Julianne M. Serovich

Psychological reactance and HIV-related stigma among women living with HIV

ABSTRACT Psychological reactance is defined as the drive to re-establish autonomy after it has been threatened or constrained. People living with HIV may have high levels of psychological reactance due to the restrictions that they may perceive as a result of living with HIV. People living with HIV may also exhibit levels of HIV-related stigma. The relationship between psychological reactance and HIV-related stigma is complex yet understudied. Therefore, the main aim of this study was to examine the association between psychological reactance and HIV-related stigma among women living with HIV. Data were obtained from one time-point (a cross-sectional assessment) of a longitudinal HIV disclosure study. Psychological reactance was measured using the 18-item Questionnaire for the Measurement of Psychological Reactance. HIV-related stigma was measured using the HIV Stigma Scale, which has four domains: personalized, disclosure concerns, negative self-image, and concerns with public attitudes. Principal component analysis was used to derive components of psychological reactance. Linear regression models were used to determine the association between overall psychological reactance and its components, and stigma and its four domains, and depressive and anxiety symptoms. The associations between stigma and mental health were also examined. Three components of psychological reactance were derived: Opposition, Irritability, and Independence. Overall psychological reactance and irritability were associated with all forms of stigma. Opposition was linked to overall and negative self-image stigma. Overall psychological reactance, opposition, and irritability were positively associated with anxiety symptoms while opposition was also associated with Centers for Epidemiologic Studies-Depression depressive symptoms. There were also positive associations between all forms of stigma, and depressive and anxiety symptoms. Health-care providers and counselors for women living with HIV addressing feelings of irritability and opposition toward others may reduce HIV-related stigma. Future research should examine the link between psychological reactance, mental health, and HIV-related stigma among other populations living with HIV.

Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV

Sexual compulsivity is operationalized by engaging in repetitive sexual acts, having multiple sexual partners and/or the excessive use of pornography. Outcome expectancy refers to the beliefs about the consequences of engaging in a given behavior. Research examining the relationship between outcome expectancy and sexual compulsivity is limited. The aim of this study was to assess the association between outcome expectancy and sexual compulsivity among men who have sex with men (MSM) living with HIV. Data were obtained from 338 MSM. Simple and multiple linear regression models were used to assess the association between outcome expectancy and sexual compulsivity. After adjusting for age, race/ethnicity, income, education, and employment status, for every one point increase in outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices, there was, on average, an approximate one point decrease in sexual compulsivity score. Prevention and intervention programs geared towards reducing sexual compulsivity among MSM should focus on increasing outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices.ResumenLas características de la compulsividad sexual incluyen actos sexuales repetitivos, múltiples parejas sexuales y el uso excesivo de la pornografía. El resultado esperado se refiere a las creencias sobre las consecuencias de envolverse en un comportamiento específico. Los estudios que examinan la relación entre el resultado esperado y la compulsividad sexual son limitados. El objetivo de esta investigación fue evaluar la asociación entre el resultado esperado y la compulsividad sexual entre los hombres que tienen sexo con hombres (HSH) viviendo con VIH. Los datos fueron obtenidos de 338 HSH. La asociación entre el resultado esperado y la compulsividad sexual fue evaluada con un análisis de regresión lineal sencilla y múltiple. Después de ajustar por la edad, la raza/etnicidad, el ingreso, la educación, y el estado de empleo, por cada punto de incremento en los resultados esperados en el área del uso del condón, divulgación de tener el VIH y negociación de prácticas sexuales seguras, hubo aproximadamente un punto de reducción en la puntación de la compulsividad sexual. Los programas de prevención e intervención para reducir la compulsividad sexual entre HSH deberían enfocarse en el aumento de los resultados esperados relacionados con el uso de condones, la divulgación de tener el VIH, y la negociación de las prácticas sexuales seguras.

Psychometric Evaluation of the HIV Disclosure Belief Scale: A Rasch Model Approach

This study provides psychometric assessment of an HIV disclosure belief scale (DBS) among men who have sex with men (MSM). This study used baseline data from a clinical trial evaluating the effectiveness of an HIV serostatus disclosure intervention of 338 HIV-positive MSM. The Rasch model was used after unidimensionality and local independence assumptions were tested for application of the model. Results suggest that there was only one item that did not fit the model well. After removing the item, the DBS showed good model-data fit and high item and person reliabilities. This instrument showed measurement invariance across two different age groups, but some items showed differential item functioning between Caucasian and other minority groups. The findings suggest that the DBS is suitable for measuring the HIV disclosure beliefs, but it should be cautioned when the DBS is used to compare the disclosure beliefs between different racial/ethnic groups.

Relationship between serostatus disclosure and categories of HIV transmission risk in men who have sex with men living with HIV

In prior studies, the relationship between serostatus disclosure and reduced HIV transmission risk has been mixed. The demonstration of a clear connection may be restricted by three main methodological limitations. This study evaluates the relationship between (1) more refined measures of serostatus disclosure and (2) eight categories of HIV transmission risk (lowest to highest risk) among men who have sex with men (MSM) living with HIV, while (3) considering a number of control variables. Results demonstrate that disclosure is more likely in sexual encounters involving no intercourse or involving protected and unprotected anal intercourse with HIV-positive partners than unprotected insertive anal intercourse with HIV-negative/unknown status partners. Additionally, substance use prior to sexual encounters is less likely in lower risk categories than the highest risk category. Results of this study are important to the design of future studies, prevention, and intervention programs for MSM and to the methods used to evaluate their effectiveness.

Age and racial disparities in substance use and self-reported viral suppression among men who have sex with men with HIV

HIV disproportionately affects men who have sex with men (MSM). Substance use is common among people living with HIV and may affect antiretroviral therapy adherence. Nevertheless, research examining the association between substance use and viral suppression is lacking. The aims of this study were to determine the association between substance use and self-reported viral suppression, and by age and race among MSM living with HIV. Data were obtained from 309 HIV-positive MSM. Logistic regression was used to determine the association between substance use and self-reported viral suppression at baseline, and by age and race. Approximately 67% of participants reported they were virally suppressed. After adjusting for sociodemographics, every increase in substance use score was associated with a 7% decrease in the odds of reporting viral suppression (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.89–0.98; p = 0.003). The negative association between substance use and self-reported viral suppression remained statistically significant among MSM aged 25–34 years (OR = 0.89; 95% CI: 0.79–1.00; p = 0.041) and statistically significant for Black MSM (OR = 0.92; 95% CI: 0.86–0.98; p = 0.009). Intervention programs for MSM living with HIV aimed at improving viral suppression should address substance use and consider the differences by age and race.

Assessment of HIV disclosure and sexual behavior among Black men who have sex with men following a randomized controlled intervention

Disclosure is important in human immunodeficiency virus (HIV) transmission risk reduction. This randomized controlled intervention assessed changes in and predictors of disclosure and risky sexual behavior among Black men who have sex with men (BMSM) living with HIV in the U.S. BMSM were randomly assigned to either the disclosure intervention or attention control case management group. Predictors of three disclosure types (behavior, beliefs, intentions) and condomless anal intercourse (CAI) included disclosure consequences (rewards and costs), disclosure readiness, and safer sex readiness. Mixed-effect results showed no differences between the groups in any of the outcomes; although disclosure behavior increased over time. Relationships were found between readiness to change and CAI; disclosure consequences and different disclosure types; and disclosure behavior and receptive CAI. When working with BMSM living with HIV, practitioners and prevention specialists should consider the importance of disclosure pertaining to receptive CAI and factors that support overall disclosure and safer sex.

Vengeance, sexual compulsivity and self-efficacy among men who have sex with men living with HIV

ABSTRACT Vengeance is defined as a continuum of thoughts and/or actions ranging from harmless thoughts to destruction or death, due to feelings of hurt or anger, as a result of a perceived personal attack. Studies assessing the association between vengeance and HIV risk behavior are extremely lacking. The primary aims of this study were to examine the associations between vengeance and sexual compulsivity (SC), and self-efficacies (SEs) for condom use, HIV disclosure, and negotiation of safer sex practices. Data were obtained from 266 men who have sex with men (MSM) living with HIV. Simple and multiple linear regression were used to explore the associations between vengeance, SC and SE. After adjusting for sociodemographic and HIV-related factors, there was a negative association between vengeance and SE for HIV disclosure: (most vengeful: β = −1.49; 95% CI: −2.40, −0.58; more vengeful: β = −1.17; 95% CI: −2.12, −0.22; vengeance (continuous: β = −0.03; 95% CI: −0.05, −0.01). Intervention programs geared towards improving SE for HIV disclosure among MSM living with HIV should endeavor to reduce vengeful feelings.

Perceived intentional transmission of HIV infection, sustained viral suppression and psychosocial outcomes among men who have sex with men living with HIV: a cross-sectional assessment

Objective HIV continues to be a global and national public health challenge, and men who have sex with men (MSM) are disproportionately affected in the USA. Transmission of HIV is intentional if the person living with HIV knows about his/her serostatus, acts with the intention to and actually transmits HIV. Research on intentional transmission of HIV infections is lacking, and the relationships between perceived intentional transmission, viral suppression and psychosocial outcomes have not been assessed. The objective of this study was to investigate the association between perceived intentional transmission of HIV, sustained viral suppression and psychosocial outcomes. Methods Data were obtained from 338 MSM living with HIV who participated in a disclosure intervention study. Logistic and linear regression models were used to assess the associations between perceived intentional transmission and viral suppression, condomless anal intercourse in the past 30 days, being at risk for clinical depression, substance use, self-efficacies for condom use, HIV disclosure and negotiation of safer sex practices, and sexual compulsivity. Results 44% of the study population reported perceiving intentional HIV transmission. After adjusting for sociodemographic characteristics, men who thought that they were infected intentionally had 69% higher odds (adjusted OR: 1.69; 95% CI 1.01 to 2.83) of being at risk for clinical depression, and on average, scored approximately 3 points and 4 points higher on depressive symptoms and sexual compulsivity, respectively (adjusted β: 3.29; 95% CI 0.42 to 6.15; adjusted β: 3.74; 95% CI 1.32 to 6.17) compared with men who did not think that they were intentionally infected. After adjusting for confounders, there was no statistically significant association between perceived intentional transmission and viral suppression. Conclusions Intervention programmes for MSM living with HIV who thought they were infected intentionally are warranted and should aim to attenuate depressive symptoms and sexual compulsivity.