Publications by authors named "Brett M Millar"

35 Publications

Stress-Related Growth among Transgender Women: Measurement, Correlates, and Insights for Clinical Interventions.

J Homosex 2021 May 14:1-24. Epub 2021 May 14.

Department of Psychology, Hunter College of the City University of New York, New York, New York, USA.

Although transgender women (TGW), and especially TGW of color, are disproportionately exposed to discrimination and violence, many of them experience stress-related growth. However, little is known about the experience of stress-related growth and its correlates among TGW. Using data from a racially-diverse sample of 210 TGW, the short version of the Stress-Related Growth Scale was modified to assess growth as a result of coming to terms with one's transgender identity among TGW. The psychometric properties of the modified scale were examined, along with its associations with various cognitive, emotional, and social factors. A confirmatory factor analysis revealed a unidimensional factor, along with excellent reliability. A stepwise regression revealed that positive reappraisal, internal locus of control, social support, and emotional expression were associated with greater stress-related growth. Findings suggest that cognitive, emotional, and social resources are related to stress-related growth in TGW. Interventions to foster stress-related growth among TGW are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00918369.2021.1921511DOI Listing
May 2021

The importance of domain-specific self-efficacy assessment for substance use and HIV care continuum outcomes among adults in an urban HIV clinic network.

AIDS Care 2021 Mar 22:1-9. Epub 2021 Mar 22.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Despite the prominence of self-efficacy as a predictor of antiretroviral therapy (ART) adherence, relatively little work has examined domain-specific associations with steps in the care continuum or the possibility that substance use may have domain-specific associations with self-efficacy. This study analyzed data from a sample of 174 people living with HIV recruited through three clinics in the New York City metro area. Consistent with hypotheses, path analysis showed that appointments kept and viral load were each predicted only by their respective domain-specific self-efficacy components (i.e., self-efficacy for keeping appointments, = 0.01, = .04; and self-efficacy for taking ART medications, = -0.02,  < .01). Path models also indicated domain-specific associations with substance use. Self-efficacy for keeping appointments was negatively associated with severity of drug use (= -1.81, < .01); meanwhile, self-efficacy for taking ART medications was negatively associated with severity of alcohol use (= -0.52, < .01). Accordingly, studies assessing barriers to retention in the HIV care continuum should conduct multi-domain assessments of self-efficacy for differential associations with specific behaviors. Furthermore, HIV care providers might consider screening for domain-specific self-efficacy to identify patients at risk of drop-out and tailoring interventions to various care continuum domains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09540121.2021.1904501DOI Listing
March 2021

Drug Use Among Adolescents and Young Adults with Unsuppressed HIV Who Use Alcohol: Identifying Patterns of Comorbid Drug Use and Associations with Mental Health.

AIDS Behav 2020 Oct;24(10):2975-2983

Center for Translational Behavioral Research, Florida State University College of Medicine, Tallahassee, FL, USA.

Youth living with HIV (YLWH; aged 16-24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporting ART non-adherence and alcohol use, were recruited at five Adolescent Trials Network clinics in urban areas of the US between November 2014 and August 2017. Participants completed the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) to assess substance use involvement scores, and the Brief Symptom Inventory. Latent Profile Analysis identified three substance use patterns: minimal illicit drug use (15.1%), cannabis only (56.4%), and global polysubstance use (28.5%). Global polysubstance users experienced more mental health problems compared to the minimal illicit drug use group. The co-occurrence of drug use with alcohol was common among these YLWH-all of whom reported ART adherence problems-indicating the importance of interventions capable of addressing multiple substance use rather than alcohol alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-020-02848-8DOI Listing
October 2020

Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer.

Int J Behav Med 2021 Feb;28(1):14-20

Doctoral Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA.

Background: Given the need to better understand mechanisms linking poor sleep and psychological distress in the context of chronic illness, we explored a novel factor, intolerance of uncertainty (IU), in relation to insomnia among parents of adolescents and young adults (AYAs) with cancer. We hypothesized that parents with higher IU would report greater insomnia symptoms, which would be associated with higher anxiety and depressive symptoms. These greater levels of anxiety and depressive symptoms are hypothesized to mediate the relationship between insomnia symptoms and subjective well-being (SWB).

Method: Surveying 59 parents of AYAs with cancer, we computed a parallel-serial mediational analysis using bootstrapping techniques for ordinary least squares regression to test two pathways (adjusting for whether the AYA currently resided with the parent). The first serial pathway was IU→insomnia symptoms→anxiety symptoms→SWB. The second pathway was IU→insomnia symptoms→depressive symptoms→SWB.

Results: Although the first pathway involving sleep and anxiety as serial mediators was nonsignificant, the second pathway with sleep and depressive symptoms was significant. The relationship between IU and SWB was mediated through insomnia and depressive symptoms. An alternative serial mediation analysis wherein depressive symptoms preceded sleep was not significant, lending support to study findings.

Conclusion: This study provides preliminary evidence that IU's detrimental influence on depression and SWB may operate through its influence on insomnia symptoms. Given implications for parents' well-being and, likely, their subsequent capacity to care for the AYA with cancer, interventions addressing IU and disturbed sleep among this underserved population deserve attention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12529-020-09869-6DOI Listing
February 2021

Motivational interviewing with male couples to reduce substance use and HIV risk: Manifestations of partner discord and strategies for facilitating dyadic functioning.

Psychotherapy (Chic) 2020 03 30;57(1):58-67. Epub 2020 Jan 30.

Department of Psychiatry and Neurobehavioral Sciences.

The efficacy of motivational interviewing (MI) to reduce substance use is well established; however, its use with couples has met with mixed results. The development of such interventions is particularly relevant for male couples, as rates of substance use in this population are comparatively high and use is associated with aspects of sexual relationship functioning. One challenge noted in conducting MI with couples is how to respond to situations in which partners disagree with one another or argue against change. Guided by the couples interdependence theory, we conceptualized conflicts within session as failures in the accommodation process. We used qualitative analysis to examine manifestations of conflict in session and to identify effective provider response strategies. The sample included 14 cis-male couples with at least 1 partner was aged 18-29 years, reported substance use, and was HIV negative. All couples completed 3 MI sessions lasting 60-75 min each. Manifestations of conflict included conflation of thoughts/feelings, vague or indirect communication, and inaccurate assumptions. Effective provider responses included correcting assumptions, shifting focus, relationship repair, "common ground" reflections, and relationship affirmations. Observed conflicts aligned with conceptualizations of destructive resolutions to the accommodation process (i.e., exit and neglect). Effective provider responses to conflict facilitated dyadic functioning and catalyzed constructive accommodation. These results provide an initial compendium of provider skills and strategies that may be particularly relevant in work with sexual minority male couples, for whom achieving accommodation around drug use and sexual health goals is often viewed as a key mechanism of intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/pst0000278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489495PMC
March 2020

Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health.

J Int Assoc Provid AIDS Care 2019 Jan-Dec;18:2325958219888462

Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.

Evidence suggests that psychosocial stress negatively impacts immunological health in HIV-positive individuals. However, few studies have explored this association in substance-using older adults living with HIV (OALWH). We evaluated the effect of depression, loneliness, substance use problems, and HIV stigma on primary markers of immune function in a sample of 120 OALWH with substance-related issues. HIV stigma correlated with the greatest number of factors, including depression, loneliness, and substance use problems. Older age and antiretroviral adherence were associated with viral suppression, which was in turn associated with higher percentage of CD4 count. Multivariate path analyses demonstrated that lower HIV stigma and viral suppression were the only factors independently associated with higher percentage of CD4 count, with a significant indirect effect of adherence on CD4 through viral suppression. HIV stigma emerged as the most salient factor associated with both psychosocial well-being and immune health in the current study, suggesting that it is a critical factor to consider in future interventions for the rapidly growing population of OALWH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325958219888462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893929PMC
July 2020

Attachment as a Predictor of Psychological and Sexual Wellbeing Among Transgender Women in New York City.

J Sex Res 2019 Nov-Dec;56(9):1192-1202. Epub 2019 Aug 5.

Department of Psychology, Hunter College of the City University of New York (CUNY).

Transgender women are disproportionately affected by HIV and experience high rates of depression and anxiety. The importance of secure attachment in buffering against negative sexual and mental health outcomes is well established. However, few studies have examined attachment among transgender women. We recruited a community-based convenience sample of 213 transgender women in New York City (34.3; = 11.7). The majority were women of color (75.6%), almost half identified as heterosexual (47.4%), and 34.7% were HIV-positive. Preliminary analyses examined the sample distribution across attachment categories using the Revised Experiences in Close Relationships scale. Specifically, Brennan, Clark and Shaver's guidelines were used for categorization (43.19% fearful, 22.5% preoccupied, 21.6% dismissive, and 12.7% secure). Regression analyses examined the association of dimensional attachment anxiety, attachment avoidance, and their interaction with depression, anxiety, self-efficacy for condom use, temptations for condomless sex, and condomless sex acts. Results indicated a positive association between attachment anxiety and depression, anxiety, temptations and probability for condomless sex; and also between attachment avoidance and condomless sex probability. A significant interaction indicated that individuals with low attachment anxiety and attachment avoidance (i.e., secure) had the greatest condom use self-efficacy and the lowest probability of engaging in condomless sex.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00224499.2019.1644486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791782PMC
September 2020

Motivational Interviewing to Reduce Drug Use and HIV Incidence Among Young Men Who Have Sex With Men in Relationships and Are High Priority for Pre-Exposure Prophylaxis (Project PARTNER): Randomized Controlled Trial Protocol.

JMIR Res Protoc 2019 Jul 4;8(7):e13015. Epub 2019 Jul 4.

Hunter College, City University of New York, New York, NY, United States.

Background: Men who have sex with men (MSM) currently account for more than two-thirds of new HIV diagnoses in the United States and, among young MSM (YMSM) aged 20 to 29 years, as many as 79% to 84% of new infections occur between primary partners. Contributing to HIV risk, YMSM use drugs at comparatively high rates. To date, no interventions have been developed that specifically address the unique needs of partnered YMSM or incorporate a focus on relationship factors in addressing personal motivation for change.

Objective: The study's primary aim is to evaluate the efficacy of the PARTNER intervention and evaluate potential moderators or mediators of intervention effects. The study's secondary aims were to gather ideographic data to inform a future effectiveness implementation study and develop a novel biomarker for pre-exposure prophylaxis (PrEP) adherence by analyzing PrEP drug levels in fingernails.

Methods: PARTNER is a 4-session motivational interviewing-based intervention that integrates video-based communication training to address drug use and HIV prevention among partnered YMSM. This study utilizes a randomized controlled trial design to compare the PARTNER intervention with an attention-matched psychoeducation control arm that provides information about HIV-risk reduction, PrEP, and substance use. Participants are randomized in a 1-to-1 ratio stratified on age disparity between partners, racial composition of the couple, and relationship length. Follow-up assessments are conducted at 3-, 6-, 9-, and 12-months postbaseline. The study recruits and enrolls 240 partnered YMSM aged between 18 to 29 years at a research center in New York City. Participants will be HIV-negative and report recent (past 30-day) drug use and condomless anal sex with casual partners; a nonmonogamous primary partner (regardless of HIV status); or a serodiscordant primary partner (regardless of sexual agreement). Primary outcomes (drug use and HIV sexual transmission risk behavior) are assessed via a Timeline Follow-back interview. Biological markers of outcomes are collected for drug use (fingernail assay), sexual HIV transmission risk (rectal and urethral gonorrhea and chlamydia testing), and PrEP adherence (dried blood spots and fingernails for a novel PrEP drug level assay).

Results: The study opened for enrollment in February 2018. Anticipated completion of enrollment is October 2021. Primary outcome analyses will begin after final follow-up completion.

Conclusions: Existing research on partnered YMSM within the framework of Couples Interdependence Theory (CIT) has suggested that relationship factors (eg, dyadic functioning and sexual agreements) are meaningfully related to drug use and HIV transmission risk. Results pertaining to the efficacy of the proposed intervention and the identification of putative moderators and mediators will substantially inform the tailoring of interventions for YMSM in relationships and contribute to a growing body of relationship science focused on enhancing health outcomes.

Trial Registration: ClinicalTrials.gov NCT03396367; https://clinicaltrials.gov/ct2/show/NCT03396367 (Archived by WebCite at http://www.webcitation.org/78ti7esTc.

International Registered Report Identifier (irrid): DERR1-10.2196/13015.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/13015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637725PMC
July 2019

Changes in Sleep Quality and Associated Health Outcomes among Gay and Bisexual Men Living with HIV.

Behav Sleep Med 2020 May-Jun;18(3):406-419. Epub 2019 May 2.

STAR Program, SUNY Downstate Medical Center, Brooklyn, New York.

: Although gay, bisexual, and other men who have sex with men (GBMSM) bear a disproportionate burden of HIV in the U.S., they are underrepresented in HIV-related sleep research. This study sought to (a) investigate changes in self-reported sleep quality among a sample of GBMSM living with HIV during participation in an online sexual risk reduction intervention and (b) examine whether changes in sleep quality predicted later health outcomes.: Men ( = 505) completed measures of sleep quality, psychological distress, condom use self-efficacy, and antiretroviral therapy (ART) adherence. Analyses focused on data obtained from participants as part of the eligibility survey, baseline assessment, and the 9- and 12-month follow-up assessments.: Most participants did not report changes in their sleep quality (i.e., 50.1% maintained good sleep quality, 22.8% maintained poor sleep quality) between study screening and 9-month follow-up. Nevertheless, 17.0% indicated improved sleep quality and 10.1% indicated a negative change in sleep quality. Compared to those who maintained good sleep quality during the study, men whose sleep quality declined by 9 months reported significantly greater symptoms of depression and anxiety, as well as lower ART adherence and condom use self-efficacy at 12 months. Similarly, men who maintained poor sleep quality reported greater symptoms of depression and anxiety at 12 months. Men whose sleep quality improved reported better mental health than those with poor or worsening sleep quality.: Findings suggest that optimizing sleep health should be prioritized in interventions aimed at improving overall well-being of GBMSM living with HIV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15402002.2019.1604344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824963PMC
June 2020

Trajectories of sexual identity development and psychological well-being for highly sexually active gay and bisexual men: A latent growth curve analysis.

Psychol Sex Orientat Gend Divers 2019 Mar 20;6(1):64-74. Epub 2018 Sep 20.

The Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.

Objective: Examining sexual identity development-the process through which sexual minorities discover and disclose their sexual orientations-within a minority stress framework may help to contextualize sexual and mental health disparities among gay and bisexual men. Research on sexual identity development has typically focused on ages of achieving specific milestones (i.e., awareness, identification, sexual experience, and disclosure), though differences in onset and speed of the process and impact of these trajectories on healthy functioning in adulthood are understudied.

Method: We analyzed cross-sectional data from 374 highly sexually active gay and bisexual men in NYC. Using latent growth curve modelling, we examined trajectories of sexual identity development through the four primary milestones. We next examined their associations with childhood and background characteristics, adult experiences of sexual minority stress, and adult mental health.

Results: Gay sexual identity and greater childhood gender nonconformity were associated with earlier reported onset of sexual identity development and younger age was significantly associated with faster progression through the developmental process. The model showed that faster progression through sexual identity development was associated with higher levels of sexual orientation-based discrimination, emotion dysregulation, sexual compulsivity, and anxiety and depression in adulthood.

Conclusions: These findings support the need for a comprehensive and developmentally-informed model of adulthood functioning among gay and bisexual men that considers trajectories of sexual identity development-including onset and duration-as potential precursors to mental health difficulties in adulthood. Given the early onset of sexual identity development and potential lifelong sequelae, early prevention programs promoting positive sexual identity development are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456266PMC
March 2019

The role of chronotype, circadian misalignment, and tiredness in the substance use behaviors of gay and bisexual men.

Psychol Sex Orientat Gend Divers 2019 Mar 5;6(1):96-106. Epub 2018 Nov 5.

Health Psychology and Clinical Sciences doctoral program, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016 USA.

Although the potential of alcohol and drugs to detrimentally affect sleep has been established, the potential of tiredness to in turn influence substance use has received less attention. We contend that tiredness increases risk for substance use because tiredness impairs self-regulation and heightens the utility of substances to combat tiredness, albeit temporarily-and that these links are especially important because decision-making regarding use often occurs late at night when people are tired. Accordingly, we investigated chronotype, circadian misalignment, and perceived tiredness as risk factors in substance use among gay and bisexual men (GBM). We analyzed two online survey datasets-one of 3,696 GBM and one of 1,113 GBM-asking participants about their time for most frequently using alcohol or club/party drugs, their chronotype, whether they use substances to stay awake, and use severity. Alcohol use and club/party drug use most often occurred from 9pm onwards (for 51.3% and 75.1% of men, respectively), especially among younger men and evening types. Further, many men with a morning chronotype reported most often using alcohol (33.2%) and drugs (64.7%) from 9pm onwards, implicating circadian misalignment. Additionally, feeling tired was a motivator of alcohol use and drug use (for 53.1% and 26.9% of men, respectively), especially among younger men. Finally, those endorsing this motivation had greater use severity. These findings highlight the importance of chronotype, circadian misalignment, and tiredness in substance use, especially among younger men. We therefore recommend including substance use among the behaviors adversely affected by tiredness from circadian misalignment and inadequate/overdue sleep.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426147PMC
March 2019

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

Transgend Health 2018 26;3(1):210-219. Epub 2018 Dec 26.

Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.

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. 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. 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. 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/trgh.2018.0032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308277PMC
December 2018

Motivational interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay male couples.

Psychol Sex Orientat Gend Divers 2018 Dec 25;5(4):490-502. Epub 2018 Jun 25.

Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA.

Epidemiological data indicate the need to address substance use and sexual HIV transmission risk among gay and bisexual men in relationships. While brief Motivational Interviewing (MI) delivered to the individual has shown efficacy in reducing sexual HIV risk with casual partners and substance use, the application of MI with couples has received less attention. Most studies of MI with couples have conceptualized the "spouse" or partner as an adjunct participant in the treatment of an identified client. We propose a theoretical framework for conducting MI with a couple, which approaches the couple as the identified client, and may be adopted when either one or both partners engage in the target behavior. We then discuss similarities between MI-processes conceptualized with our proposed framework and those that are salient in existing couples therapies. We utilize case examples from brief MI sessions targeting substance use and sexual HIV risk in gay male couples to illustrate three phenomena unique to the implementation of MI with couples: 1) interpersonal ambivalence; 2) the role of dyadic functioning in tolerating and resolving interpersonal ambivalence; and 3) joint goal formation as a prerequisite to the planning phase of MI. Connecting these phenomena with the transformation of motivation and accommodation processes outlined in Couples Interdependence Theory, this paper suggests that brief MI may be a promising modality for substance use and HIV risk reduction interventions with couples generally and gay couples specifically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300150PMC
December 2018

Motivational interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay male couples.

Psychol Sex Orientat Gend Divers 2018 Dec 25;5(4):490-502. Epub 2018 Jun 25.

Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA.

Epidemiological data indicate the need to address substance use and sexual HIV transmission risk among gay and bisexual men in relationships. While brief Motivational Interviewing (MI) delivered to the individual has shown efficacy in reducing sexual HIV risk with casual partners and substance use, the application of MI with couples has received less attention. Most studies of MI with couples have conceptualized the "spouse" or partner as an adjunct participant in the treatment of an identified client. We propose a theoretical framework for conducting MI with a couple, which approaches the couple as the identified client, and may be adopted when either one or both partners engage in the target behavior. We then discuss similarities between MI-processes conceptualized with our proposed framework and those that are salient in existing couples therapies. We utilize case examples from brief MI sessions targeting substance use and sexual HIV risk in gay male couples to illustrate three phenomena unique to the implementation of MI with couples: 1) interpersonal ambivalence; 2) the role of dyadic functioning in tolerating and resolving interpersonal ambivalence; and 3) joint goal formation as a prerequisite to the planning phase of MI. Connecting these phenomena with the transformation of motivation and accommodation processes outlined in Couples Interdependence Theory, this paper suggests that brief MI may be a promising modality for substance use and HIV risk reduction interventions with couples generally and gay couples specifically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300150PMC
December 2018

Three Reasons to Consider the Role of Tiredness in Sexual Risk-Taking Among Gay and Bisexual Men.

Arch Sex Behav 2019 01 20;48(1):383-395. Epub 2018 Aug 20.

Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA.

Numerous factors have been shown to increase sexual risk-taking-especially among gay and bisexual men (GBM), who remain disproportionately affected by HIV and STIs. We present three lines of evidence that highlight the need to consider a previously under-explored situational factor in sexual risk-taking: tiredness. While tiredness has been shown, in sleep science literature, to impair cognition, emotional functioning, and decision-making in a wide range of behaviors, it has yet to be considered in-depth as a risk factor in sexual behavior. Counter to the common-sense assumption that being tired should impede the performance of active, effortful behaviors such as sex, we propose that tiredness may actually increase sexual risk-taking. Analyzing data from an online survey of 1113 HIV-negative GBM, we found that sex with casual partners most commonly occurred at night, especially among younger GBM and those with an evening chronotype, and that sex without condoms more often occurred at or later than one's usual time of feeling tired (as was reported by 44.2% of men) than did sex with condoms (reported by 36.6%). We also found that tiredness can increase sexual desire in many GBM (endorsed by 29.9%), and increases the likelihood of engaging in receptive positioning in anal sex (endorsed by almost 40% of men with a versatile sexual positioning identity). These findings highlight the importance of considering tiredness as a situational risk factor in sexual health-especially among younger GBM-and of counting sex among the behaviors that can be adversely impacted by poor or overdue sleep.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10508-018-1258-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349479PMC
January 2019

Eriksonian intimacy development, relationship satisfaction, and depression in gay male couples.

Psychol Sex Orientat Gend Divers 2017 Jun;4(2):241-250

Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY USA.

Research suggests connections or links between the mental health of both partners in a romantic relationship, as partners often report similar mental health problems, with implications for relationship functioning. The current study utilized the framework of interdependence theory to explore associations among intimacy development, as conceptualized by Erikson, relationship satisfaction, and depression in a sample of 128 same-sex male couples. In each couple, one partner was recruited first through active or passive outreach conducted online and in-person, and after completion of the online survey, was then invited to send his partner a link to the study. The 256 male respondents (mean age = 32.6 years) all reported a U.S. residence and had an average relationship length of five years. Utilizing the Actor-Partner Interdependence Model, analyses indicated that participants' intimacy development directly predicted their own relationship satisfaction (B = 1.84, < .01) as well as their partner's relationship satisfaction (B = 1.61, <.01). Similarly, both the actor (B = -0.04, < .01) and partner (B = -0.04, < .05) effects of relationship satisfaction on depression were significant. Consistent with the interdependent concept of joint control, three indirect pathways linked Eriksonian intimacy to depression through relationship satisfaction. These findings suggest that individual development may become linked to mental health through pathways involving dyadic functioning. This pattern implies highly inter-connected links between the intra-personal and inter-personal, which have implications for mental health intervention with gay men in relationships.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5966044PMC
June 2017

Eriksonian intimacy development, relationship satisfaction, and depression in gay male couples.

Psychol Sex Orientat Gend Divers 2017 Jun;4(2):241-250

Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY USA.

Research suggests connections or links between the mental health of both partners in a romantic relationship, as partners often report similar mental health problems, with implications for relationship functioning. The current study utilized the framework of interdependence theory to explore associations among intimacy development, as conceptualized by Erikson, relationship satisfaction, and depression in a sample of 128 same-sex male couples. In each couple, one partner was recruited first through active or passive outreach conducted online and in-person, and after completion of the online survey, was then invited to send his partner a link to the study. The 256 male respondents (mean age = 32.6 years) all reported a U.S. residence and had an average relationship length of five years. Utilizing the Actor-Partner Interdependence Model, analyses indicated that participants' intimacy development directly predicted their own relationship satisfaction (B = 1.84, < .01) as well as their partner's relationship satisfaction (B = 1.61, <.01). Similarly, both the actor (B = -0.04, < .01) and partner (B = -0.04, < .05) effects of relationship satisfaction on depression were significant. Consistent with the interdependent concept of joint control, three indirect pathways linked Eriksonian intimacy to depression through relationship satisfaction. These findings suggest that individual development may become linked to mental health through pathways involving dyadic functioning. This pattern implies highly inter-connected links between the intra-personal and inter-personal, which have implications for mental health intervention with gay men in relationships.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/sgd0000225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5966044PMC
June 2017

Syndemic Conditions, HIV Transmission Risk Behavior, and Transactional Sex Among Transgender Women.

AIDS Behav 2018 07;22(7):2056-2067

Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.

This study examined the effect of four syndemic conditions-namely, polydrug use, depression, childhood sexual abuse, and intimate partner violence-on rates of HIV transmission risk behavior (TRB) and separately, transactional sex among transgender women. TRB was defined as the number of condomless penetrative sex events with a casual or main partner of discordant or unknown HIV status. Using data from 212 transgender women in New York City, multivariable analyses revealed that, compared to those with no syndemic conditions, dramatically higher rates of recent HIV TRB events (ARR = 8.84, p < 0.001) and recent transactional sex events (ARR = 8.32, p < 0.001) were reported by participants with all four syndemic conditions. These findings highlight the importance of considering the role of syndemic conditions in HIV risk among transgender women, and the need for comprehensive psychosocial interventions to improve sexual health among this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-018-2100-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021215PMC
July 2018

Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men.

AIDS Behav 2018 Aug;22(8):2674-2686

Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA.

Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-018-2086-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051905PMC
August 2018

Situational HIV stigma and stimulant use: A day-level autoregressive cross-lagged path model among HIV-positive gay and bisexual men.

Addict Behav 2018 08 3;83:109-115. Epub 2018 Jan 3.

The Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, United States; Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States; Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, United States.

Background: Data on the association between HIV stigma and drug use are scarce, but some research suggests that internalized HIV stigma may be associated with increased drug use and that this association may be at least partially mediated by emotion dysregulation. We sought to test this hypothesis with event-level data to more accurately tease out the co-occurrence of these phenomena.

Methods: We conducted a 21-day, twice-daily ecological momentary assessment study with a sample of 52 HIV-positive gay and bisexual men. We utilized multivariate multilevel path analysis to test an autoregressive cross-lagged model of the direct and indirect effects of situational-level internalized HIV stigma and emotion dysregulation on non-prescription stimulant drug use.

Results: As hypothesized, we observed significant concurrent effects of internalized HIV stigma on emotion dysregulation as well as autoregressive associations of internalized HIV stigma and emotion dysregulation with themselves across the day. Furthermore, findings revealed direct effects of internalized HIV stigma on later emotion dysregulation and increased likelihood of stimulant use, but no direct effect of emotion dysregulation on stimulant use.

Conclusions: Situational increases in internalized HIV stigma appear to exert a direct risk-enhancing effect on the likelihood of daily stimulant drug use and do not appear to do so through emotion dysregulation. Future research is needed to more carefully examine distinct affective experiences and regulation strategies to better understand what mechanism links internalized HIV stigma with drug use behaviors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.addbeh.2018.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963983PMC
August 2018

The critical role of internalized HIV-related stigma in the daily negative affective experiences of HIV-positive gay and bisexual men.

J Affect Disord 2018 02 6;227:289-297. Epub 2017 Nov 6.

The Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, United States; Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States; Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, United States.

Background: Research suggests that HIV stigma exerts a detrimental impact on the mental health of HIV-positive gay and bisexual men (GBM). We sought to better understand these processes by examining two forms of HIV stigma (i.e., anticipated and internalized) at two levels (i.e., individual and situational) in association with daily negative affective experiences.

Methods: We conducted a 21-day twice-daily ecological momentary assessment study of 51 HIV-positive GBM. Twice-daily stigma measures were disaggregated into individual-level averages and situational fluctuations, and we utilized multilevel models to examine both concurrent and time-lagged effects of HIV stigma on anxious affect, depressed affect, anger, fatigue, and emotion dysregulation.

Results: Situational experiences of internalized HIV stigma were associated with increased levels of anxious and depressed affect, anger, and emotion dysregulation in both concurrent and time-lagged analyses. Situational experiences of anticipated HIV stigma were only associated with anger and only within concurrent analyses. Individual-level internalized HIV stigma was associated with anxious affect and emotion dysregulation in both concurrent and time-lagged models, and with depressed affect and fatigue in time-lagged models.

Limitations: The small and high-risk sample limits generalizability and results should be replicated in larger and more diverse samples.

Conclusions: These findings suggest that, independent of the effects of individual-level stigma, situational experiences of internalized HIV stigma are associated with increases in event-level negative affective experiences. A combination of individually-delivered and mobile interventions may be successful at reducing the impact of internalized HIV stigma on negative affect and emotion dysregulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2017.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805605PMC
February 2018

Gay men's experiences with prostate cancer: Implications for future research.

J Health Psychol 2020 03 15;25(3):298-310. Epub 2017 Jun 15.

Hunter College and the Graduate Center, The City University of New York, USA.

Gay men's experiences with prostate cancer and its impact on health-related quality of life are poorly understood. This qualitative study explored gay men's experience with prostate cancer with a focus on the emotional, physical, and sexual impact of cancer; support needs; and healthcare interactions. Three semi-structured focus groups of gay men with prostate cancer were conducted. A conventional content analytic approach was used to identify six primary content areas that described poignant aspects of the men's experience with prostate cancer: minority stress, intimacy and sexuality concerns, impact on life outlook, healthcare experiences, social support and the gay community, and intersectional identities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1359105317711491DOI Listing
March 2020

Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a U.S. national sample.

Health Psychol 2017 07 25;36(7):695-703. Epub 2017 May 25.

Department of Community Health and Social Science, City University of New York Graduate School of Public Health and Health Policy.

Objective: The syndemics framework has been used to explain the high rates of HIV infection among gay and bisexual men. However, most studies have relied primarily on urban or otherwise limited (e.g., single location) samples. We evaluated the prevalence of syndemics-here, depression, polydrug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity-among gay and bisexual men from across the United States, including nonurban areas.

Method: Using data from a national sample of 1,033 HIV-negative gay and bisexual men, demographic differences in the prevalence of each syndemic condition and associations with HIV transmission risk behavior were examined.

Results: More than 62% of men reported at least 1 syndemic condition. Prevalence did not vary by U.S. region-however, a larger proportion of nonurban men and those with lower income and education levels were above the median number of syndemic conditions. In bivariate analyses, HIV transmission risk behavior was associated with each syndemic condition except for childhood sexual abuse, whereas in multivariate analyses, it was associated with polydrug use, sexual compulsivity, being Latino, and being single and was highest among those reporting 3 or more syndemic conditions.

Conclusions: Rates of syndemic conditions among this national sample of gay and bisexual men were generally comparable to previous studies, however elevated rates in nonurban men suggest the need for targeted intervention and support. Links observed between syndemics and HIV transmission risk behavior highlight the ongoing need to address psychosocial concerns among gay and bisexual men in order to reduce their disproportionately high rates of HIV infection. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/hea0000509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532533PMC
July 2017

Clocking self-regulation: why time of day matters for health psychology.

Authors:
Brett M Millar

Health Psychol Rev 2017 12 20;11(4):345-357. Epub 2017 Apr 20.

a Health Psychology & Clinical Science Doctoral Program, The Graduate Center, City University of New York (CUNY) , New York , NY , USA.

Various lines of research have identified a number of factors that can impair a person's ability and motivation to exercise self-control, here self-regulation, in the face of a tempting object (e.g., food, sex, alcohol/drugs, smoking). Each of these in situ factors - the availability of the tempting object, one's desire for it, and impaired affective and cognitive functioning (most notably from sleep-related fatigue, daily 'wear and tear', and intoxication) - makes self-regulation more difficult, and even more so when they co-occur. This integrative paper highlights how time of day modulates the salience of these impairing factors and argues that they are likely to be especially influential on self-regulation at night, or later in one's waking day. As each factor is likely to vary considerably across the 24 hours of a day, so too will one's self-regulatory ability and motivation - although person-level characteristics such as chronotype may shift these time-based considerations. The paper thus emphasises the importance of clocking self-regulation within health psychology research and intervention design. Consideration of when a self-regulation attempt is being made and of how time of day (or night) may be altering both the person and the situation towards risk, will facilitate a more temporally contextualised account of self-regulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17437199.2017.1316673DOI Listing
December 2017

Preintervention Profiles of Information, Motivational, and Behavioral Self-Efficacy for Methamphetamine Use and HIV Medication Adherence Among Gay and Bisexual Men.

AIDS Patient Care STDS 2017 Feb 16;31(2):78-86. Epub 2017 Jan 16.

1 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.

Although rates of crystal methamphetamine use in the United States have fallen from their peak in the mid-2000s, use remains a major public health concern, which disproportionately affects gay and bisexual men (GBM). It poses a particular challenge for HIV-positive men, for whom it has been linked to medication adherence problems as well as compromised immune function. Although the information, motivation, and behavioral skills (IMB) model has been widely used to conceptualize health behavior, little is known about GBM's initial levels of information, motivation, and behavioral self-efficacy to improve HIV medication adherence and to reduce crystal methamphetamine use at the outset of treatment. The present study identified profiles of IMB factors related to HIV medication adherence and crystal methamphetamine use in a sample of 210 HIV-positive GBM who consented to participate in an intervention study. Results indicated three distinct patterns of IMB factors. The largest group was ready to change both adherence and methamphetamine use (n = 104). This group also had depression scores that were significantly lower than other groups. A second group appeared ready to change medication adherence, but was ambivalent about changing methamphetamine use (n = 60). This group reported significantly more symptoms of methamphetamine dependence than the other groups. A third group was characterized by global IMB barriers to change (n = 46). Results are discussed in the context of tailoring psychoeducation, motivational interviewing, and cognitive behavioral interventions to match these preintervention patterns of IMB factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/apc.2016.0196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312573PMC
February 2017

The Impact of Comorbidities, Depression, and Substance Use Problems on Quality of Life Among Older Adults Living With HIV.

AIDS Behav 2017 Jun;21(6):1684-1690

Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.

Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people's lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual orientation, education, and relationship status). In both bivariate and multivariable contexts, the number of comorbid conditions was associated with reduced quality of life. Depression and substance use were also negatively associated with quality of life. These findings indicate that clinical and supportive care for OALWH, particularly when related to mental health and substance use, should also include an integrated focus on the comparatively high number of current comorbid conditions that often accompany, and potentially complicate, HIV treatment and quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-016-1613-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423848PMC
June 2017

The Impact of Comorbidities, Depression, and Substance Use Problems on Quality of Life Among Older Adults Living With HIV.

AIDS Behav 2017 Jun;21(6):1684-1690

Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.

Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people's lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual orientation, education, and relationship status). In both bivariate and multivariable contexts, the number of comorbid conditions was associated with reduced quality of life. Depression and substance use were also negatively associated with quality of life. These findings indicate that clinical and supportive care for OALWH, particularly when related to mental health and substance use, should also include an integrated focus on the comparatively high number of current comorbid conditions that often accompany, and potentially complicate, HIV treatment and quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-016-1613-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423848PMC
June 2017

The Impact of Comorbidities, Depression, and Substance Use Problems on Quality of Life Among Older Adults Living With HIV.

AIDS Behav 2017 Jun;21(6):1684-1690

Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.

Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people's lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual orientation, education, and relationship status). In both bivariate and multivariable contexts, the number of comorbid conditions was associated with reduced quality of life. Depression and substance use were also negatively associated with quality of life. These findings indicate that clinical and supportive care for OALWH, particularly when related to mental health and substance use, should also include an integrated focus on the comparatively high number of current comorbid conditions that often accompany, and potentially complicate, HIV treatment and quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-016-1613-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423848PMC
June 2017

The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: Results from a randomized controlled trial with young adult gay and bisexual men.

J Consult Clin Psychol 2016 Jul 21;84(7):565-70. Epub 2016 Apr 21.

Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division.

Objective: As empirical evidence for the effectiveness of LGB-affirmative psychotherapy emerges, the question of whether some clients may derive greater benefit than others becomes important. The current study investigated whether internalized homonegativity (IH), both explicit and implicit, moderated the efficacy of a cognitive-behavioral intervention designed to improve the mental and sexual health of young gay and bisexual men through facilitating minority stress coping.

Method: At baseline, young gay and bisexual men (n = 54) experiencing symptoms of depression and anxiety completed measures of explicit and implicit IH. Participants also completed self-reports of mental health and an interviewer-based assessment of past-90-day risk behavior before and after treatment in a 10-session individual LGB-affirmative intervention.

Results: Moderation analyses showed that participants higher in implicit IH experienced greater reductions in depression (b = -2.99, p = .031, 95% confidence interval [CI] [-5.69, -0.29]), anxiety (b = -3.56, p = .014, 95% CI [-6.35, -0.76]), and past-90-day condomless anal sex with casual partners (b = -1.29, p = .028, 95% CI [-2.44, -0.14]). Participants higher in explicit IH experienced greater reductions in past-90-day heavy drinking (b = -0.42, p = .003, 95% CI [-0.69, -0.15]).

Conclusions: These findings indicate that greater gains from LGB-affirmative psychotherapy were observed in gay and bisexual men who were higher in IH, particularly when measured implicitly. As the first study that examines factors moderating the efficacy of LGB-affirmative psychotherapy, the present research has important implications for intervention development and highlights the value of incorporating implicit measures into clinical work. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/ccp0000113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919208PMC
July 2016

Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples.

AIDS Behav 2016 Feb;20(2):439-48

Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.

The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners' HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners' syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-015-1248-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831131PMC
February 2016