Paul Robert Appleby

Consideration of Future Consequences and Unprotected Anal Intercourse Among Men Who Have Sex with Men

Abstract This study of men who have sex with men (MSM) examined whether tendencies to consider the future consequences of ones actions were associated with sexual behaviors that place oneself at risk for HIV infection. A total of 339 HIV-negative MSM responded to the Consideration of Future Consequences Scale (CFC; Strathman et al, 1994) and to questions about their anal intercourse practices in the past year. In bivariate analyses, men with a stronger future orientation were less likely to engage in anal intercourse unprotected by a condom (p < .05). Multivariate analyses revealed that CFC accounted for significant variance in three of four measures of unprotected anal sex after statistically controlling for demographic covariates (education, income, ethnicity, age). CFC was a better predictor of sexual behavior and accounted for more unique variance than any of the demographic factors. Additional research is needed to confirm that CFC is an antecedent of behavior and to examine the feasibility and efficacy of focusing on CFC in HIV prevention interventions.

Future HIV prevention options for men who have sex with men: intention to use a potential microbicide during anal intercourse.

Development of an effective rectal microbicide holds promise for HIV prevention. This study examined mens personal efficacy standards (i.e., preferences about product efficacy) for a future rectal microbicide and intentions to use it during anal intercourse. Three hundred eighty-five men who have sex with men, sampled in West Hollywood, completed a behavioral questionnaire, read a detailed description of a potential rectal microbicide gel, and expressed their preferences about product efficacy and intended use. On average, participants wanted a microbicide gel to be 84% effective in preventing HIV infection before they would use it as the only means of protection during anal intercourse; 53% of the men wanted the gel to be at least 95% effective. In multivariate analyses, intention to use the gel by itself was associated with higher efficacy standards for the microbicide, negative attitudes about using condoms, and a history of unprotected anal intercourse. Thirty-seven percent of the men who always used a condom during anal sex in the past year said they would be more likely to use a microbicide gel than a condom in the future; however, 85% of this subgroup wanted the gel to offer protection comparable to a condom before they would use it alone. In conclusion, an effective rectal microbicide may have a sizable public health benefit because it provides an alternative for men who dislike condoms.

Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web.

Men who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual “normal.” Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk‐taking (e.g., alcohol abuse), sexual shames link to sexual risk‐taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSMs sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSMs reported past unprotected anal intercourse (UAI) is related to shame; MSMs exposure to SOLVE compared to a wait‐list control (WLC) condition reduces MSMs shame; and shame‐reduction mediates the link between WLC condition and UAI risk reduction.

Is 'knowing people with HIV/AIDS' associated with safer sex in men who have sex with men?

ObjectiveTo examine the sexually protective role of knowing person(s) with HIV/AIDS (PWHA) by conducting a multidimensional analysis distinguishing the number of PWHA known (by disease status and relationship category) and aspects of the relationship with the closest PWHA (emotional closeness, length of time known, disease status, type of relationship). DesignCross-sectional study of white, Latino, and African–American men who have sex with men recruited at street locations in West Hollywood, California, in 1997. MethodsThe analyses conducted with linear regression models focused on men (n = 334) who reported that they were seronegative or of unknown serostatus and thus at risk for HIV infection. Unprotected sex was defined as percentage of anal intercourse partners in the past 12 months with whom unprotected anal intercourse (UAI) occurred at least once. ResultsThe number of PWHA known was not associated with the percentage of UAI partners in multivariate or univariate analyses. Greater emotional closeness to a person who was HIV-positive without AIDS was associated with reduced UAI in multivariate models even after excluding participants whose close PWHA was a lover or sex partner. Younger men (18–25 years) knew fewer PWHA, reported less emotional closeness to a PWHA, and had a higher level of UAI than did older men. ConclusionsEmotional closeness to a seropositive person without AIDS may be a sexually protective factor. The results suggest the possibility that lower levels of emotional closeness to a PWHA may partially underlie the elevated sexual risk behavior of younger men who have sex with men.

Attachment Fertility Theory: Complex Systems of Mechanisms Simplify Sex, Mating, and Sexual Risks

Sex and mating are central to evolutionary processes. Understanding the factors, including the evolved mechanisms, affecting men’s and women’s sexual decision-making, is of interest to scientists, and the public at-large. But, “getting it right” is critical to researchers trying to develop more effective interventions to address today’s important health issues (e.g., preventing HIV, the sexually transmitted virus that causes AIDS, in high-risk populations). In the current work, we briefly describe Attachment Fertility Theory (AFT) (Miller & Fishkin, 1997; Miller, Putcha-Bhagavatua, & Pedersen, 2002; Miller, Pedersen, & Putcha-Bhagavatula, 2005; Pedersen, Miller, Putcha, & Yang, 2002; Pedersen, Putcha-Bhagavatula, & Miller, 2011), and Stewart-Williams and Thomas approach (this issue), then we discuss the communalities and differences between these approaches. AFT’s ability to provide a unified, universal (sex-similar) framework for understanding intra-individual and inter-individual sexual diversity (e.g., from short-term relationships to pair-bonds) has guided unique research questions, including in HIV prevention research. It has done so with high-risk populations (e.g, men who have sex with men) who engage in high levels of sex (and unprotected anal intercourse [UAI)]) with numerous sexual partners. One might think that high-risk MSM might be an unlikely population for testing AFT’s predictions. Nevertheless, we briefly present a new set of findings that demonstrates how generalizable and useful AFT can be in developing testable hypotheses regarding sexual behaviors and sexual risk-taking. Finally, along with our conclusions, we discuss what tools are needed to better understand systems of evolved mechanisms and advance future work in this field.

Identity Conflict and Sexual Risk for Black and Latino YMSM

Young (aged 18–30) Black and Latino men who have sex with men are at a higher risk of contracting HIV than their White counterparts. In order to better understand the unique nature of sexual risk-taking, we examined the extent to which ethnic group, ethnic identity, and sexual pride predicted condomless anal sex with casual partners among 161 young men who have sex with men (YMSM) who identify as Black or Latino. Negative binomial regressions were conducted using a cross-sectional design. Sexual pride was a negative predictor of condomless anal sex across all participants, but this effect was moderated by ethnic exploration and ethnic group; the relationship between sexual pride and condomless anal sex was strengthened by greater ethnic exploration among Latino YMSM, and weakened by greater ethnic exploration among Black YMSM. Implications for intersectional identity, identity conflict, and HIV prevention among young gay men of color are discussed.ResumenLos hombres jóvenes (en edades de 18 a 30 años) negros y latinos que tienen sexo con hombres tienen mayor riesgo de contraer VIH que sus homólogos blancos. Con el fin de comprender mejor la naturaleza única de los comportamientos sexuales de riesgo, examinamos hasta qué punto el grupo étnico, la identidad étnica y el orgullo sexual predijeron quiénes de los que tuvieron sexo anal sin condón con parejas ocasionales, entre 161 hombres jóvenes que tienen sexo con hombres (HSHJ), se identifican como negros o latinos. Se realizaron regresiones binomiales negativas utilizando un diseño transversal. El orgullo sexual fue un predictor negativo de que el sexo anal sin condón se realiza a través de todos los participantes, pero este efecto fue moderado por la exploración y grupo étnico; la relación entre el orgullo sexual y el sexo anal sin condón fue reforzada por una mayor exploración étnica entre los HSHJ latinos, y debilitada por una mayor exploración étnica entre HSHJ negros. Las implicaciones para la múltiple identidad, los conflictos de identidad y la prevención del VIH entre los jóvenes homosexuales de color son discutidos.