Lack of evidence for transmission of human immunodeficiency virus through vaginal intercourse

Preliminary Study of a Chinese Language Short Form of the Marlowe–Crowne Social Desirability Scale

To evaluate the internal consistency reliability and discriminant validity of a Chinese language short form (14-item) of the Marlowe–Crowne Social Desirability Scale, data from 197 Chinese medical students were analyzed. Half (48 men, M age = 23.0 yr.; 51 women, M age = 22.0 yr.) were randomly assigned to receive standard instructions, and half (46 men, M age = 21.7 yr.; 52 women, M age = 21.5 yr.) were given mock job-selection instructions. The later had a higher mean Social Desirability score, which demonstrates discriminant validity. Split-half reliability was .71. Five factors were identified, but confirmatory factor analysis indicated adequate fit with a 1- or 2-factor model. Despite the challenge of translation into Chinese (in this case, involving translation into Mandarin and back-translation by native speakers for examination by a native speaker of English), this short form appears to have adequate internal consistency reliability and discriminant validity.

Overestimation of heterosexually attributed AIDS deaths is associated with immature psychological defence mechanisms and clitoral masturbation during penile–vaginal intercourse

Research shows that (1) greater use of immature psychological defence mechanisms (associated with psychopathology) is associated with lesser orgasmic consistency from penile–vaginal intercourse (PVI), but greater frequency of other sexual behaviours and greater condom use for PVI, and (2) unlike the vectors of receptive anal intercourse and punctures, HIV acquisition during PVI is extremely unlikely in reasonably healthy persons. However, the relationship between overestimation of AIDS deaths due to ‘heterosexual transmission’ (often misunderstood as only PVI), sexual behaviour and mental health has been lacking. Two hundred and twenty-one Scottish women completed the Defense Style Questionnaire, reported past month frequencies of their various sexual activities, and estimated the total number of women who died from AIDS in Scotland nominally as a result of heterosexual transmission in the UK from a partner not known to be an injecting drug user, bisexual or infected through transfusion. The average respondent overestimated by 226,000%. Women providing lower estimates were less likely to use immature psychological defences, and had a lower frequency of orgasms from clitoral masturbation during PVI and from vibrator use. The results indicate that those who perceive ‘heterosexual transmission’ led to many AIDS deaths have poorer psychological functioning, and might be less able to appreciate PVI.

Barriers to and Facilitators of HIV–STD Behavior Change: Intrapersonal and Relationship-Based Factors

This article draws on clinical, cognitive, and health psychology literature to explore a range of barriers to sexual risk behavior change. It is divided into 5 sections, each of which presents obstacles and solutions to address them. The first 4 sections are organized around antecedent factors commonly addressed in models of risk behavior. Barriers related to effective information, risk perception, attitudes and intentions, and behavioral skill acquisition are discussed. The 5th section focuses on barriers related to the psychological and social context of sexual encounters, factors relatively underexplored in traditional approaches to risk reduction. It is believed that future intervention programs will be strengthened by incorporating a more integrative and comprehensive approach to intrapersonal and interpersonal aspects of sexual behavior.

Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I

Studies of heterosexual HIV transmission have consistently found anal intercourse to be a highly predictive risk factor for seroconversion. Yet most AIDS prevention messages targeted at heterosexuals, presumably influenced by cultural taboos against acknowledging this sexual practice, continue to emphasize vaginal and, increasingly, oral sex transmission. The health risks of anal sex appear to be severely underestimated by a substantial proportion of sexually active women and men in North and Latin America as well as parts of South Asia, Africa, and other regions. Among heterosexuals reported rates of condom use are nearly universally lower for anal than for vaginal intercourse. This review examines anal sex among the general population, including its prevalence in various world regions, related sociocultural factors, and other associated health problems including anorectal STDs, Hepatitis B infection, and HPV-related anal cancer in women. U.S. survey and other data suggest that, in terms of absolute numbers, approximately seven times more women than homosexual men engage in unprotected receptive anal intercourse. Research among higher risk subpopulations, including bisexual men, injecting drug users, female sex workers, inner-city adolescents, and serodiscordant heterosexual couples, indicates that persons particularly at risk of being infected by or transmitting HIV are also more likely to practice anal sex. Considering this finding, along with the much greater efficiency for HIV infection as well as lower rates of condom usage, a significant proportion of heterosexual transmission in some populations is due to anal intercourse. This typically stigmatized and hidden sexual practice must be given greater emphasis in AIDS/STD prevention, women's care, and other health promotion programs.

Development and testing of an HIV-risk screening instrument for use in health care settings

OBJECTIVE

To develop and test a brief, reliable, and valid HIV-risk screening instrument for use in primary health care settings.

DESIGN

A two-phase study: (1) developing a self-administered HIV-risk screening instrument, and (2) testing it with a primary care population, including testing the effect of confidentiality on disclosure of HIV-risk behaviors.

SETTING

Phase 1: 3 types of sites (a blood donor center, a methadone clinic, and 2 STD clinics) representing low and high HIV-seroprevalence rates. Phase 2: 4 primary care sites.

PARTICIPANTS

Phase 1: 293 consecutively recruited participants. Phase 2: 459 randomly recruited primary care patients.

MAIN OUTCOME MEASURE

Phase 1: comparison of the responses of participants from low and high HIV-seroprevalence sites. Phase 2: primary care patients' rates of disclosure of HIV-risk behaviors and ratings of acceptability.

RESULTS

Phase 1: through examining item-confirmation rates, item-total correlations, and comparison of responses from low and high HIV-seroprevalence sites, we developed a final 10-item HIV-risk Screening Instrument (HSI) with an internal consistency coefficient of .73. Phase 2: 76% of primary care patients disclosed at least 1 risky behavior and 52% disclosed 2 or more risky behaviors. Patients were willing to disclose HIV-risk behaviors even knowing that their physician would see this information. Ninety-five percent of our patient participants were comfortable with the questions on the HSI, 78% felt it was important that their doctor know their answers, and 52% wished to discuss their answers with their physician.

CONCLUSION

Our brief, self-administered HSI is a reliable and valid measure. The HSI can be used in health care settings to identify individuals at risk for HIV and to initiate HIV testing, early care, and risk-reduction counseling, necessary goals for effective HIV prevention efforts.

Childhood stress, behavioural symptoms and mother-daughter pubertal development

Belsky, Steinberg and Draper (Child Development 1991, 62, 647-670) predicted that early childhood stress or conflict in the family environment would be associated with childhood behavioural symptoms, early puberty and early, less discriminate sexual behaviour. Their theory was tested in a retrospective self-report survey in 28 daughters (aged 12 to 15) and 21 mothers. In daughters, earlier menarche correlated with more family stress in a late childhood (age 7 to 11); more conflict with mother in early childhood (birth to age 6); more rejection from and less closeness to mother throughout childhood (birth to age 11); more anxiousness and internalizing symptoms (anxiousness/depression) in late childhood (age 7 to 11); earlier age at dating boys; and more boyfriends. An alternative interpretation is considered based on genetic transmission of maternal characteristics.

Patients misrepresenting their risk factors for AIDS

To determine the truthfulness of patients' and research subjects' self-reports of their sexual and drug use histories in studies of human immunodeficiency virus (HIV) transmission and acquired immunodeficiency syndrome (AIDS) risk factors, studies of or pertinent to lying about AIDS risk factors were extracted from MEDLINE and PSYCLIT. The present paper describes normal and pathological motives for misrepresenting risk factors, and reviews the literature on such underreporting. There is much evidence for lying about anal intercourse and intravenous drug use risk factors, implying that the estimates of risk for vaginal transmission of HIV (particularly in Pattern-I industrialized countries) have been inflated. Research on HIV/AIDS behavioural risk factors must include sophisticated methods for the assessment of self-report validity, such as the use of behavioural markers, improved lie scales and interview methods, and physical methods.