mental health AIDS

Spring 2005 Newsletter

HIV Prevention News

Kalichman and Cain (2004) studied a convenience sample of 453 STD clinic attendees (313 men, 140 women) over a 6-month period and found that, for men, sensation seeking (i.e., the inclination to seek optimal stimulation and take behavioral risks) predicted unprotected intercourse 6 months later. "Sensation seeking also predicted alcohol outcome expectancies [i.e., the expectation that the sexual experience would be enhanced by drinking alcohol], which predicted alcohol use in sexual contexts 6 months later, which in turn predicted unprotected sex" (p. 367). Kalichman and Cain further determined that alcohol outcome expectancies mediated the relationship between sensation seeking and alcohol use in sexual contexts. Importantly, "[t]hese findings replicate previous research, with the prospective design confirming directional hypotheses and supporting causal conclusions" (p. 367). Noting several methodological limitations, the authors still suggest that this study

supports the conclusion that alcohol outcome expectancies serve as a cognitive mechanism through which sensation seeking influences sexual risk-related alcohol use. Unlike sensation seeking and other personality dispositions, alcohol expectancies may be amenable to change, therefore offering a potential inroad into behavioral intervention. ... Cognitive and motivational counseling approaches ... include cognitive-restructuring strategies that can address expectancies that alcohol enhances sexual outcomes. Effective counseling for risk-related alcohol use can be integrated into existing counseling services offered by ... mental health clinics. (p. 372)

In another study focusing on alcohol use, Matos et al. (2004) explored the association between alcohol intoxication and HIV risk behaviors in 557 street-recruited heroin and cocaine injecting drug users (IDUs) from "semi-rural" areas of Puerto Rico . "Findings ... suggest that, among drug injectors, the association between alcohol intoxication and both injection and sexual risk behaviors is straightforward" (p. 233); after adjustment, specific risk factors include sharing needles, sharing cotton, engaging in sex with a casual or paying partner, and trading sex for money or drugs. While these findings diverge from those of earlier studies involving different cohorts of IDUs, Matos and colleagues reason that "HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors" (p. 229).

Williams and Latkin (2005) interviewed a community sample of 332 current and former drug users from inner-city Baltimore on three occasions between 1997 and 2002 and found that high levels of depressive symptoms appeared to be causally related to sexual activity with multiple partners, as well as engaging in sex with IDUs and crack users. "Results suggest that depressive symptoms are a major contributing factor to sexual risk behavior, and therefore, at minimum, depression should be assessed [by clinicians]. ... The stress of high crime and poor living conditions may also contribute to depressive symptoms" (pp. 72-73).

On this point, Latkin, Williams, Wang, and Curry (2005) surveyed 701 IDUs from the same community (95% African American, 66% male, 21% HIV-positive) and found, among men only , that "psychological distress is higher in more socially disordered neighborhoods , that distress leads to greater injection frequency and equipment sharing, and that injection frequency predicts equipment sharing" (p. 96). Latkin and colleagues stress that "[d]epressive symptoms could be targeted for interventions; however, without reducing the neighborhood stressors it is doubtful that this would be a sustainable approach" (p. 99).

Extending their line of research on methamphetamine (meth) users, Semple, Patterson, and Grant (2004) explored condom use "stage of change" in a sample of 181 HIV-negative, heterosexual meth users : 89 in the contemplation stage of change and 92 in the preparation stage of change. 1,2 They report that

[s]exual risk behavior was highest among those in the contemplation stage of change. When compared with those in the preparation stage of change, contemplators were more likely to be never married, more likely to have an STD, consumed larger amounts of meth and other illicit drugs, had lower scores on self-efficacy and outcome expectancies for condom use and negotiation of safer sex practices, and had less positive social norms in relation to AIDS preventive behaviors. ... [In contrast,] the preparation stage of change was associated with increased self-efficacy for condom use, stronger social norms regarding condom use, and reduced occurrence of [STDs]. (p. 391)

Observing these differences between groups, Semple and colleagues point to factors "that appear to be important in terms of helping meth users, who are in the early stages of change, to adopt condom use behaviors" (p. 399).

[T]he main goal of counseling in the contemplative stage of change focuses on helping the participant resolve ambivalence toward AIDS preventive strategies. This might be accomplished by eliciting self-motivated reasons for change and enhancing the participant's self-efficacy for change. In particular, this research suggests that a focus on enhancing self-efficacy for condom use, promoting positive social norms favoring AIDS preventive behaviors, and raising awareness of STD risk, may be effective strategies for advancement from the contemplative to the preparation stage of change. (pp. 398-399)

 

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