Joseph A. Catania

Towards an Understanding of Risk Behavior: An AIDS Risk Reduction Model (ARRM)

This report presents a three-stage model (ARRM) that characterize peoples efforts to change sexual behaviors related to HIV transmission. ARRM focuses on social and psychological factors hypothesized to influence (1) labeling of high risk behaviors as problematic, (2) making a commitment to changing high risk behaviors, and (3) seeking and enacting solutions directed at reducing high risk activities. The proposed model integrates important concepts from prior behavioral medicine and human sexuality stud ies, specifies their differential import to achieving the goals associated with each stage of the model, and denotes factors hypothesized to influence peoples motivation to con tinue the change process over time. Current findings are discussed within this three-stage model and directions for further research are suggested. Recent findings from our ongoing studies of gays and heterosexuals in San Francisco are presented.

Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men

OBJECTIVES We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). METHODS We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. RESULTS Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. CONCLUSIONS AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men : The Urban Men's Health Study

OBJECTIVE The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.

Battering Victimization Among a Probability-Based Sample of Men Who Have Sex With Men

OBJECTIVES This study measured the prevalence of battering victimization (i.e., experience of psychological/symbolic, physical, and sexual battering) among men who have sex with men (MSM) and identified characteristics of these men. METHODS A probability-based sample of 2881 MSM living in 4 cities completed telephone interviews between 1996 and 1998. RESULTS Prevalence estimates were 34% for psychological/symbolic battering, 22% for physical battering, and 5% for sexual battering. The strongest demographic correlate independently associated with all forms of battering was age 40 or younger, whereas education and HIV serostatus were associated with physical and psychological/symbolic violence. CONCLUSIONS Rates of battering victimization among urban MSM are substantially higher than among heterosexual men and possibly heterosexual women. Public health efforts directed toward addressing intimate partner battering among these men are needed.

Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study.

We examined the prevalence and correlates of condom use in a community-based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use.

Differential HIV Risk in Bathhouses and Public Cruising Areas

OBJECTIVES This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both. METHODS We used a probability sample of MSM residing in 4 US cities (n = 2,881). RESULTS Men who used party drugs and had unprotected anal intercourse with nonprimary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely to report risky sex in public settings. CONCLUSIONS Distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission.

Suicide Attempts Among Gay and Bisexual Men: Lifetime Prevalence and Antecedents

OBJECTIVES We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). METHODS A telephone probability sample of US urban MSM (n = 2881) were interviewed between November 1996 and February 1998. RESULTS Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. CONCLUSIONS MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.

A test of the AIDS Risk Reduction Model: Psychosocial correlates of condom use in the AMEN cohort survey.

We examined the AIDS Risk Reduction Model (J. Catania, S. Kegeles, & T. Coates) in a sample of unmarried heterosexual adults with an HIV risk factor (n = 716). Labeling ones sexual behavior as risky was associated with having a history of sexually transmitted diseases, particularly genital herpes, and fewer stereotypic health beliefs. For people with secondary sexual partners, greater condom commitment was related to increased labeling, supportive condom norms, and greater enjoyment, and high levels of condom use were related to greater condom commitment, supportive norms, greater enjoyment, and health protective sexual communication. For people with primary partners, greater condom commitment was correlated with increased supportive condom norms, greater enjoyment, and having genital herpes, and high levels of condom use were correlated with greater condom commitment, greater enjoyment, and health protective sexual communication.

Prevalence and Social Distribution of Men Who Have Sex with Men: United States and Its Urban Centers

Prevalence data on the social distribution and AIDS‐related risk behavior of men who have sex with men are presented from two national probability surveys [General Social Survey (GSS) and National Health and Social Life Survey (NHSLS)] and a probability survey of urban centers in the U.S. [National AIDS Behavioral Surveys (NABS)]. Men residing in large cities, the highly educated, and Whites were more likely to report sex with men. In the urban sample (NABS), one third reported sex with women. In addition, minority men were more likely to report sex with men and women. More than half of the men with an HIV risk factor reported consistent condom use. The surveys were based on two different modes of interviewing (self‐administered and telephone), conducted independently of each other and by different organizations. The prevalence estimates from these surveys are consistent with each other and with other population‐based surveys in the United States and Europe. We discuss these data in light of the ongoing d...

Recalling sexual behavior: a methodological analysis of memory recall bias via interview using the diary as the gold standard

This study examined the effect of time lag on the validity of retrospective self‐reports of sexual behavior. Seventy‐five heterosexual students (44 women, 31 men) made daily recordings of sexual behavior, condom use, and alcohol or substance use for 1 month. Ability of respondents to recall sexual behavior recorded during this period was assessed at 1, 2, and 3 months after diary completion using recall interviews (25 interviewed at each interval). For vaginal intercourse, total recall error was significantly greater at 3 months than at 1 month post‐diary. For all other variables assessed, the 2‐ and 3‐month time intervals did not produce significant increases in total recall error. Higher frequency of vaginal intercourse, orgasm, and alcohol use prior to sexual activity were associated with total recall error for some but not all behaviors and outcomes. The results provide a partial validation of the diary‐interview recall model as a method for studying recall error.