Ron S. Gold

Situational factors and thought processes associated with unprotected intercourse in gay men

Abstract Gay men were asked to recall two sexual encounters from the preceding year: one in which they had unprotected intercourse (“unsafe” encounter or UE) and one in which they had resisted a strong temptation to have unprotected intercourse (“safe” encounter or SE). In each case questions covered the type of partner involved, physical location, desires at each stage of the encounter, level of sexual attraction and arousal, mood, communication about desires regarding safe sex, and alcohol and drug consumption. For UE, respondents also identified self-justifications they had used when deciding to have unprotected intercourse. Type of partner distinguished between UE and SE. With this variable controlled, desires, sexual attraction, mood, knowledge of condom availability, and communication about safe sex differentiated between the encounters. Consumption of alcohol or drugs, by contrast, did not. The most common self-justification used in UE was a resolution to have intercourse without ejaculation. The f...

Unprotected anal intercourse in HIV‐infected and non‐HIV‐infected gay men

In 1990, gay men (N = 296) in Sydney, Australia, were asked to recall two sexual encounters from the preceding year: one in which they had unprotected anal intercourse (“unsafe” encounter) and one in which they had resisted a strong temptation to have unprotected intercourse (“safe” encounter). The aims were to record self‐justifications for unprotected intercourse used in the unsafe encounter and to identify situational factors distinguishing between the encounters. Among men who had been HIV infected at the time of the unsafe encounter (n = 88), the most common self‐justification had been the thought that they had nothing more to lose; among uninfected men (n = 207), it had been a resolution to have intercourse without ejaculation. The first factor emerging from a factor analysis of the infected groups self‐justifications involved reactions to a negative mood state; in the uninfected group it involved inferring from perceptible characteristics that the partner was unlikely to be infected. Some variable...

The reasoning behind decisions not to take up antiretroviral therapy in Australians infected with HIV.

A substantial minority of HIV-infected Australians are not taking antiretroviral drugs. This study investigated the reasons behind their decision not to do so. Anyone who was HIV-infected but not taking antiretroviral drugs could participate. A self-administered, anonymous questionnaire was used, the principal recruitment method being through insertion of the questionnaire into gay community newspapers in Sydney and Melbourne. All respondents were asked questions covering demographics, previous AIDS-defining illnesses, T-cell and viral load monitoring, and previous use of antiretroviral drugs. In addition, respondents who had considered going on antiretroviral treatment, but then decided not to do so, were given a list of possible reasons for their decision and asked to indicate how much each played a role in their thinking. Of the 270 respondents, the great majority were gay men. One-eighth had experienced AIDS-defining illnesses. Two-thirds had recently had T-cell and viral load tests. One-third had taken antiretroviral drugs previously. Over two-thirds had considered antiretroviral therapy, most having given the matter quite some thought. Reasons for not taking up therapy did not differ greatly at different stages of HIV disease. The most common individual reason was fear of side effects. Important themes that emerged from factor analysis of the reasons data included distrust of conventional medical approaches to treatment, practical problems associated with taking antiretroviral drugs, unpleasant thoughts that being on therapy would evoke, and acceptance of the idea of dying. The findings can be used by doctors and counsellors to help patients clarify and evaluate their concerns about antiretroviral therapy.

Preventing unprotected anal intercourse in gay men: a comparison of two intervention techniques

This study compared the effectiveness of getting gay men to evaluate the self-justifications they use when breaking their safe sex rules to that of a standard approach to AIDS education. Men (n = 109) who had ‘slipped up’ (broken their safe sex rules by having unprotected anal intercourse) kept diaries of their sexual behaviour for 16 weeks. After 4 weeks they were allocated to one of 3 conditions, 2 involving brief interventions—Self-justifications (evaluation of self-justifications) and Standard (examination of posters used in AIDS education)—and a Control (diary only). At the time of the intervention, more members of the Self-justifications than the Standard group thought that it would help them not to slip up. In the post-intervention period, the 3 groups did not differ in the incidence of sexual activity or in the proportion who slipped up at least once, but the Self-justifications group were less likely to have had multiple slip-ups. Three possible explanations are offered for the effectiveness of the Self-justifications intervention. This approach may provide a useful alternative to standard techniques of AIDS education.

Judging a book by its cover: gay men's use of perceptible characteristics to infer antibody status.

This study investigated gay mens use of perceptible characteristics to infer antibody status. Participants (n =66) read brief descriptions of men they did not know and estimated the likelihood that they were HIV-infected. Each description highlighted one of 6 characteristics: physical attractiveness, intelligence/education level, healthy appearance and lifestyle, personality, a combination of the preceding, and wealth. Three versions of each sketch were used; they depicted the man in positive, neutral, and negative terms respectively. There were significant differences in the ratings for the 3 versions in the case of every characteristic except wealth. In general, the negative version elicited higher ratings (corresponding to a greater likelihood that the man was HIV-positive) than either the positive or neutral versions; in the case of physical attractiveness, the positive version elicited higher ratings than the neutral version. Results are discussed in relation to earlier findings regarding gay mens inferences, during sexual encounters, of antibody status from perceptible characteristics; to possible differences between AIDS-related thinking during sexual encounters and in the cold light of day; and to educational techniques that might be used to counter inferences of this type.

Thought processes associated with reluctance in gay men to be tested for HIV.

This study explored the thought processes that are associated with reluctance in gay men to be tested for HIV antibodies. The sample comprised 97 men who had not been tested for at least four years; 69 had never been tested. They were asked to imagine that someone had suggested that they be tested very soon and to identify, from the list provided, any negative thoughts prompted by this suggestion. The most commonly reported thoughts were that testing was unnecessary because risks had not been taken, that it was unnecessary because there were no symptoms, and that there was no urgency to be tested. Data were explored by means of factor analysis and comparisons across subgroups differing in risk level. The results are interpreted as indicating the use of rationalizations to buttress a decision not to be tested, the powerful influence on HIV decision-making exerted by salient perceptible features, and the ‘status quo bias’. Techniques that could be used to encourage testing in gay men are discussed.

The link between judgments of comparative risk and own risk : Further evidence

Abstract Individuals typically believe that they are less likely than the average person to experience negative events, a phenomenon termed “unrealistic optimism”. The direct method of assessing unrealistic optimism employs a question of the form, “Compared with the average person, what is the chance that X will occur to you?”. However, it has been proposed that responses to such a question (direct-estimates) are based essentially just on estimates that X will occur to the self (self-estimates). If this is so, any factors that affect one of these estimates should also affect the other. This prediction was tested in two experiments. In each, direct- and self-estimates for an unfamiliar health threat—homocysteine-related heart problems—were recorded. It was found that both types of estimate were affected in the same way by varying the stated probability of having unsafe levels of homocysteine (Study 1, N = 149) and varying the stated probability that unsafe levels of homocysteine will lead to heart problems (Study 2, N = 111). The results are consistent with the proposal that direct-estimates are constructed just from self-estimates.

Unrealistic optimism and event threat

Abstract Individuals typically exhibit “unrealistic optimism” (UO), the belief that they are less likely than the average person to experience a negative event. This may be because, fearing the event, they try to reassure themselves by distorting their reasoning to conclude that they are at comparatively little risk. If this is so, the greater the “event threat” (i.e., the more serious the events consequences and/or the greater the likelihood that those consequences will be experienced), the more reassurance should be required, and the greater the UO that should be observed. This prediction was tested in a study in which students (N = 148) were informed about a type of heart disease that could develop in later life due to inadequate diet when young. The risk attributable to diet was stated to be either slight (low-threat condition) or great (high-threat condition). Participants were asked to rate their own risk and that of the average student of developing the disease; question order was counterbalanced. The effects of event threat and question order were found to interact: event threat affected UO in the predicted way, but only when the question about own risk came first. The results are explained in motivational terms. Implications for health education are discussed.

Unprotected Anal Intercourse in Gay Men: The Resolution to Withdraw before Ejaculating

734 gay men who had recently engaged in unprotected anal intercourse reported self-justifications they used at the time. A common self-justification involved a resolution to withdraw before ejaculating. Compared with other self-justifications, this resolution was associated with a “last minute” rather than a “premeditated” decision to have unprotected anal intercourse, suggesting that the resolution derived just from “heat of the moment” thinking. Implications for AIDS education are discussed.

Event valence and unrealistic optimism: further evidence

Unrealistic optimism is assessed using either a single question, the rating of own likelihood of experiencing an event compared to that of the average person, or two questions, separate rating of own likelihood and that of the average person. The effect of event valence on unrealistic optimism was studied in a sample of 175 students using the two-question measure. Valence was manipulated to be positive, i.e., outcome was desirable, or negative, i.e., outcome was undesirable, by ‘framing’ the same event appropriately. Unrealistic optimism was greater for negative than positive valence. The effect was of the same direction and magnitude as that found by Gold and Martyn (2003) using the single-question measure. The relationship between event valence and unrealistic optimism does not depend on whether unrealistic optimism is assessed with one or two questions.