Hot And Bothered: The Role Of Arousal And Rejection Sensitivity In Dual Process Sexual Decision Making For Gay And Bisexual Men

Dual process theories of decision making acknowledge the functioning of two distinct yet simultaneous processes termed System 1 and System 2. While System 1 relies more heavily on automatic and affective processing, System 2 relies more heavily on effortful and cognitive processing. Over the past several decades, many lines of research have shown the importance of System 1 in decision making and several prominent social psychological theories of interpersonal behavior, such as rejection sensitivity, rely on this dual distinction between affective and cognitive processing. Despite the prominence of dual process theories in many areas of psychology, the role of System 1 has been largely absent from psychological inquiries into sexual decision making. As such, the aims of this dissertation were to: (1) investigate a dual process model of sexual decision making by incorporating the role of anxious and sexual arousal into a model with known System 2 predictors of sexual behavior; and (2) examine whether rejection sensitivity as a dispositional trait can be applied to condom use as a behavior and whether it acts upon condom use via interactions within the dual process framework investigated within the first aim. To achieve these aims, data were collected as part of a larger, longitudinal study of highly sexually active gay and bisexual men in New York City. As part of the project, men completed a one-hour survey from home (i.e., computer-assisted survey interviewing or CASI) as part of their 12-month longitudinal follow-up appointment and subsequently completed a 30-day online daily diary of their affect and sexual behavior. Using multilevel modeling, I tested a series of hypotheses regarding the role of anxious arousal (within-person), sexual arousal (within-person), perceived behavioral control (within-person), safer sex self-efficacy (between-person), and condom-related rejection sensitivity (between-person) on daily engagement in unprotected anal intercourse (UAI) with casual male partners. Across models, results supported several of the hypotheses from the first aim. Although anxious arousal was not found to be associated with engagement in UAI, sexual arousal was significantly positively associated with UAI, as hypothesized. Similarly, perceived behavioral control and safer sex self-efficacy were both shown to be negatively associated with engaging in UAI. Results did not support the hypothesis that System 1 (i.e., sexual arousal) and System 2 (i.e., behavioral control) processing interact in their influence on UAI, but rather that System 1 biases System 2 processing as demonstrated through a mediational analysis. Building upon these analyses, several of the hypotheses from the second aim were also confirmed. Condom-related rejection sensitivity was found to be significantly and positively associated with engaging in UAI as well as with higher levels of anxious arousal on a given day. Examining potential mechanisms of the association between rejection sensitivity and UAI, results revealed significant interactions between rejection sensitivity and self-efficacy as well as rejection sensitivity and sexual arousal. Taken together, findings suggest that rejection sensitivity may ameliorate the protective effect of self-efficacy on UAI and heighten the risk for UAI influenced by sexual arousal. The theoretical and public health implications of the findings and directions for future research are discussed

How different are men who do not know their HIV status from those who do? Results from an U.S. online study of gay and bisexual men

We compared self-described HIV-positive (31.6%, n=445), HIV-negative (56.8%, n=801), and HIV-unknown (11.6%, n=164) gay and bisexual men (GBM) on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8% of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men

Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and implementation

Introduction: Recent research has shown high efficacy of HIV treatment for reducing the risk of HIV transmission to sexual partners. As the efficacy of treatment as prevention (TasP) has proliferated, a new messaging campaign, Undetectable = Untransmittable, has been gaining popularity. The purpose of this paper was to assess factors associated with the perceived accuracy of this TasP messaging strategy among a large and diverse sample of gay, bisexual, and other men who have sex with men (GBMSM) in order to inform subsequent efforts at large-scale and implementation of the HIV prevention message. Methods: We conducted a nationwide survey of GBMSM in the U.S. recruited from an online social networking site and a mobile sexual networking app. We analysed data from 12,222 GBMSM separately by HIV status to examine sociodemographic and behavioural factors associated with ratings of the accuracy of the Undetectable = Untransmittable message, which included the option to indicate not understanding what “undetectable” meant. Results: Among HIV-negative and unknown men, multivariable linear regression indicated that being on pre-exposure prophylaxis (PrEP), identifying as gay or queer (versus bisexual or straight), recent serodiscordant condomless anal sex (CAS), testing every six months or more often, less concern about sexually transmitted infection (STI) infection, and lower perceived risk of HIV infection were the factors with the largest independent effect on rating the Undetectable = Untransmittable statement as more accurate. Fewer factors emerged as associated with accuracy ratings among HIV-positive participants—reporting an undetectable viral load, a lifetime acquired immune deficiency syndrome (AIDS) diagnosis, and lower concern about STI infection were the factors most strongly associated with rating the statement as more accurate. Conclusions: The findings of the current study highlight variability in the perceived accuracy of the Undetectable = Untransmittable message, suggesting potential subgroups who might benefit from targeted educational campaigns, perhaps broadcast utilizing sexual networking apps. Numerous factors, particularly among HIV-negative and unknown GBMSM, were associated with rating the message as more accurate. In particular, being on PrEP and testing regularly were two of the variables most strongly associated with higher accuracy ratings among HIV-negative GBMSM, suggesting HIV prevention services as potential points of intervention for increasing HIV knowledge and decreasing HIV stigma

Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial inperson clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use

Accuracy of highly sexually active gay and bisexual men’s predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV Pre-Exposure Prophylaxis

Objective: We sought to examine highly sexually active gay and bisexual men’s accuracy in predicting their sexual behavior for the purposes of informing future research on intermittent, event-driven HIV Pre-Exposure Prophylaxis (PrEP). Design: For 30 days, 92 HIV-negative men completed a daily survey about their sexual behavior (n = 1,688 days of data) and indicated their likelihood of having anal sex with a casual male partner the following day. Method: We utilized multilevel modeling to analyze the association between self-reported likelihood of and subsequent engagement in anal sex. Results: We found a linear association between men’s reported likelihood of anal sex with casual partners and the actual probability of engaging in sex, though men overestimated the likelihood of sex. Overall, we found that men were better at predicting when they would not have sex than when they would, particularly if any likelihood value greater than 0% was treated as indicative that sex might occur. We found no evidence that men’s accuracy of prediction was affected by whether it was a weekend or whether they were using substances, though both did increase the probability of sex. Discussion: These results suggested that, were men taking event-driven intermittent PrEP, 14% of doses could have been safely skipped with a minimal rate of false negatives using guidelines of taking a dose unless there was no chance (i.e., 0% likelihood) of sex on the following day. This would result in a savings of over $1,300 per year in medication costs per participant

Day-Level Associations Between Substance Use and HIV Risk Behavior Among a Diverse Sample of Transgender Women

Purpose: Transgender women in the United States face elevated rates of HIV and of substance use. Studies measuring overall or aggregate levels of substance use have linked use to increased HIV transmission risk behavior (TRB). Although intensive longitudinal studies in other populations have found day-level links between substance use and TRB, no study has yet explored such links among transgender women. This study aimed to fill this gap in the literature. Methods: Utilizing survey and 60-day timeline follow-back interview data from a sample of 214 transgender women in New York City, we tested whether day-level heavy drinking, marijuana use, and/or nonprescription stimulant use were associated with odds of engaging in any sex (vs. no sexual activity) or engaging in TRB (vs. sex without TRB), adjusting for overall levels of use. Results: Multilevel models showed that each of the three substance types was associated with greater odds of engaging in sex on a given day—and more strongly so for heavy drinking among those with higher rates of heavy drinking, and for stimulant use among those with lower rates of stimulant use. Only marijuana use was associated with greater odds of TRB on a given day, but only among those with higher rates of use. Conclusion: These findings substantiate day-level links between substance use and engaging in sexual activity among transgender women, and importantly, between marijuana use and greater likelihood of TRB on a day when sexual activity occurs. This highlights the importance of addressing substance use for sexual health among transgender women especially focusing on marijuana use

HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status–Neutral Cohort Study Using an Observational-Implementation Hybrid Approach

Background: Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. Objective: This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. Methods: Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). Results: The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. Conclusions: The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. International registered report identifier (irrid): DERR1-10.2196/48548.</p

Model-Based Methods to Translate Adolescent Medicine Trials Network for HIV/AIDS Interventions Findings Into Policy Recommendations: Rationale and Protocol for a Modeling Core (ATN 161)

BACKGROUND: The United States Centers for Disease Control and Prevention estimates that approximately 60,000 US youth are living with HIV. US youth living with HIV (YLWH) have poorer outcomes compared with adults, including lower rates of diagnosis, engagement, retention, and virologic suppression. With Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) support, new trials of youth-centered interventions to improve retention in care and medication adherence among YLWH are underway. OBJECTIVE: This study aimed to use a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to evaluate selected ongoing and forthcoming ATN interventions to improve viral load suppression among YLWH and to define the benchmarks for uptake, effectiveness, durability of effect, and cost that will make these interventions clinically beneficial and cost-effective. METHODS: This protocol, ATN 161, establishes the ATN Modeling Core. The Modeling Core leverages extensive data-already collected by successfully completed National Institutes of Health-supported studies-to develop novel approaches for modeling critical components of HIV disease and care in YLWH. As new data emerge from ongoing ATN trials during the award period about the effectiveness of novel interventions, the CEPAC-Adolescent simulation model will serve as a flexible tool to project their long-term clinical impact and cost-effectiveness. The Modeling Core will derive model input parameters and create a model structure that reflects key aspects of HIV acquisition, progression, and treatment in YLWH. The ATN Modeling Core Steering Committee, with guidance from ATN leadership and scientific experts, will select and prioritize specific model-based analyses as well as provide feedback on derivation of model input parameters and model assumptions. Project-specific teams will help frame research questions for model-based analyses as well as provide feedback regarding project-specific inputs, results, sensitivity analyses, and policy conclusions. RESULTS: This project was funded as of September 2017. CONCLUSIONS: The ATN Modeling Core will provide critical information to guide the scale-up of ATN interventions and the translation of ATN data into policy recommendations for YLWH in the United States

Examining the impact of daily discrimination on alcohol use among racially diverse, trauma-exposed sexually minoritized adults: A pilot study

OBJECTIVE: Identity-based stress and trauma are key drivers of alcohol use-related health inequities among minoritized people. Research on intersectional experiences of identity-based stress and alcohol use among trauma-exposed minoritized people is scant. This pilot study used a 30-day diary design to examine the effect of identity-based discrimination exposure on alcohol use in a racially diverse sample of trauma-exposed sexual minoritized (SM) adults ( = 47; 63.8% cisgender female; 65.2% Black, Indigenous, and People of Color [BIPOC]). METHOD: Multilevel logistic regression models were used to evaluate whether days marked by any (vs. no) identity-based discrimination were concurrently or prospectively associated with increased likelihood of reporting a higher (vs. lower) level of drinking-and whether these associations differed by race/ethnicity. RESULTS: Discrimination was associated with increased likelihood of reporting a higher level of same-day drinking ( = 0.91, = .03), but did not predict next-day drinking. BIPOC (vs. White) individuals were less likely to report a higher drinking level on or following nondiscrimination days (s = -2.18 to -1.52, s ≤ .005), but more likely to do so on or following discrimination days (s = 1.13-1.60, s ≤ .03). CONCLUSIONS: Results suggest that everyday discrimination may create insidious risk for coping-motivated alcohol use among SM BIPOC, a subgroup that otherwise exhibits resilience with respect to drinking. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence.

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial in-person clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use