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Brown MJ, Osinubi MO, Amoatika D, Haider MR, Kirklewski S, Wilson P, Hansen NB. Childhood Sexual Abuse and Compulsive Sexual Behavior Among Men Who Have Sex with Men Newly Diagnosed with HIV. AIDS Behav 2024:10.1007/s10461-024-04438-4. [PMID: 38992227 DOI: 10.1007/s10461-024-04438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Childhood sexual abuse (CSA) continues to be a public health challenge. The prevalence of experiencing CSA is higher among men who have sex with men (MSM) than the general population. CSA has been linked to compulsive sexual behavior (CSB) among varying populations but has not been examined among MSM who were newly diagnosed with HIV. Therefore, the aims of this study were to assess the direct association between CSA and CSB among newly diagnosed MSM living with HIV, and to identify the potential mediating roles of depressive symptoms and emotion regulation in the association between CSA and CSB. The study was a secondary data analysis using data obtained from 2012 to 2017 from two community HIV clinics in New York City (n = 202). CSA was operationalized with questions asking about sexual abuse during childhood/adolescence. CSB was measured using the 13-item Compulsive Sexual Behavior Inventory (CSBI). Depressive symptoms were measured using the 20-item Centers for Epidemiologic Studies Depression (CES-D) scale and emotion regulation was measured using a 36-item Difficulties in Emotion Regulation Scale (DERS). Path analysis was conducted to determine the mediating role of depressive symptoms and emotion regulation in the association between CSA and CSB. There was a statistically significant association between CSA and CSB (β = 0.160; p = 0.019). There were statistically significant indirect associations between CSA, depressive symptoms, emotion regulation, and CSB (depressive symptoms β = 0.0.071; p = 0.010; DERS: β = 0.080; p = 0.006). Depressive symptoms were also correlated with emotion regulation (r = 0.596; p < 0.001). The relationship between CSA and CSB was significantly mediated by depressive symptoms and emotion regulation. Trauma-informed interventions addressing depressive symptoms and difficulties in emotion regulation may help to reduce CSB among MSM living with HIV.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, South Carolina, USA.
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
| | - Medinat Omobola Osinubi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, South Carolina, USA
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, South Carolina, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Sally Kirklewski
- ENRICH Lab, Yale School of Public Health, New Haven, Connecticut, USA
| | - Patrick Wilson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
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Kondur HR, Lee TK, McIntosh R, Gouse H, Paul R, Grov C, Fuchs D, Gómez W, Dilworth SE, Neilands TB, Carrico AW. HIV-related drivers of sexual compulsivity and sexuality in sexual minority men who use methamphetamine. J Neurovirol 2022; 28:446-455. [PMID: 35821194 DOI: 10.1007/s13365-022-01085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Although co-occurring methamphetamine (meth) use and HIV amplify the risk for neuropsychiatric comorbidities, the underlying neuroimmune mechanisms are not well characterized. We examined whether a detectable viral load and dysregulated metabolism of amino acid precursors for neurotransmitters predicted subsequent levels of sexual compulsivity and sexual sensation seeking. This 15-month longitudinal study enrolled 110 sexual minority men (SMM) living with HIV who had biologically confirmed meth use (i.e., reactive urine or hair toxicology results). Peripheral venous blood samples collected at baseline, 6 months, 12 months, and 15 months were used to measure a detectable viral load (> 40 copies/mL), the kynurenine/tryptophan (K/T) ratio, and the phenylalanine/tyrosine (P/T) ratio. The K/T and P/T ratios index dysregulated serotonin and catecholamine (e.g., dopamine) synthesis, respectively. In a cross-lagged panel model, a detectable viral load at 6 months predicted greater sexual compulsivity at 12 months after adjusting for prior levels of sexual compulsivity and recent stimulant use (β = 0.26, p = 0.046). A greater P/T ratio at baseline predicted decreased sexual sensation seeking at 6 months (β = - 0.25, p = 0.004) after adjusting for baseline sexual sensation seeking and recent stimulant use. Taken together, HIV replication and dysregulated catecholamine synthesis could potentiate sexual compulsivity while decreasing sexual pleasure in SMM who use meth.
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Affiliation(s)
- Hema R Kondur
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Tae K Lee
- Department of Child Psychology and Education, Sungkyunkwan University, Seoul, Korea
| | - Roger McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Hetta Gouse
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, MO, USA
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Walter Gómez
- Jane Addams College of Social Work, University of Illinois, Chicago, IL, USA
| | - Samantha E Dilworth
- School of Medicine, Department of Medicine, Division of Prevention Science, San Francisco Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Torsten B Neilands
- School of Medicine, Department of Medicine, Division of Prevention Science, San Francisco Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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Cienfuegos-Szalay J, Moody RL, Talan A, Grov C, Rendina HJ. Sexual Shame and Emotion Dysregulation: Key Roles in the Association between Internalized Homonegativity and Sexual Compulsivity. JOURNAL OF SEX RESEARCH 2022; 59:610-620. [PMID: 34410183 PMCID: PMC8976551 DOI: 10.1080/00224499.2021.1963649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual minority men (SMM) are at increased risk for mental health problems due to effects of sexual minority stigma (e.g., internalized homonegativity (IH)). Both IH and emotion dysregulation are contributors to sexual compulsivity; however, the role of feelings of sexual shame have not been examined in this association. A sample of 982 HIV-negative SMM completed online surveys (Mage = 42.4, SD = 13.74). Path analyses indicated significant direct effects of IH on sexual shame (β = 0.44, p < .001), emotion dysregulation (β = 0.19, p < .001), and sexual compulsivity (β = 0.22, p < .001). Modeled simultaneously, the association between sexual shame and sexual compulsivity (β = 0.26, p < .001) was significant, as was the association between emotion dysregulation and sexual compulsivity (β = 0.27, p < .001). Finally, an indirect effect of IH on sexual compulsivity through both sexual shame (p < .001) and emotion dysregulation (p < .001) was significant, and the association between IH and sexual compulsivity was reduced to non-significant (β = 0.01, p = .74). Targeting feelings of sexual shame and emotion dysregulation in clinical interventions may help reduce the negative health impact of sexual compulsivity among SMM.
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Affiliation(s)
- Jorge Cienfuegos-Szalay
- Department of Psychology, Hunter College of the City University of New York (CUNY)
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY)
| | - Raymond L Moody
- Department of Psychology, Hunter College of the City University of New York (CUNY)
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY)
| | - Ali Talan
- Department of Psychology, Hunter College of the City University of New York (CUNY)
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY)
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY)
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Interpersonal Stigma, Mental Health, and Sexual Compulsivity Among an Online U.S. Sample of Men Who Have Sex with Men Living with HIV. AIDS Behav 2022; 26:1321-1331. [PMID: 34698953 DOI: 10.1007/s10461-021-03489-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
This cross-sectional study sought to determine whether HIV-related interpersonal stigma was associated with the presence of sexual compulsivity (SC) in a national online sample of 936 men who have sex with men (MSM) living with HIV who reported recent suboptimal adherence to their antiretroviral therapy (ART) or virologic non-suppression. A modest association was found between perceptions of HIV-related interpersonal stigma and SC that was partially mediated by current mental health symptoms. White MSM were significantly more likely than Black MSM to report SC or HIV-related interpersonal stigma. Findings signal the need for therapeutic interventions that include behavioral and/or pharmacologic therapy to address overlapping intervention targets, including mental health, substance use, and sexual health. Future research should assess temporality of HIV-related interpersonal stigma and SC, as well as racial differences in relation to these constructs.
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Ewart LD, Johnson A, Bainter S, Brown EC, Grov C, Harkness A, Roth AM, Paul R, Neilands TB, Dilworth SE, Carrico AW. Tina's ParTy line: Polysubstance use patterns in sexual minority men living with HIV who use methamphetamine. Drug Alcohol Rev 2022; 41:338-346. [PMID: 34806244 PMCID: PMC11215554 DOI: 10.1111/dar.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/25/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This cross-sectional study examined the associations of demographic, structural and psychological factors with distinct typologies of polysubstance use in sexual minority men (SMM) living with HIV who use methamphetamine. METHODS In total, 161 SMM living with HIV who reported methamphetamine use in the past 3 months were recruited in San Francisco from 2013 to 2017 for a randomised controlled trial. A latent class analysis was conducted by leveraging baseline measures of self-reported use of 15 substances in the past 3 months as well as validated screening measures of hazardous alcohol and cannabis use. Correlates of latent class membership were examined using a three-step categorical latent variable logistic regression. RESULTS Four typologies of substance use were identified: (i) methamphetamine use only (43%); (ii) methamphetamine and crack-cocaine use (22%); (iii) party and play use-methamphetamine, gamma-hydroxybutyrate and amyl nitrites (i.e. poppers) with erectile dysfunction drugs (31%); and (iv) high polysubstance use (4%). SMM of colour and those with a history of incarceration were more commonly classified as engaging in methamphetamine and crack-cocaine use compared to party and play use. Men with higher sexual compulsivity scores were more commonly classified as engaging in party and play use and polysubstance use. DISCUSSION AND CONCLUSIONS There is substantial heterogeneity in polysubstance use patterns among SMM living with HIV who use methamphetamine. This will inform the development of tailored substance use interventions addressing the unique needs of SMM of colour and targeting sexual compulsivity as a prominent comorbidity for some men.
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Affiliation(s)
| | - Ariana Johnson
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sierra Bainter
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric C. Brown
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian Grov
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Audrey Harkness
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexis M. Roth
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Robert Paul
- University of Missouri St. Louis, Department of Psychological Sciences, St. Louis, MO, USA
| | - Torsten B. Neilands
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA USA
| | - Samantha E. Dilworth
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA USA
| | - Adam W. Carrico
- University of Miami Miller School of Medicine, Miami, FL, USA
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Prediction Model for the Risk of HIV Infection among MSM in China: Validation and Stability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19021010. [PMID: 35055826 PMCID: PMC8776241 DOI: 10.3390/ijerph19021010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 12/04/2022]
Abstract
The impact of psychosocial factors on increasing the risk of HIV infection among men who have sex with men (MSM) has attracted increasing attention. We aimed to develop and validate an integrated prediction model, especially incorporating emerging psychosocial variables, for predicting the risk of HIV infection among MSM. We surveyed and collected sociodemographic, psychosocial, and behavioral information from 547 MSM in China. The participants were split into a training set and a testing set in a 3:1 theoretical ratio. The prediction model was constructed by introducing the important variables selected with the least absolute shrinkage and selection operator (LASSO) regression, applying multivariate logistic regression, and visually assessing the risk of HIV infection through the nomogram. Receiver operating characteristic curves (ROC), Kolmogorov–Smirnov test, calibration plots, Hosmer–Lemeshow test and population stability index (PSI) were performed to test validity and stability of the model. Four of the 15 selected variables—unprotected anal intercourse, multiple sexual partners, involuntary subordination and drug use before sex—were included in the prediction model. The results indicated that the comprehensive prediction model we developed had relatively good predictive performance and stability in identifying MSM at high-risk for HIV infection, thus providing targeted interventions for high-risk MSM.
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Gleason N, Finotelli I, Miner MH, Herbenick D, Coleman E. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021; 18:1545-1554. [PMID: 37057439 DOI: 10.1016/j.jsxm.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior. AIM To estimate the prevalence and examine demographic correlates of CSB among gay men in the United States. METHODS A U.S. national probability sample of 227 gay-identified men were collected as part of the 2015 National Survey of Sexual Health and Behavior (NSSHB). OUTCOMES Participants completed the Compulsive Sexual Behavior Inventory (CSBI-13) and demographic measures. RESULTS Eighteen participants (7.93%) scored above the CSBI-13 clinical cut point, indicating they would likely meet criteria for clinically significant compulsive sexual behavior. To assess demographic correlates of CSB, demographic variables were entered into a logistic regression. Results of the logistic regression indicated that participant age, education, and religious affiliation were significant predictors of CSB status. Individuals scoring above the cut point were younger on average (M = 39.17; SD = 14.84) than those scoring below the cut point (M = 47.52; SD = 14.62; P = .02). Odds of scoring above the cut point were about six times greater for religiously affiliated participants compared to non-religiously affiliated participants (P = .005), and four times greater for those who had attended college compared to those who had not (P = .03). CLINICAL IMPLICATIONS These results indicate the prevalence of CSB in gay men is more modest than previously estimated, and is similar to the general population prevalence estimated in a previous study. The strongest predictor of CSB in this sample was religious affiliation, which underscores the importance of evaluating the role of religiosity in the etiology and/or identification of this clinical syndrome. STRENGTHS AND LIMITATIONS These findings are strengthened by the national probability sampling methodology and the use of the empirically validated CSBI-13 cut point. However, this sample was also older and had higher income and educational attainment than the larger population of gay men in the U.S. CONCLUSION These results indicate gay men may have a CSB prevalence rate similar to the general population, which contradicts previous research suggesting they are at greater risk for CSB. Gleason N, Finotelli I, Miner MH, et al. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021;18:1545-1554.
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Affiliation(s)
- Neil Gleason
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Itor Finotelli
- Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA
| | - Michael H Miner
- Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA
| | - Debra Herbenick
- The Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University, Bloomington, IN, USA
| | - Eli Coleman
- Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA
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Santa Maria D, Padhye N, Businelle M, Yang Y, Jones J, Sims A, Lightfoot M. Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial. J Med Internet Res 2021; 23:e26704. [PMID: 34255679 PMCID: PMC8292946 DOI: 10.2196/26704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. OBJECTIVE This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. METHODS A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. RESULTS Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). CONCLUSIONS Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024.
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alexis Sims
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
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Martins A, Canavarro MC, Pereira M. Multidimensional factors associated with perceived risk of HIV among sexually experienced individuals in Portugal. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1933146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexandra Martins
- Faculty of Psychology and Educational Sciences, University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Coimbra, Portugal
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Janssen E, Prause N, Swinburne Romine R, Raymond N, MacDonald A, Coleman E, Miner MH. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020; 17:1751-1760. [PMID: 32653392 DOI: 10.1016/j.jsxm.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested. AIM The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM). METHODS A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films. OUTCOMES Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study. RESULTS Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership. CLINICAL TRANSLATION Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior. STRENGTHS & LIMITATIONS Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli. CONCLUSION Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.
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Affiliation(s)
- Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium; Kinsey Institute, Indiana University, IN, USA.
| | | | | | - Nancy Raymond
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Angus MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Eli Coleman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Michael H Miner
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
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Massonnat-Modolo I, Chevalier A, Chollier M. Exploration de la dimension d’addiction sexuelle dans une population d'HSH en consultation de dépistage IST/VIH. SEXOLOGIES 2020. [DOI: 10.1016/j.sexol.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Briken P. An integrated model to assess and treat compulsive sexual behaviour disorder. Nat Rev Urol 2020; 17:391-406. [DOI: 10.1038/s41585-020-0343-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
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Chumakov EM, Petrova NN, Kraus SW. Compulsive Sexual Behavior in HIV-Infected Men in a Community Based Sample, Russia. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/10720162.2019.1582379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Egor M. Chumakov
- Saint-Petersburg State University, Saint-Petersburg, Russia
- Saint-Petersburg Psychiatric Hospital No. 1 named after P.P. Kaschenko, Saint-Petersburg, Russia
| | | | - Shane W. Kraus
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Ballester-Arnal R, Castro-Calvo J, Gil-Julia B, Giménez-García C, Gil-Llario MD. A Validation Study of the Spanish Version of the Hypersexual Behavior Inventory (HBI): Paper-and-Pencil Versus Online Administration. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:283-302. [PMID: 30657020 DOI: 10.1080/0092623x.2018.1518886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hypersexuality is a problematic behavior characterized by the combination of an excessive sexual desire and the pathological inability to control it. This study presents the psychometric properties of the Spanish paper-and-pencil and online versions of the Hypersexual Behavior Inventory (HBI), one of the most popular scales to assess this issue. A total of 2,250 participants (1,070 men) completed a translated version of the HBI (1,450 in paper-and-pencil; 800 online). The exploratory factor analysis yielded three factors that explained 67.53% of total variance for the HBI paper-and-pencil version. This factor structure was confirmed in the HBI online version through confirmatory factor analysis (CFA). Factorial, structural, scalar and error variance-invariance according to gender was also confirmed through multigroup CFA. Reliability of the total score and subscales ranged between .89 and .96. Likewise, correlations with other related scales were positive and significant (r between .511 and .743). Temporal stability one year after the first application was .77 (paper-and-pencil format) and .68 (online version). These results support the reliability and validity of the HBI and justify its use in the assessment of hypersexuality in Spanish-speaking countries.
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Affiliation(s)
- Rafael Ballester-Arnal
- a Departmento de Psicología Básica, Clínica y Psicobiología, Universiat , Jaume I , Castellón , Spain
| | - Jesús Castro-Calvo
- a Departmento de Psicología Básica, Clínica y Psicobiología, Universiat , Jaume I , Castellón , Spain
- b Addictive and Compulsive Behaviours Lab, Institute for Health and Behaviour, University of Luxembourg , Esch-sur-Alzette , Luxembourg
| | - Beatriz Gil-Julia
- c Departamento de Personalidad, Evaluación y Tratamientos Psicológicos , Universitat de València , Estudi General , Spain
| | - Cristina Giménez-García
- a Departmento de Psicología Básica, Clínica y Psicobiología, Universiat , Jaume I , Castellón , Spain
| | - María Dolores Gil-Llario
- d Departamento de Psicología Evolutiva y de la Educación , Universitat de València , Estudi General, Spain
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Castro-Calvo J, Ballester-Arnal R, Billieux J, Gil-Juliá B, Gil-Llario MD. Spanish validation of the Sexual Addiction Screening Test. J Behav Addict 2018; 7:584-600. [PMID: 30273048 PMCID: PMC6426369 DOI: 10.1556/2006.7.2018.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS Sexual addiction is a pathological behavior characterized by a combination of excessive sexual desire and impaired ability to control it. Its incidence ranges between 1.2% and 32.2%, although this number may vary depending on the screening tool used. This wide variability is largely due to the use of non-validated instruments (e.g., structural validity relying on exploratory analyses, instruments translated without an additional validation process, or instruments validated in another format). To deal with these limitations, this study tested the psychometric properties of the Spanish paper-and-pencil and online versions of the Sexual Addiction Screening Test (SAST). METHODS A total of 2,528 participants (1,163 males) completed the Spanish version of the SAST, along with other instruments assessing sexual compulsivity (1,585 = paper-and-pencil, 943 = online). RESULTS The exploratory factor analysis yielded a four-factor structure explaining 57.39% of the variance for the SAST paper-and-pencil version. This factor structure was then verified for the online version through the use of confirmatory factor analysis [χ2(264) = 441.59; χ2/df = 1.66; RMSEA = 0.02; CFI = 0.94; IFI = 0.94]. This methodology was also used to support measurement invariance (configural, metric, and scalar invariance) according to gender. The reliability of the total score ranged from .82 to .85. Similarly, correlations with related scales were positive and significant (r between .22 and .71). Temporal stability 1 year after the first application was 0.65 (paper-and-pencil format) and 0.60 (online version). CONCLUSION These results, together with the absence of questionnaires translated into Spanish to assess this construct, justify the use of the SAST in the evaluation of sexual addiction in Spanish-speaking countries.
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Affiliation(s)
- Jesús Castro-Calvo
- Salusex-Unisexsida, Departamento de Psicología Básica, Clínica y Psicobiología, Facultad de Ciencias de la Salud, Universitat Jaume I, Castellón, Spain
- Addictive and Compulsive Behaviours Lab, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Rafael Ballester-Arnal
- Salusex-Unisexsida, Departamento de Psicología Básica, Clínica y Psicobiología, Facultad de Ciencias de la Salud, Universitat Jaume I, Castellón, Spain
| | - Joel Billieux
- Addictive and Compulsive Behaviours Lab, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Beatriz Gil-Juliá
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Estudi General, Spain
| | - María Dolores Gil-Llario
- Departamento de Psicología Evolutiva y de la Educación, Universitat de València, Estudi General, Spain
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Rooney BM, Tulloch TG, Blashill AJ. Psychosocial Syndemic Correlates of Sexual Compulsivity Among Men Who Have Sex with Men: A Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:75-93. [PMID: 28840435 DOI: 10.1007/s10508-017-1032-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/16/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Efforts have been made to better understand sexual compulsivity by examining salient psychosocial syndemic correlates, though examination of such factors has yielded inconclusive results. Given that research on sexual compulsivity has predominately involved men who have sex with men (MSM), the aims of the current study were to establish the mean effect sizes of seven psychosocial syndemic indicators with sexual compulsivity, to determine if the effect varied as a function of the type of psychosocial syndemic, and investigate the potential moderating effects using MSM samples. A total of 95 studies were included for analyses among the psychosocial syndemic indicators of interest (i.e., depression, anxiety, alcohol use, drug use, intimate partner violence, childhood sexual abuse, and sexual risk behavior). Results revealed a medium mean effect size of sexual compulsivity, the strength of which was significantly moderated by type of psychosocial syndemic indicator. Significant mean effect sizes for all syndemic indicators on sexual compulsivity were found, with depression and anxiety having the strongest relationships; significant moderating effects were found and are discussed. Findings highlight clinical considerations regarding sexual compulsivity and its role within the HIV syndemic framework among MSM.
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Affiliation(s)
- Benjamin M Rooney
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA.
| | - Tyler G Tulloch
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Aaron J Blashill
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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Walton MT, Cantor JM, Bhullar N, Lykins AD. Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle". ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2231-2251. [PMID: 28687897 DOI: 10.1007/s10508-017-0991-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 05/03/2023]
Abstract
An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.
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Affiliation(s)
- Michael T Walton
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - James M Cantor
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Navjot Bhullar
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
| | - Amy D Lykins
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia.
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Semple SJ, Pitpitan EV, Goodman-Meza D, Strathdee SA, Chavarin CV, Rangel G, Torres K, Patterson TL. Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues. PLoS One 2017; 12:e0186814. [PMID: 29065132 PMCID: PMC5655432 DOI: 10.1371/journal.pone.0186814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, United States of America
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Claudia V Chavarin
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | | | - Karla Torres
- Agencia Familiar Binacional, A.C., Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Brown MJ, Serovich JM, Kimberly JA. Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV. AIDS Behav 2016; 20:1667-74. [PMID: 26979416 DOI: 10.1007/s10461-016-1361-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sexual compulsivity is operationalized by engaging in repetitive sexual acts, having multiple sexual partners and/or the excessive use of pornography. Outcome expectancy refers to the beliefs about the consequences of engaging in a given behavior. Research examining the relationship between outcome expectancy and sexual compulsivity is limited. The aim of this study was to assess the association between outcome expectancy and sexual compulsivity among men who have sex with men (MSM) living with HIV. Data were obtained from 338 MSM. Simple and multiple linear regression models were used to assess the association between outcome expectancy and sexual compulsivity. After adjusting for age, race/ethnicity, income, education, and employment status, for every one point increase in outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices, there was, on average, an approximate one point decrease in sexual compulsivity score. Prevention and intervention programs geared towards reducing sexual compulsivity among MSM should focus on increasing outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices.
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Affiliation(s)
- Monique J Brown
- College of Behavioral and Community Sciences, University of South Florida, Tampa, 33612, FL, USA.
| | - Julianne M Serovich
- College of Behavioral and Community Sciences, University of South Florida, Tampa, 33612, FL, USA
| | - Judy A Kimberly
- College of Behavioral and Community Sciences, University of South Florida, Tampa, 33612, FL, USA
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Jardin C, Garey L, Sharp C, Zvolensky MJ. Acculturative Stress and Risky Sexual Behavior: The Roles of Sexual Compulsivity and Negative Affect. Behav Modif 2015; 40:97-119. [PMID: 26584611 DOI: 10.1177/0145445515613331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent syndemic models of sexual health disparities affecting racial/ethnic minorities have highlighted the role of discrimination. Yet no previous work has examined how acculturative stress (distress at the transition from one's original culture toward a new culture) associates with sexual HIV-risk behavior (SHRB). Work among other minority populations suggests sexual compulsivity (SC) may contribute to syndemic sexual health disparities as a means of coping with distress. With this in mind, the present study examined whether SC explained the relation between acculturative stress and SHRB. Separate analyses were conducted for males and females within a sample of 758 sexually initiated racial/ethnic minority college students. Among males and females, acculturative stress had an indirect effect on SHRB via SC. As the first study to examine SHRB in relation to acculturative stress, findings provide preliminary evidence that targeting SC among racial/ethnic minorities may help reduce sexual health disparities.
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Affiliation(s)
| | | | - Carla Sharp
- University of Houston, Houston, TX, USA The Menninger Clinic, Houston, TX, USA
| | - Michael J Zvolensky
- University of Houston, Houston, TX, USA University of Texas MD Anderson Cancer Center, Houston, TX, USA
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