Laura Widman

Serostatus disclosure to sexual partners among people living with HIV: Examining the roles of partner characteristics and stigma

Abstract HIV serostatus disclosure among people living with HIV/AIDS (PLWHA) is an important component of preventing HIV transmission to sexual partners. Due to barriers like stigma, however, many PLWHA do not disclose their serostatus to all sexual partners. This study explored differences in HIV serostatus disclosure based on sexual behavior subgroup (men who have sex with men [MSM]; heterosexual men; and women), characteristics of the sexual relationship (relationship type and HIV serostatus of partner), and perceived stigma. We examined disclosure in a sample of 341 PLWHA: 138 MSM, 87 heterosexual men, and 116 heterosexual women who were enrolled in SafeTalk, a randomized, controlled trial of a safer sex intervention. We found that, overall, 79% of participants disclosed their HIV status to all sexual partners in the past 3 months. However, we found important differences in disclosure by subgroup and relationship characteristics. Heterosexual men and women were more likely to disclose their HIV status than MSM (86%, 85%, and 69%, respectively). Additionally, disclosure was more likely among participants with only primary partners than those with only casual or both casual and primary partners (92%, 54%, and 62%, respectively). Participants with only HIV-positive partners were also more likely to disclose than those with only HIV-negative partners, unknown serostatus partners, or partners of mixed serostatus (96%, 85%, 40%, and 60%, respectively). Finally, people who perceived more HIV-related stigma were less likely to disclose their HIV serostatus to partners, regardless of subgroup or relationship characteristics. These findings suggest that interventions to help PLWHA disclose, particularly to serodiscordant casual partners, are needed and will likely benefit from inclusion of stigma reduction components.

Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis

IMPORTANCE Parent-adolescent sexual communication has received considerable attention as a factor that can positively affect safer sex behavior among youth; however, the evidence linking such communication to youth contraceptive and condom use has not been empirically synthesized. OBJECTIVES To examine the effect of parent-adolescent sexual communication on safer sex behavior among youth and explore potential moderators of this association. DATA SOURCES A systematic search of studies published from database inception through June 30, 2014, using the MEDLINE, PsycINFO, and Communication & Mass Media Complete databases and relevant review articles yielded 5098 studies, of which 52 studies with 25,314 adolescents met the study eligibility criteria. Analysis was conducted from July 1, 2014, to July 27, 2015. STUDY SELECTION Studies were included if they sampled adolescents (mean sample age ≤18 years), included an adolescent report of sexual communication with one or both parents, measured safer sex behavior, and were published in English. DATA EXTRACTION AND SYNTHESIS Correlation coefficients (r) and 95% CIs were computed from studies and meta-analyzed using random-effects models. MAIN OUTCOMES AND MEASURES Safer sex behavior, including use of contraceptives or condoms. RESULTS Fifty-two articles, including 71 independent effects representing more than 3 decades of research on 25,314 adolescents (weighted mean age, 15.2 years) were synthesized. Across studies, there was a significant weighted mean effect (r = 0.10; 95% CI, 0.08-0.13) linking parent-adolescent sexual communication with safer sex behavior, which was statistically heterogeneous (Q = 203.50, P < .001, I2 = 65.60). Moderation analyses revealed larger effects for communication with girls (r = 0.12) than boys (r = 0.04) and among youth who discussed sex with their mothers (r = 0.14) compared with their fathers (r = 0.03). Effects did not differ for contraceptive vs condom use or among longitudinal vs cross-sectional studies, indicating that parent sexual communication had a similar effect across study designs and outcomes. Several methodological issues were identified in the literature; future studies can improve on these issues by measuring parent-adolescent communication with robust, multi-item measures, clearly specifying the target parent, and applying multimethod longitudinal designs. CONCLUSIONS AND RELEVANCE Sexual communication with parents, particularly mothers, plays a small protective role in safer sex behavior among adolescents; this protective effect is more pronounced for girls than boys. We discuss the implications for practice and make suggestions for future research on parent-adolescent sexual communication.

Sexual Communication Between Early Adolescents and Their Dating Partners, Parents, and Best Friends

This study assessed early adolescents’ sexual communication with dating partners, parents, and best friends about six sexual health topics: condoms, birth control, sexually transmitted diseases (STDs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pregnancy, and abstinence/waiting. Using a school-based sample of 603 youth (ages 12 to 15; 57% female; 46% Caucasian), we examined communication differences across demographic and developmental factors, tested whether communication with parents and best friends was associated with greater communication with partners, and examined associations between communication and condom use. More than half of participants had not discussed any sexual topics with their dating partners (54%), and many had not communicated with parents (29%) or best friends (25%). On average, communication was more frequent among adolescents who were female, African American, older, and sexually active, despite some variation in subgroups across partner, parent, and friend communication. Importantly, communication with parents and friends—and the interaction between parent and friend communication—was associated with increased communication with dating partners. Further, among sexually active youth, increased sexual communication with partners was associated with more frequent condom use. Results highlight the importance of understanding the broader family and peer context surrounding adolescent sexual decision making and suggest a possible need to tailor sexual communication interventions.

Psychophysiological and neuroendocrine responses to laboratory stressors in women: Implications of menstrual cycle phase and stressor type☆

This study assessed stressor and menstrual phase effects on psychophysiological and neuroendocrine responses to laboratory stressors in freely cycling women (N=78, ages 18-45). Participants performed counterbalanced stressors [Paced Auditory Serial Addition Test (PASAT) or cold pressor test (CP)] during their follicular and luteal menstrual cycle phases between 1:00 and 3:00p.m. to control for cortisol rhythm. Participants rested 30-min, performed the stressor, and then recovered 30-min while electrocardiography continuously monitored heart rate (HR). Systolic (SBP) and diastolic blood pressure (DBP), salivary cortisol, and state anxiety were assessed at timed intervals. HR, SBP, and cortisol varied more over the course of luteal than follicular phase testing. A three-way interaction revealed state anxiety reactivity was greater with the PASAT during the follicular phase. DBP showed equal and persistent reactivity with both stressors during both cycle phases. Results extend the stressor-specific HPAA hypothesis and have important methodological implications for womens biopsychology research.

Sexual narcissism and the perpetration of sexual aggression.

Despite indirect evidence linking narcissism to sexual aggression, studies directly examining this relationship have yielded inconsistent results. Likely contributing to such inconsistencies, prior research has used global measures of narcissism not sensitive to whether the components of narcissism are activated in sexual versus non-sexual domains. The current research avoided such problems by using a measure of sexual narcissism to predict sexual aggression. In a sample of 299 men and women, Study 1 validated the Sexual Narcissism Scale, a new sexuality research instrument with four subscales—Sexual Exploitation, Sexual Entitlement, Low Sexual Empathy, and Sexual Skill. Then, in a sample of 378 men, Study 2 demonstrated that sexual narcissism was associated with reports of the frequency of sexual aggression, three specific types of sexual aggression (unwanted sexual contact, sexual coercion, and attempted/completed rape), and the likelihood of future sexual aggression. Notably, global narcissism was unrelated to all indices of sexual aggression when sexual narcissism was controlled. That sexual narcissism outperformed global assessments of narcissism to account for variance in sexual aggression suggests that future research may benefit by examining whether sexual narcissism and other sexual-situation-specific measurements of personality can similarly provide a more valid test of the association between personality and other sexual behaviors and outcomes (e.g., contraceptive use, infidelity, sexual satisfaction).

The Implications of Sexual Narcissism for Sexual and Marital Satisfaction

There is theoretical reason to believe narcissism is associated with a number of sexual behaviors and outcomes that affect both sexual and relationship satisfaction. Nevertheless, research on the association between personality and behavior demonstrates that personality traits, such as narcissism, only predict behavior in domains that activate the components of the personality system. Given that global assessments of narcissism do not capture the extent to which the components of narcissism are activated in the sexual domain, we examined the extent to which the facets of a domain-specific measure of sexual narcissism accounted for the trajectories of own and partner sexual and marital satisfaction over the first five years of 120 new marriages. Three of the four facets of sexual narcissism (sexual exploitation, sexual entitlement, and low sexual empathy) were negatively associated with both trajectories. The fourth facet (sexual skill) was positively associated with both trajectories. Notably, sexual satisfaction mediated the effect of every facet of sexual narcissism on marital satisfaction. A global assessment of narcissism was not associated with either trajectory of satisfaction. These findings highlight (1) the importance of narcissistic tendencies for sexual processes, (2) the benefits of using domain-specific measures of personality in research on sexual behavior, and (3) the importance of examining the implications of the specific facets of personality constructs.

Sexual Narcissism and Infidelity in Early Marriage

There is theoretical reason to believe that narcissism is associated with infidelity. Yet, studies that have examined this association have yielded inconsistent results. Given that these inconsistencies may have emerged because prior studies used global assessments of narcissism that do not capture the extent to which the components of narcissism are activated in the sexual domain, the current research drew from two longitudinal studies of 123 married couples to examine the extent to which sexual narcissism predicted marital infidelity. Consistent with the idea that narcissism predicts sexual behavior when activated in the sexual domain, own sexual narcissism was positively associated with infidelity, controlling for own marital and sexual satisfaction, own globally-assessed narcissism, partner globally-assessed narcissism, and partner sexual narcissism. Helping to explain why this association emerged, further analyses demonstrated that it was driven by all four facets of sexual narcissism—sexual exploitation, grandiose sense of sexual skill, sexual entitlement (Study 1 only), and lack of sexual empathy (husbands only). Additionally, although partner sexual narcissism was unrelated to infidelity on average, partners’ grandiose sense of sexual skill and partners’ sexual entitlement (Study 2 only) were positively associated with infidelity, and partners’ lack of sexual empathy was negatively associated with infidelity (Study 2 only). These findings highlight the benefits of using domain-specific measures of sexual narcissism in research on sexual behavior and the benefits of using domain-specific measures of personality more generally.

Self-Reported Sexual Assault in Convicted Sex Offenders and Community Men

Although self-reported sexual assault perpetrated by men against women has been well documented among college men, less is known about self-reported perpetration among convicted sex offenders and community men. This study provides unique descriptive and comparative information on sexual assaults in these understudied populations. Participants were 40 convicted sex offenders and 49 demographically comparable community men who completed the Sexual Experiences Survey (SES; Abbey, Parkhill, & Koss, 2005; Koss, Gidycz, & Wisniewski, 1987) and other surveys to capture the promiscuous sex and hostile masculinity pathways posited by the confluence model (Malamuth, 2003). We found notably few differences between sex offenders and community men in the rate and severity of sexual assault perpetration and the tactics used to obtain unwanted sexual contact. Specifically, 68% of sex offenders and 59% of community men acknowledged they had perpetrated sexual assault. Both groups used guilt and anger as the most frequent tactics to obtain unwanted sexual activity from their female victims. Consistent with the confluence model, an impersonal orientation toward sexual relationships was associated with sexual assault for both sex offenders and community men. Future directions for research on sexual assault perpetration and violence prevention efforts are discussed in light of these findings.

When do condom use intentions lead to actions? Examining the role of sexual communication on safer sexual behavior among people living with HIV.

This study investigated the moderating role of sexual communication in the association between intentions to use condoms and unprotected sex in a sample of 358 individuals living with HIV (233 men, 125 women, M age = 43). Longitudinal analyses revealed a significant interaction between condom intentions and sexual communication: individuals who were high in both condom intentions and safer sex communication engaged in less unprotected sex with all partners and with partners of HIV negative or unknown serostatus over six months of follow-up. Among individuals low in communication, intentions were not associated with unprotected sex. Implications for interventions are discussed.

Incarceration and unstable housing interact to predict sexual risk behaviours among African American STD clinic patients

Given the dramatic racial disparities in the rates of HIV/sexually transmitted infections (STIs) among African Americans, understanding broader structural factors that increase the risk for HIV/STIs is crucial. This study investigated incarceration history and unstable housing as two structural predictors of HIV risk behaviour among 293 African Americans (159 men/134 women, mean age = 27). Participants were recruited from an urban sexually transmitted disease (STD) clinic in the southeastern U.S. Approximately half the sample had been incarcerated in their lifetime (54%), and 43% had been unstably housed in the past six months. Incarceration was independently associated with the number of sex partners and the frequency of unprotected sex. Unstable housing was independently associated with the frequency of unprotected sex. However, these main effects were qualified by significant interactions: individuals with a history of incarceration and more unstable housing had more sex partners and more unprotected sex in the past three months than individuals without these structural barriers. Implications for structural-level interventions are discussed.