A Randomized Controlled Intervention Trial of a Sexual Health Approach to Long-Term HIV Risk Reduction for Men Who Have Sex with Men: Effects of the Intervention on Unsafe Sexual Behavior

This controlled prospective study assessed the effectiveness of a sexual health approach to HIV prevention for men who have sex with men (MSM). Participants (N = 422 Midwestern MSM) were randomly assigned to the intervention group, who participated in a 2-day comprehensive human sexuality seminar designed to contextually address long-term risk factors and cofactors, or to the control group, who watched 3 hours of HIV prevention videos. Risk behavior during the preceding 3 months was measured at baseline, 3-month follow-up, and 12-month follow-up. Any unprotected anal intercourse outside a long-term seroconcordant relationship was the dependent variable. Of the total, 14%-24% of the participants were considered at risk of acquiring or transmitting HIV. At the 12-month follow-up, the control reported a 29% decrease in the use of condoms during anal intercourse; the intervention group reported an 8% increase (t = 2.546; p = .015). The sexual health seminars appear a promising new intervention at significantly reducing unprotected anal intercourse between men

Drug Use, Unsafe Sexual Behavior, and Internalized Homonegativity in Men Who Have Sex With Men

Previous research has identified alcohol and drug use as predictive of unsafe sexual behavior among men who have sex with men (MSM). The purpose of this study was to assess whether substances associated with the greatest alteration in consciousness are associated with increased risk behavior, and to explore any relationship between internalized homonegativity and alcohol and other drug use. Participants in the study were 422 Midwestern MSM who volunteered to evaluate a seminar on sexuality and intimacy between men. Alcohol, chemical use, and dependency during the last 2 weeks were assessed using standardized questions and CAGE screening questions. Internalized homonegativity was assessed using the 26-item Reactions to Homosexuality scale. Components of unsafe sexual behavior during the preceding 3 months was assessed using dichotomous variables and collapsed into an overall measure of contextualized risk. Consistent and strong associations (ORs between 2.32 and 4.57) were found between unsafe sexual behavior and alcohol and other drug use. The greater the alcohol problem and the harder the drugs and the more they may impact consciousness or disinhibition, the greater the apparent association with unsafe sex. Degree of alteration of consciousness and disinhibition appear to be the common underlying dimensions of risk, although dose-level data were not available. The data did not support any consistent association between internalized homonegativity and use of drugs and alcohol

Aberrant Intrinsic Activity and Connectivity in Cognitively Normal Parkinson’s Disease

Disturbances in intrinsic activity during resting-state functional MRI (rsfMRI) are common in Parkinson's disease (PD), but have largely been studied in a priori defined subnetworks. The cognitive significance of abnormal intrinsic activity is also poorly understood, as are abnormalities that precede the onset of mild cognitive impairment. To address these limitations, we leveraged three different analytic approaches to identify disturbances in rsfMRI metrics in 31 cognitively normal PD patients (PD-CN) and 30 healthy adults. Subjects were screened for mild cognitive impairment using the Movement Disorders Society Task Force Level II criteria. Whole-brain data-driven analytic approaches first analyzed the amplitude of low-frequency intrinsic fluctuations (ALFF) and regional homogeneity (ReHo), a measure of local connectivity amongst functionally similar regions. We then examined if regional disturbances in these metrics altered functional connectivity with other brain regions. We also investigated if abnormal rsfMRI metrics in PD-CN were related to brain atrophy and executive, visual organization, and episodic memory functioning. The results revealed abnormally increased and decreased ALFF and ReHo in PD-CN patients within the default mode network (posterior cingulate, inferior parietal cortex, parahippocampus, entorhinal cortex), sensorimotor cortex (primary motor, pre/post-central gyrus), basal ganglia (putamen, caudate), and posterior cerebellar lobule VII, which mediates cognition. For default mode network regions, we also observed a compound profile of altered ALFF and ReHo. Most regional disturbances in ALFF and ReHo were associated with strengthened long-range interactions in PD-CN, notably with regions in different networks. Stronger long-range functional connectivity in PD-CN was also partly expanded to connections that were outside the networks of the control group. Abnormally increased activity and functional connectivity appeared to have a pathological, rather than compensatory influence on cognitive abilities tested in this study. Receiver operating curve analyses demonstrated excellent sensitivity (≥90%) of rsfMRI variables in distinguishing patients from controls, but poor accuracy for brain volume and cognitive variables. Altogether these results provide new insights into the topology, cognitive relevance, and sensitivity of aberrant intrinsic activity and connectivity that precedes clinically significant cognitive impairment. Longitudinal studies are needed to determine if these neurocognitive associations presage the development of future mild cognitive impairment or dementia