Susan M. Kiene

Alcohol, Helping Young Adults to Have Unprotected Sex with Casual Partners: Findings from a Daily Diary Study of Alcohol Use and Sexual Behavior

PURPOSE To examine the event-level association between alcohol consumption and the likelihood of unprotected sex among college-age young adults considering contextual factors of partner type and amount of alcohol consumed. METHODS A 30-day, Web-based, structured daily diary was used to collect daily reports of sexual behaviors and alcohol use from 116 sexually active young adults, yielding 2,764 diary records. Each day we assessed the prior evenings behavior regarding alcohol consumption, opportunities for sex, sexual intercourse, condom use, and contextual factors including type of sexual partner. RESULTS Based on multilevel models, drinking proximal to events of sexual intercourse increased the likelihood of unprotected sex with casual but not steady partners. For women there was a positive association between number of drinks and a greater likelihood of unprotected sex with casual partners but a negative association with steady partners. Drinking during situations involving opportunities for sex with casual partners increased the likelihood of sex. For women especially, drinking more increased the likelihood of sex occurring regardless of partner type. CONCLUSIONS Failure to assess the contextual determinants of the alcohol-unprotected sex association may result in underestimates of the magnitude of this association. These data highlight an important area for intervention with young adults: reducing alcohol-involved sexual risk behavior with casual partners, especially among women.

Motivations for infidelity in heterosexual dating couples: The roles of gender, personality differences, and sociosexual orientation

A motivational/individual differences model of infidelity is proposed in the course of empirically evaluating the traditional dichotomy between emotional and sexual motives. A scale assessing motivations for infidelity was developed and administered to 432 college students, 120 of whom reported past dating infidelity. Four motivations were identified and were associated as predicted with Big Five and other trait constructs; Sex was predicted by male gender, lower age, and unrestricted sociosexual orientation (SO); Dissatisfaction was predicted by female gender and Extraversion; Neglect was predicted by Neuroticism; and Anger by Neuroticism and low Agreeableness. As predicted, a two-factor model provides a poorer fit with the data than a multi-factor model. Unrestricted SO partially mediates the gender difference in endorsement of a sex motive for infidelity.

Why are you bringing up condoms now? The effect of message content on framing effects of condom use messages.

According to prospect theory (A. Tversky & D. Kahneman, 1981), messages advocating a low-risk (i.e., easy, low-cost) behavior are most effective if they stress the benefits of adherence (gain framed), whereas messages advocating a risky behavior are most effective if they stress the costs of nonadherence (loss framed). Although condom use is viewed as a low-risk behavior, it may entail risky interpersonal negotiations. Study 1 (N = 167) compared ratings of condom use messages advocating relational behaviors (e.g., discussing condoms) or health behaviors (e.g., carrying condoms). As predicted, loss-framed relational messages and gain-framed health messages received higher evaluations. Study 2 (N = 225) offers a replication and evidence of issue involvement and gender as moderators. Results are discussed with reference to the design of condom use messages.

High Rates of Unprotected Sex occurring among HIV-Positive Individuals in a Daily Diary Study in South Africa: The Role of Alcohol Use

Objectives:The objectives of this study were to assess the prevalence of unprotected sex and to examine the association between alcohol consumption before sex and unprotected sex among HIV-positive individuals in Cape Town, South Africa. Methods:For 42 days, daily phone interviews assessed daily sexual behavior and alcohol consumption. Logistic and Poisson generalized estimating equation models were used to examine associations between alcohol consumption before sex and subsequent unprotected sex. Results:During the study which yielded 3035 data points, 58 HIV-positive women and 24 HIV-positive men drank an average of 6.13 drinks when they drank and reported 4927 sex events, of which 80.17% were unprotected. More than half (58%) of unprotected sex events were with HIV-negative partners or with partners with unknown HIV status. Extrapolating from the data using likelihood of infection per act estimates, we calculated that an estimated 2.95 incident HIV infections occurred during the study. Drinking alcohol before sex by the female partner or the male partner, or by both partners increased the proportion and number of subsequent unprotected sex events. However, these associations held only when the quantity of alcohol consumed corresponded to moderate or higher risk drinking. Conclusions:Among HIV positive individuals, engaging in moderate or higher risk drinking before sex increases the likelihood and rate of unprotected sex. Prevention efforts need to address reducing alcohol-involved unprotected sex among HIV-positive persons.

Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: results of a pilot study.

Objective:To evaluate the feasibility, fidelity, and effectiveness of a human immunodeficiency virus (HIV) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal, South Africa. Methods:A total of 152 HIV-infected patients, aged 18 years and older, receiving clinical care at an urban hospital in South Africa, were randomly assigned to intervention or standard-of-care control counselors. Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior. Self-report questionnaires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months. Results:Intervention was delivered in 99% of routine patient visits and included a modal 8 of 8 intervention steps. Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline, patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events. There was a marginally significant increase in these events among patients in the standard-of-care control condition. Conclusions:A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior.

Sexual Risk Behaviour among HIV-Positive Individuals in Clinical Care in Urban KwaZulu-Natal, South Africa

We assessed the incidence and predictors of unprotected sex among 152 HIV-positive patients in clinical care in KwaZulu-Natal, South Africa. Nearly 50% were sexually active; 30% of those reported unprotected sex. Alcohol use during sex, reporting forced sex, sex with a perceived HIV-positive partner, and sex with a casual partner predicted more unprotected sex, whereas HIV status disclosure was related to less unprotected sex. These findings highlight the need for linking HIV prevention and care in Africa.

Today I'll Use a Condom, But Who Knows About Tomorrow : A Daily Process Study of Variability in Predictors of Condom Use

OBJECTIVE Most models of health behavior change applied to condom use behavior have focused on individual differences in theoretical constructs to explain condom use or nonuse, while ignoring the possibility that day-to-day within-person changes in these constructs may contribute to understanding behavior. The goal of the present study was to investigate day-to-day variability in condom use attitudes, self-efficacy, and behavioral intentions and assess the utility of this variability in predicting the likelihood of condom use each day. DESIGN A 30-day Web-based structured daily diary was used to collect daily reports of sexual behaviors and data on theoretical predictors of condom use behavior from sexually active college students (N = 116). MAIN OUTCOME MEASURES The authors investigated whether condom use attitudes, self-efficacy, and behavioral intentions vary day to day; whether this within-person variability predicts condom use behavior; and whether negative affective states explain this variability. RESULTS AND CONCLUSIONS Within-person variability was found for each of the constructs. Within-person day-to-day changes in behavioral intentions and attitudes predicted the instances in which an individual used a condom and daily negative affect partially explained within-person day-to-day changes in behavioral intentions and self-efficacy. Implications for models of health behavior change and for behavior change interventions are discussed.

Alcohol-involved sexual risk behavior among heavy drinkers living with HIV/AIDS: negative affect, self-efficacy, and sexual craving.

Evidence of the effects of negative affect (NA) and sexual craving on unprotected sexual activity remains scant. We hypothesized that NA and sexual craving modify the same day association between low self-efficacy to use condoms and unprotected anal or vaginal sex, and the same-day association between alcohol use during the 3 hours prior to sexual activity and unprotected sex. We used an electronic daily diary, drawing on a sample of 125 men and women recruited from an agency serving economically disadvantaged persons living with HIV/AIDS. Casual or steady partner type designation and perceived partner HIV serostatus were also examined. Findings support the hypothesized moderating effects of high NA and sexual craving on the association between low self-efficacy and unprotected sex, and the association between alcohol use and unprotected sex. Implications are discussed.

The idiographic study of inconsistent condom use behavior of persons living with HIV.

Abstract A pilot study was conducted to assess the feasibility of using, in a multiply disadvantaged population, an electronic daily diary to test hypotheses linking affective states to variability in psychosocial determinants of condom use. Twenty-one mostly non-Caucasian individuals reporting profound economic disadvantage, heavy alcohol use and HIV infection completed a 5–7 minute interactive voice response (IVR) telephone-based survey daily for three weeks. Potentially affect-related within-person variability was observed in HIV-preventive attitudes, intentions and self-efficacy. Surprisingly, in this sample, HIV-preventive attitudes, intentions and self-efficacy exhibited as much, or greater, variability within persons as compared to between persons. Positive affect was found to significantly co-vary with self-efficacy to practice safer sex B=0.20, t (199)=2.14, p=0.03. For each unit increase in daily positive affect, daily self-efficacy increased by 0.20. Results suggest that a daily diary methodology is both feasible in a high-risk population and may offer new insights into understanding unprotected sexual behavior.

Barriers to and acceptability of provider-initiated HIV testing and counselling and adopting HIV-prevention behaviours in rural Uganda: A qualitative study:

In Uganda, a nationwide scale-up of provider-initiated HIV testing and counselling presents an opportunity to deliver HIV-prevention services to large numbers of people. In a rural Ugandan hospital, focus group discussions and key informant interviews were conducted with outpatients receiving provider-initiated HIV testing and counselling and staff to explore the HIV-prevention information, motivation and behavioural skills strengths and weaknesses, and community-level and structural barriers to provider-initiated HIV testing and counselling acceptability and HIV prevention among this population. Strengths and weakness occurred at all levels, and results suggest brief client-centred interventions during provider-initiated HIV testing and counselling may be an effective approach to increase prevention behaviours in outpatient settings.