Lance M. Pollack

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.

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.

Disclosing Hiv seropositivity to significant others

ObjectivesTo examine gay mens patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals. DesignLongitudinal questionnaire survey of gay men. MethodsA total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being. ResultsHIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection. ConclusionWhile disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

EFFECTS OF INTERVIEWER GENDER, INTERVIEWER CHOICE, AND ITEM WORDING ON RESPONSES TO QUESTIONS CONCERNING SEXUAL BEHAVIOR

The authors examined factors influencing responses to questions on sexual behavior among adult respondents 18-49 years old (unweighted N = 2,030) obtained through a random-digit dialing survey. Based on self-disclosure and perceived control theory, they hypothesized that giving people a choice in selecting the gender of their interviewer rather than being assigned an interviewer, and using questions that are supportive of what may be perceived of as nonnormative behavior (enhanced items), would increase data quality relative to, respectively, matched-or opposite-gender interviewer conditions and standard worded items. The enhanced items facilitated responding to a number of sensitive topics. However, the effects of item wording on item response are often mediated by interviewer conditions. The choice results suggest that giving respondents greater control decreases question threat. However, the overall findings argue for matching respondents and interviewers on gender over opposite-gender interviewers or allowing respondents to select their interviewers gender. Wording and interviewer manipulations reduced the discrepancies between mens and womens self-reports of sexual behavior, but they did not eliminate them, and in some cases they had no effect. The present findings suggest that males tend to be influenced by variations in item wording, interviewer gender, and respondent control across a somewhat wider range of sexual topics. In general, the findings recommend matching respondents and interviewers on gender and the use of more supportive wording in sexual behavior questions. However, for assessment of some topics (e.g., sexual violence) in particular segments of the population (e.g., men), other procedures, such as increasing respondent control, may be a better choice. Overall, the data support the view that in terms of preferred procedures, not all sexual topics are created equal

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.

Stress, coping, and high-risk sexual behavior.

We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping ones feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.

Disparities in Smoking Between the Lesbian, Gay, and Bisexual Population and the General Population in California

OBJECTIVES We conducted a large, population-based study to assess tobacco use in Californias lesbian, gay, and bisexual (LGB) population. METHODS Standard measures of tobacco use from 2 separate, statewide household-based studies were used to compare basic prevalence rates in the LGB population and the general population in California. Data were derived from a 2003-2004 survey of LGB individuals living in California as well as from the 2002 version of the California Tobacco Survey, which gathered data on the states general population. RESULTS Smoking prevalence rates were higher in our sample of lesbians, bisexual women, and women who have sex with women than among women in the general California population. In the case of men, the only significant difference was that rates were higher among gay men than among men in the general population. Disparities in tobacco use between the LGB population and the general population were still evident after we controlled for key demographic variables and in comparisons with other tobacco use indicators such as average cigarette consumption. CONCLUSIONS Tobacco control efforts targeting the LGB population are needed to reduce this groups high rate of cigarette smoking.

Longitudinal predictors of reductions in unprotected anal intercourse among gay men in San Francisco: the AIDS Behavioral Research Project.

Predictors of unprotected anal intercourse were examined among 508 gay men in San Francisco. The cohort was recruited in 1983-84 at which time 49.8 percent of non-monogamous men (N = 435) and 71.2 percent of monogamous men (N = 73) reported practicing unprotected anal intercourse. Only 12 percent of non-monogamous and 27.4 percent of monogamous men reported these practices in 1988. The non-monogamous men who practiced unprotected anal intercourse in 1984 were more likely to be younger, to report that unprotected anal intercourse was their favorite sexual activity, to be low in perceived efficacy to change sexual behavior, to report that friends were more likely to engage in high-risk behaviors, to have less knowledge of health guidelines, and to be less depressed at that time. Non-monogamous individuals who in 1984 reported that unprotected anal intercourse was their favorite sexual activity were more likely to practice that behavior in 1988. Those who knew their serostatus as positive were less likely to report unprotected anal intercourse in 1988. These data infer that in order to modify AIDS-related high-risk behaviors, community risk-reduction programs be differentially aimed at young persons so as to increase personal efficacy about risk reduction, challenge peer norms, promote antibody testing, and eroticize safer sexual activities.