Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users e. Literature concerning pre-exposure prophylaxis PrEP among gay and bisexual identifying men GBM has explored facilitators and barriers to uptake and adherence. Participants who were still taking PrEP the month follow up were compared to those that had stopped.
Those that discontinued provided details on why via a free response question. Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers.
More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost. Background The sexual decision-making literature suggests that sexual arousal and behavior are associated. The somatic marker hypothesis suggests that individual neuropsychological differences in decision making, as measured by the Iowa Gambling Task IGT , may moderate these associations; however, this hypothesis has yet to be tested with event-level sexual behavior data.
Purpose We hypothesized that a daily sexual arousal would be positively associated with likelihood of engaging in sex and condomless anal sex CAS and b IGT scores would moderate these associations such that the associations would be stronger among those with higher IGT scores.
Methods We used daily diary data from highly sexually active gay and bisexual men to examine the main and interaction effects of sexual arousal and IGT scores on sexual engagement and CAS. Results As hypothesized, daily sexual arousal was positively associated with greater odds of both sexual engagement and CAS with casual male partners.
Individual-level IGT performance significantly moderated the day-level association between arousal and sexual engagement, which was stronger for men with higher IGT scores. There was no main effect of IGT scores on either sexual behavior outcome, nor did it moderate the association between arousal and CAS.
Conclusions These findings highlight the influence of sexual arousal on sexual engagement, which differed by IGT scores; the effect of arousal on CAS was much less variable and may not be moderated by neurocognitive factors. Home-based pre-exposure prophylaxis PrEP services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence.
Despite the promise of pre-exposure prophylaxis PrEP in reducing HIV transmission risk, barriers for uptake and persistence exist. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services i. 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.
A sample of participants 89 women, men completed an Internet-based survey that assessed the prevalence of sexual orientation discrimination e. The survey was conducted between April and October Women and men reported similar levels of sexual orientation discrimination in the military. Our findings demonstrate the prevalence of MST and sexual orientation discrimination among LGBT service members in the military and point to the need for strong accountability and oversight to protect sexual minority persons while they are serving their country.
The study has launched! We look forward to sharing preliminary results in early ! Testing a biopsychosocial model of New paper on situational variability in HIV stigma and its role on negative affect Available free through December, at this link: Data showed that there was no main effect for the frequency of SEM watched in association on either the number of CAS acts with casual partners or the probability of engaging in CAS during a casual sex event.
However, there was an interaction between amount of SEM consumed and percentage of bareback SEM consumed on both outcomes, such that men who reported both a high frequency of SEM consumption and a high percentage of their SEM being bareback reported the highest levels of risk behavior.
These findings highlight the role that barebacking depicted in SEM may play in the normalization of sexual risk behaviors for GBM. Interventions looking to target the role SEM may play in the lives of GBM should examine what variables may help to mediate associations between viewing SEM and engaging in risk behavior. We examined trends in SID milestones by birth cohort in a U.
Birth cohort was independent of when men first felt sexually attracted to someone of the same sex median age 11 to However, with the exception of age of first same-sex attraction, older cohorts tended to pass other milestones at later ages than younger cohorts. The other two classes felt same-sex attraction during teen years ages Findings highlight the need to monitor ongoing generational differences in passing SID milestones.
There is evidence that viewing greater amounts of SEM may result in more negative body attitude and negative affect. However, no studies have examined these variables within the same model. Greater consumption of SEM was directly related to more negative body attitude and both depressive and anxious symptomology. There was also a significant indirect effect of SEM consumption on depressive and anxious symptomology through body attitude. These findings highlight the relevance of both SEM on body image and negative affect along with the role body image plays in anxiety and depression outcomes for GBM.
They also indicate a potential role for body image in explaining the co-occurrence of SEM consumption and negative affect. For interventions looking to alleviate negative affect for GBM, it may be important to address SEM consumption and body image as they are shown to be associated with both anxious and depressive symptomology. Depression negatively impacts the health and well-being of gay and bisexual men GBM.
However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health.
The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators. Participants provided their zip codes, which were categorized according to population density and rank-normalized.
These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.
Substance use among HIV-positive persons exacerbates health problems. This study sought to estimate the prevalence of alcohol and drug-use diagnoses and examined hypothesized predictors associated with alcohol and drug-use diagnoses among HIV-positive patients in New York City NYC. These patients attended a comprehensive care clinic in NYC in Multinomial logistic regression was used to predict the odds of classification into substance use diagnosis grouping.
Of the full sample, only Compared with the No Alcohol or Drugs group, the regression model showed that older age and having a recent inpatient hospital stay independently predicted being in the Alcohol Only group; years living with HIV, having an unsuppressed viral load, and having a recent inpatient hospital stay were associated with higher odds of being in the Drugs Only and Alcohol and Drugs groups; and being women and men who have sex with men MSM were associated with decreased odds of being in the Drugs Only and Alcohol and Drugs groups.
Substance use diagnosis was associated with viremia and low CD4 counts and hospital stays. This implies that providers should screen for substance use in HIV-positive patients with poor health. Further examination of the extent of such comorbidity is instrumental for intervention efforts. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP.
Being in a monogamish relationship arrangement as compared to a monogamous arrangement and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP. 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. 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.
Using data from a national sample of 1, HIV-negative gay and bisexual men, demographic differences in the prevalence of each syndemic condition and associations with HIV transmission risk behavior were examined. Prevalence did not vary by U. 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.
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. Findings from a large cohort of gay and bisexual men in the U. We sought to examine differences between hypothetical willingness and behavioral intentions to begin PrEP in a national sample of gay and bisexual men GBM across the U.
We utilized data collected in to examine differences between those Unwilling Men with less education had higher odds of Intending to take PrEP. Those who saw themselves as appropriate candidates for PrEP had higher odds of Intending to take PrEP while those who saw themselves as inappropriate candidates for PrEP had lower odds of Intending to take PrEP in comparison to men unsure if they were appropriate candidates.
Increased motivation for condom non-use because of perceived sexual pressure by partners was associated with higher odds of Intending to take PrEP. The groups did not differ by risk behavior nor recent STI diagnosis. Overall, the distinction between willingness and intentions to take PrEP was meaningful and may help explain disparities between PrEP acceptability and uptake.
While much of the literature has focused on hypothetical willingness to take PrEP, these results highlight the importance of simultaneously assessing willingness and intentions when examining correspondence with uptake and developing interventions to increase PrEP uptake.
Despite its highly prevalent and stigmatizing nature, genital herpes has received little attention from stigma researchers relative to other sexually transmitted infections. This limitation is of great relevance to researchers and practitioners in both clinical and health care settings, given that stigma can cause psychological distress and hinder disclosure to sexual partners, hence contributing to the spread of genital herpes.
The present research developed and examined the psychometric properties of a quantitative measure of genital herpes stigma. Two hundred individuals diagnosed with genital herpes recruited through online genital herpes support groups completed a survey containing 37 items adapted from the HIV Stigma Scale, questions about demographic and herpes-related characteristics, and measures of relevant psychosocial variables. A confirmatory factor analysis yielded an item scale with 4 factors: Construct validity was supported by correlations with relevant psychosocial variables, including negative affect, rumination, and perceived social support.
As a psychometrically sound assessment tool, the Genital Herpes Stigma Scale can be used in both clinical and research settings to facilitate future efforts to alleviate the negative psychological consequences of this incurable viral infection.
The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We analyzed data from men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. A large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.
Implications for Researchers and Providers. Willingness to take PrEP were as follows: Experience having taken PrEP was as follows: In multivariable modeling, willingness to go on PrEP was independently associated with being younger, single, a person of color, and having been tested for HIV in the past 12 months.
Source of recruitment was largely unassociated with willingness to start PrEP. Number of recent male partners, number of recent condomless anal sex CAS events, and when data were collected i. In multivariable models, experience having taken PrEP was positively associated with sexual identity as gay, number of recent male sex partners, number of recent CAS acts, being tested for HIV in the past 12 months, and time in months.
Experience taking PrEP varied greatly by recruitment source, suggesting both researchers and providers might be well served to utilize digital mediums to effectively identify these individuals; however, should do so with caution as not all digital options may prove fruitful. Gay and bisexual men GBM report high rates of sexual compulsivity SC , yet no empirically based treatments exist. Participants completed a baseline interview, and were offered up to ten intervention sessions.
Of those, 11 completed a 3-month follow-up assessment. Despite problems with session attendance only 4 men completed all 10 sessions , improvements were observed in all psychological outcomes, including SC, depression, and anxiety. Decreases were observed in drug use and HIV risk. Future work should consider if fewer sessions produce similar results, whether barriers to attending all sessions could be alleviated, and how the intervention would perform compared to treatments.
However, it is less clear how willingness to start using PrEP has changed over time. Likewise, some have expressed concerns regarding the potential for risk compensation i. We examined change over time both between participants based on when they entered the study , as well as within each participant over the 12 months of his involvement.
Familiarity with PrEP increased over time both between and within participants ; however, willingness to take PrEP did not change neither between nor within participants. However, a majority believed PrEP would increase temptation for CAS, and this did not change over time within participants. Participants became more familiar with PrEP over time; however, willingness to start PrEP did not change, and this may serve as an opportunity for providers to discuss PrEP with their patients.
Looking on the Bright Side of Stigma: Stigma has been linked to adverse mental health outcomes among gay and bisexual men, yet how psychological resources facilitate adaptive coping remains unclear. The present study examined the association between stress-related growth and internalizing mental health symptoms and considered emotion regulation as a mechanism mediating this association.
Gay and bisexual men completed questionnaires measuring stress-related growth associated with sexual orientation identity development, emotion regulation difficulties, and anxiety and depressive symptoms. Stress-related growth was associated with more effective emotion regulation, which in turn predicted fewer internalizing symptoms. These findings have important implications for understanding and alleviating sexual minority mental health disparities.
We surveyed a national U. When asked to choose between forms of PrEP, Those who preferred the most effective form were younger, had less education, and reported more recent club drug use. Those who reported condomless anal sex and those who thought they were good PrEP candidates were more willing to take PrEP.
The results of ongoing clinical trials of LAI PrEP will need to demonstrate similar or greater efficacy as daily Truvada for uptake to be maximized. Prospective Measurement of Daily Health Behaviors: Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports.
We used multilevel modeling to analyze data from an online daily diary study of gay and bisexual men focused on sexual behavior and substance use. We found that greater education and older age as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time.
The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.
Results from an U. Online Study of Gay and Bisexual Men. We compared self-described HIV-positive Participants from across the U. Racial homophily partnering with those of the same race has been suggested as contributing to racial disparities in HIV among gay and bisexual men GBM. In general, 1 men tended to partner with others of the same race, 2 HIV was more prevalent among men of color, and 3 race acted independent of whether one would engage in behaviors that would put them at highest risk for transmitting HIV i.
Our findings suggest that racial disparities in HIV may be due to a higher exposure frequency i. However, men were also less likely to have anal sex when having sex with someone of the same race-a finding that works against the premise of higher exposure frequency.
Future researchers should examine both racial homophily as well as variation in sexual behavior based on same-race or different-race partnerships. Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics.
Young adults aged recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants.
During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.
We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large US national studies of gay and bisexual men GBM , and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview CASI survey.
Compared to those who completed milestones: Those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year.
Effect sizes for significant findings were small. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups. A majority of the sample consisted of TGW of color, primarily Black The most frequently reported drug used was marijuana On average, women reported Overall prevalence of any active STI was Substance use among highly sexually active gay and bisexual men: Examining sexual compulsivity, hypersexuality, and substance use.
Nov College on Problems of Drug Dependence. A day Diary Study. This study examined the time-variant association between daily minority stress and daily affect among gay and bisexual men. Tests of time-lagged associations allow for a stronger causal examination of minority stress-affect associations compared with static assessments.
Multilevel modeling allows for comparison of associations between minority stress and daily affect when minority stress is modeled as a between-person factor and a within-person time-fluctuating state. Multilevel analyses examined associations between minority stress and affect in both same-day and time-lagged analyses, with minority stress assessed as both a between-person factor and a within-person state.
Daily minority stress, modeled as both a between-person and within-person construct, significantly predicted lower PA and higher NA and AA. Self-report assessments and the unique sample may limit generalizability of this study.
The time-variant association between sexual minority stress and affect found here substantiates the basic tenet of minority stress theory with a fine-grained analysis of gay and bisexual men's daily experience. Time-lagged effects suggest a potentially causal pathway between minority stress as a social determinant of mood and anxiety disorder symptoms among gay and bisexual men. When modeled as both a between-person factor and within-person state, minority stress demonstrated expected patterns with affect.
Researchers have identified harm reduction strategies that gay, bisexual, and other men who have sex with men GBMSM use to reduce HIV transmission-including serosorting, status disclosure, and strategic positioning. We report on patterns of these behaviors among highly sexually active i. We found evidence that many men engaged in serosorting, status disclosure, and strategic positioning; however, rates varied based on the participant's HIV status.
HIV-positive and HIV-negative men both engaged in sex with men of similar status more often than they engaged in sex with men known to be a different HIV status i. With regard to strategic positioning, HIV-positive participants were the receptive partner about half the time with their HIV-negative partners and with their HIV-positive partners.
Highly sexually active GBMSM are a critical population in which to both investigate HIV prevention strategies as well as develop effective intervention programs. Providers and clinicians might be well served to include a wide range of behavioral harm reduction strategies in addition to condom use and biomedical approaches to reduce onward HIV transmission. When Parsimony Is Not Enough: The literature on sexual decision making that has been used to understand behaviors relevant to HIV and STI risk has relied primarily on cognitive antecedents of behavior.
In contrast, several prominent models of decision making outside of the sexual behavior literature rely on dual process models, in which both affective and cognitive processing are considered as important precursors to behavior. Moreover, much of the literature on sexual behavior utilizes individual-level traits and characteristics to predict aggregated sexual behavior, despite decision making itself being a situational or event-level process.
This article proposes a framework for understanding sexual decision making as the result of dual processes affective and cognitive operating at dual level of influence individual and situational.
Finally, this article ends with a discussion of the conceptual and methodological benefits and challenges to its use and future directions for research. Aggregate and event-level associations between substance use and sexual behavior among gay and bisexual men: Comparing retrospective and prospective data. Despite limited research, some evidence suggests that examining substance use at multiple levels may be of greater utility in predicting sexual behavior than utilizing one level of measurement, particularly when investigating different substances simultaneously.
We aimed to examine aggregate and event-level associations between three forms of substance use - alcohol, marijuana, and club drugs - and two sexual behavior outcomes - sexual engagement and condomless anal sex CAS. Analyses focused on both 6-week timeline follow-back TLFB; retrospective and day daily diary prospective data among a demographically diverse sample of highly sexually active HIV-positive and HIV-negative gay and bisexual men. Models from both TLFB and diary showed that event-level use of alcohol, marijuana, and club drugs was associated with increased sexual engagement, while higher aggregated frequency marijuana and any frequency club drug use were associated with decreased sexual engagement.
Event-level use of club drugs was consistently associated with increased odds of CAS across both TLFB and diary models while higher frequency marijuana use was most consistently associated with a lower odds of CAS. Findings indicated that results are largely consistent between retrospective and prospective data, but that retrospective results for substance use and sexual engagement were generally greater in magnitude.
These results suggest that substance use primarily acts to increase sexual risk at the event-level and less so through individual-level frequency of use; moreover, it primarily does so by increasing the likelihood of sex on a given day with fewer significant associations with the odds of CAS on sex days.
We tested the preliminary efficacy of a transdiagnostic cognitive-behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks i. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of pastday risk behavior.
Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men's co-occurring health problems at their source in minority stress.
If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice.
Further Evidence for a Three Group Conceptualization. Among gay and bisexual men GBM , a syndemic describes a situation in which negative conditions e. Research has suggested that sexual compulsivity SC may also be a syndemic condition. The average number of syndemic factors experienced was lowest among those who experienced Neither SC nor HD and highest among the group that experienced Both SC and HD, with those experiencing SC Only falling between the two other groups.
We examined data from highly sexually active GBM to assess how the three groups compare across a range of risk factors for HIV infection. Comparisons focused on psychosexual measures-temptation for condomless anal sex CAS , self-efficacy for avoiding CAS, sexual excitation and inhibition-as well as reports of actual sexual behavior.
While we found no significant differences between the three groups on reported number of male partners, anal sex acts, or anal sex acts with serodiscordant partners, the Both SC and HD group reported higher numbers of CAS acts and CAS acts with serodiscordant partners and also had a higher proportion of their anal sex acts without condoms compared to the SC Only group. Notwithstanding the need for sex positive HIV prevention programs, interventions that attempt to help Both SC and HD men deal with distress and address their psychosexual needs specifically may derive HIV prevention benefits.
We investigated demographic, behavioral, and psychosocial differences in willingness to use PrEP as well as the perceived impact of PrEP on participants' condom use in a sample of highly sexually active HIV-negative gay and bisexual men. Although men willing to take PrEP vs. There was limited evidence to suggest men would risk compensate. Men who had not tested for HIV recently were also significantly more likely than others to indicate willingness to take PrEP.
Numerous scales and assessments are available to assess sexual compulsivity SC. This study sought to conduct an item response theory IRT analysis of the Sexual Compulsivity Scale SCS to provide evidence about its measurement precision at the various levels of the SC construct in a sample of highly sexually active gay and bisexual men GBM.
However, the SCS could be a useful screening tool to provide a preliminary screening of people at risk for meeting criteria on the HDSI. Though research indicates a complex link between substance use and sexual risk behavior, there is limited research on the association between sexual risk behavior and prescription drug misuse.
Nearly half of the sexually active young adult prescription drug misusers in this sample reported recent sex under the influence of prescription drugs; more than three-quarters reported recent sex without a condom; and more than one-third reported recent sex without a condom after using prescription drugs.
Zero-inflated Poisson regression models indicated that White race, younger age, higher parental class, and being a heterosexual man were all associated with sexual risk behavior, sex under the influence of prescription drugs, and sexual risk under the influence of prescription drugs. Findings have implications for the targeting of prevention and intervention efforts.
A typology of prescription drug misuse: A latent class approach to contexts and risks. Introduction and Aims—Prescription drug misuse is a considerable problem among young adults, and the identification of types of misuse among this population remains important for prevention and intervention efforts.
We use Latent Class Analysis LCA to identify possible distinct latent groups of prescription drug misusers across multiple prescription drug types pain killers, sedatives, and stimulants. 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.
We utilized multilevel modeling to analyze the association between self-reported likelihood of and subsequent engagement in anal sex. 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.
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. Sexual compulsivity represents a significant public health concern among gay and bisexual men, given its co-occurrence with other mental health problems and HIV infection.
The purpose of this study was to examine a model of sexual compulsivity based on minority stress theory and emotion regulation models of mental health among gay and bisexual men. Distal minority stress processes e. Proximal minority stressors and emotion dysregulation, in turn, generally predicted sexual compulsivity both directly and indirectly through anxiety and depression.
The final model suggests that gay-specific e. Tests of interventions that address these targets to treat sexual compulsivity among gay and bisexual men represent a promising future research endeavor. Prescription drug misuse has emerged as a significant problem among young adults. While the effects of motivational contexts have been demonstrated for illicit drugs, the role of motivational contexts in prescription drug misuse remains understudied. Using data from young adults recruited via time-space sampling, we examined the role of motivational contexts in the frequency of misuse of three prescription drug types as well as drug-related problems and symptoms of dependency.
Both negative and positive motivations to use drugs are associated with increases in prescription drug misuse frequency. Only negative motivations are associated directly with drug problems and drug dependence, as well as indirectly via prescription pain killer misuse. Addressing positive and negative motivational contexts of prescription drug misuse may not only provide a means to reduce misuse and implement harm reduction measures, but may also inform the content of treatment plans for young adults with prescription drug misuse problems.
Although much is known about the association between substance use and sexual behavior, less is known about the relative contribution of individual-level i. Aggregated substance use frequency TLFB was entered it into multilevel models along with day-level substance use to predict daily sexual behavior, adjusting for HIV and relationship status. When examined simultaneously, individual-level patterns of substance use and event-level substance use on a given day have opposite effects on sexual behaviors.
These findings suggest that frequency may be suggestive of interference with sexual pursuits, while event-level use may indicate impairment in decision-making.
More Black patients Gender comparisons revealed that a smaller proportion 2. A significantly smaller proportion of MSM Three-quarters of patients with an alcohol problem also had a co-morbid drug problem and compared with patients with no alcohol problem, had nearly 9 times the odds of having a drug problem.
Contrary to previous studies showing higher rates of substance use among HIV-positive MSM and transgender populations, our results found these groups had lower rates. Partners met via sex parties have significantly greater odds for anal sex without condoms: Research suggests that the venues where men who have sex with men MSM meet their male sex partners is associated with engaging in anal intercourse with no condoms AINC.
Mean age was 37, Eighty-seven percent were gay identified. We used multivariate GEE models to account for the nested nature of the data. These findings highlight the need to innovative targeted HIV and STI prevention initiatives for men who attend sex parties. HIV-positive patients with co-occurring alcohol and drug-use problems are at increased risk for medical comorbidities.
These findings suggest that comprehensive approaches that integrate ways to address ADU problems are needed for HIV-infected patients. Syndemic factors—substance use, intimate partner violence IPV , childhood sexual abuse CSA , and depression—as well as issues of sexual compulsivity SC and hypersexual disorder HD have been shown to significantly increase risk of HIV infection and transmission.
These findings demonstrate the utility of examining distinctions in the severity of SC and HD within the existing syndemics framework. Translation, Adaptation, and Validation for Use in Brazil. Epidemiological, behavioral, and clinical data on sexual compulsivity in Brazil are very limited. For a secret to retain its power, one needs to remain within the logic of the secret, and its necessary paradox. It is known and hidden, released but guarded. Within the regime of open justice, justice must be seen to be done, but the disclosure of the secret demands that somebody is there to see it.
There are many contexts in which disclosure is — or feels — wrong. The law attempts to protect these feelings, recognising that some information or relationships might be private, personal, confidential, privileged, intimate, sensitive, or secret.
Not all of these feelings have consistent and coherent legal definition, and not all of these feelings are protected by law all of the time; sometimes the law will recognise the feeling but say that it is outweighed by a greater interest in disclosure.
Sometimes the law will recognise the feeling and regret that it cannot be protected; that it is too late, too soon, or too hard. Sometimes these feelings are protected through a legal doctrine that recognises autonomy, or control over the secret, or ownership of the secret, or responsibility for the secret.
Legal remedies might flow where the secret has been taken without permission, or distributed without consent or by accident, or where harm has been done — to the person or to another — by the disclosure, or where a law has been violated by the disclosure. But often it is the case that there is another competing legal principle that is satisfied through the disclosure: Mark Fenster, argues that legal mechanisms for regulating secrets are doomed to fail, and that the more effective techniques for keeping secrets are likely to be political or ethical.
He also argues that the binary between secrecy and disclosure cannot be sustained and, since secrecy is implausible, we would be better to focus our efforts into more effective management of disclosure. In announcing that there was a media application before the court, Deputy Chief Magistrate Felicity Broughton acknowledged that the principles of open justice would guide her decision, but she also articulated sensitivity to some of the visual evidence:.
So I raise [the media application] now as an issue that will need to be considered. In the appropriate and dignified manner in which these proceedings need to take place, be very mindful of having some fruitful discussions as to how [the media application] might be managed in accordance with the principles of open justice, but having regard to what I already anticipate are some extremely distressing and sensitive materials which certainly, on the face of it, without having made any final decision in relation to that that, certainly give me some concern.
As the proceedings unfolded, she twice interrupted counsel for the media to correct him about the degree of sensitivity involved. I understand there has also been an indication from Your Honour that there is some sensitive material Very sensitive and very distressing. Later in the proceedings, Broughton DCM revealed where the greatest sensitivities arose for her: Her Honour appeared to recognise a sensory concept of sensitivity, although she did not attempt to provide any legal framework for her feelings.
It was clear, from the audio recording of the proceedings that was released to me by the court, that she felt there was something wrong with showing these images, and that everyone in the courtroom felt it too. This could be an illustrative example of how a jurisprudence of sensitivity might start, but I would argue that there needs to be something more to make it clear that whilst everyone in the courtroom is feeling something, the wheels of justice are actually turning. Sometimes it referred to the dignity of Jill Meagher, at other times it was used when protecting her family from distress.
At times, it appeared to protect the sensibilities of strangers — casual consumers of the news media. And on at least one occasion, it referred to Adrian Bayley, as the release of this material could cause unfair prejudice to him at a future trial, given that the media application was made and resolved before he had been committed to stand trial. Significantly, and worthy of further study, is the issue of sensitive jurisprudence as a form of labour; it demands effort, time and care in a courtroom which is already busy and under pressure.
Her Honour responded that she wanted to release some materials today; whilst the defence counsel wanted to work closely, the court wanted to work fast. Her Honour offered the parties a short adjournment in order for them to identify the materials that would not be released, and for providing some legal justification for the non-disclosure. When they returned, the order was made. Photographs of her handbag and its contents were included in the police photo books released to the media in the name of open justice.
There is jurisprudential uncertainty about whether media access of this kind is required by the principles of open justice. Whilst, as I have argued elsewhere, the release of the handbag photographs likely does not promote the objectives of open justice,  it is also not clear where the line might be drawn. As heartbreaking as it feels to ask this question: We can see photographs of a squalid suburban home, taken after the discovery of the bodies of twin toddlers, starved to death as a result of parental neglect and dysfunction.
Should we share the final despairing moments in the lives of these strangers? Can we poke through their personal effects, inspect the contents of their bedroom, their lounge room, their laundry, their car?
Did I need to see that? For Sissela Bok, secrecy is the intentional concealment of information. The secret might be revealed reluctantly, it might be revealed only to certain others, it might be redacted, or we might get a quick peek at it before it is snatched from view. The withholding might be to protect something that is vulnerable, or to protect something that is powerful, or the withholding might itself be a source of pleasure.
It reminds us that disclosure is both a thing and a practice; the secret and its revelation. Sensitivity applies to both: Do the circumstances of secret capture create an ethical obligation upon those of us who might look at them?
Does it limit our motivations for looking? Are we, for example, restricted to looking for the purpose of learning? Might we look in order to investigate unlawful conduct, or to calculate the probative value of these images? Are we also entitled to look for pleasure? A jurisprudence of sensitivity needs to recognise that disclosures will have multiple effects, not always predictable or governable, and not capable of being ranked in a pre-formed hierarchy.
And so a jurisprudence of sensitivity also needs to retain a space for regret; for the disclosure that, upon reflection, ought not to have been made. Where evidence is tendered in criminal proceedings, laws operate to protect the accused from most of the unfair consequences of the evidence, and victims from some of the effects of giving evidence.
But the law does not control every consequence, nor does it control the effects of the evidence upon other people. Mark Fenster, writing about information management, said: It might do so by working slowly, by asking questions, consulting widely, deliberating, acting and then reflecting, and maybe then re-thinking, articulating concerns, regrets, and new ways forward.
Whilst evidence is adduced in order to disclose the hidden crimes of the accused, it might also make further disclosures that demand sensitivity, to the accused and to others. Separately from — although not necessarily after — the criminal trial, historians, artists, curators, scholars and journalists come to this evidence with fresh new questions, sometimes unconnected with the guilt of the accused. A jurisprudence of sensitivity would be responsive to the effects of these extra-legal projects.
It would not aim to prevent this work from being done, it favours negotiation over censorship, but it demands an active engagement with the unforeseen consequences of disclosing criminal secrets in an open justice regime.
From the Pacific war to the internet age , Oxford: Rowman and Littlefield, Curated, and with a catalogue introduction by Naomi Cass. Reflections on Photography , New York: Hill and Wang, , Farrar, Straus and Giroux, , Disclosure of Personal Information generally. Canada has opted to rely on a model of sensitivity relying, in part, on context: For the contextual approach to privacy more broadly, see Helen Nissenbaum, Privacy in context: A critique of the public trial , Oxford: Oxford University Press, , In her writing about spectatorship in some contemporary art practice, Alison Young shows how the concept of the secret-in-public operates to provoke the spectator to recognise the public secret, and also to actually see public spaces as public zones of secrecy.
Debating the Understandings of Privacy , Frankfurt am Main: Duke University Press, Policy Choices for the Digital Age , Toronto:Sometimes it referred to the dignity of Jill Meagher, at other times it was used when protecting her family from distress. It would have defeated the whole point. For the contextual approach to privacy more broadly, see Helen Nissenbaum, Privacy in context: Casualencounters craigslist cas Queensland analyses demonstrated the convergent validity of sexual shame and sexual pride with relevant constructs. Pantheon Books, Interview reproduced in Aperture, Sydemics and Resilience for HIV transmission in a national sample of vulnerable men. However, with the exception of age of first same-sex attraction, older cohorts tended to pass other milestones at later ages than younger cohorts.