeking (the propensity to seek optimal stimulation), and sexual compulsivity (persistent sexual preoccupations). Twenty-six per cent of the sample reported having recent multiple unprotected sexual intercourse partners. Across support group and prevention programme participants, men with multiple unprotected partners reported greater sexual compulsivity than men with one or no unprotected partners, but groups did not differ in terms of sensation-seeking. Results suggest that intensive therapeutic interventions are needed for a relatively small number of people who may contribute significantly to the HIV epidemic.

Psychosocial and Behavioral Predictors of Partner Notification After HIV and STI Exposure and Infection Among MSM

“…Prior empirical research has shown that psychosocial risk factors such as depression, PTSD, and substance use play a role in STI/HIV acquisition and transmission (Cooper 1992;Donovan and McEwan 1995;Kalichman et al 2004;Leigh and Stall 1993;Plankey et al 2007;Rein et al 2004;Rosario et al 2006;Stall et al 2003) and individuals scoring higher on measures of psychological distress are more likely to engage in behavior that puts them at risk for HIV and STIs (Hutton et al 2004;Kalichman et al 1997;Kelly et al 1993;Rein et al 2004). Research also suggests that people with high levels of psychological distress tend to use avoidant-oriented coping strategies (for example, substance use or withdrawal) to manage stressful situations (Penedo et al 2003).…”

Prevention for HIV-Seropositive Persons

“…Use of substances and sexual risk were linked over time among young people living with HIV (Rotheram-Borus, Lee, et al, 2000). Substance use has also been associated with continued patterns of high-risk sex among HIV-positive adults (Edlin, et al, 1994;Kalichman, Greenberg, & Abel, 1997;Kelly et al, 1993). Substance use among HIV-positive persons also appears linked to depressive symptoms and disorders (S. R. Friedman, Wiebel, Jose, & Levin, 1993;Rotheram-Borus, Murphy, et al, 2000), a factor related to both increased sexual risk and lower health adherence (L. N. Friedman, Williams, Singh, & Frieden, 1996).…”

Effective Detection of HIV

“…Third, a protocol for publicly funded HIV counseling and testing in the United States has been broadly implemented (9,10). Fourth, HIV counseling and testing appear to be effective intervention strategies for seropositive persons (11)(12)(13)(14)(15)(16)(17)(18). Many persons who are aware of being HIV-seropositive reduce their risk acts substantially compared with those who test HIV-seronegative (18); fewer than 50% (typically only one third) of seropositive persons continue to engage in risk acts (16,(19)(20)(21).…”

“…Fourth, HIV counseling and testing appear to be effective intervention strategies for seropositive persons (11)(12)(13)(14)(15)(16)(17)(18). Many persons who are aware of being HIV-seropositive reduce their risk acts substantially compared with those who test HIV-seronegative (18); fewer than 50% (typically only one third) of seropositive persons continue to engage in risk acts (16,(19)(20)(21). The most consistent evidence of risk reduction subsequent to HIV counseling and testing has been documented among serodiscordant couples (18); rates of transmission have been reduced among heterosexual couples in San Francisco (22) and Rwanda (23), and in gay male couples in New York City (24).…”