Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: prevalence and predictors of high-risk behaviors

Childhood Sexual Abuse and Compulsive Sexual Behavior Among Men Who Have Sex with Men Newly Diagnosed with HIV

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.

Psychometric Properties of the Sexual Compulsivity Scale in Men Who Have Sex with Men in Spanish Population

The Sexual Compulsivity Scale (SCS) has been translated, adapted and validated in general Spanish population, making its application difficult in certain groups, such as men who have sex with men (MSM). This paper evaluates the psychometric properties of the SCS in a sample of MSM in Spain. The SCS was administered to 881 participants. The factorial structure of the SCS was examined with an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Both EFA and CFA confirmed a two-factor structure: (1) Interference of sexual behavior, and (2) Failure to control sexual impulses. Internal consistency was really good for the scale and also for both factors. The SCS also presented adequate psychometric properties. Thus, it is an appropriate measure for assessing sexual compulsivity in MSM, and a tool to be taken into account in future researches to reduce sexual risk behaviors in the MSM Spanish population.

Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study

The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (r_{general sexual responsiveness}=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.

The Relationship Between Alcohol and Drug Use, Compulsive Sexual Behavior, and Condomless Anal Sex in Men Who have Sex with Men: Analysis of Retrospectively-Reported Sexual Behavior

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

OBJECTIVES

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD.

METHODS

An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD.

CONCLUSIONS

An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

Impulsivity, Sexual Compulsivity, and Sexual Risk Behaviors among Hispanic Men Who Have Sex with Men in a US-Mexico Border City

Hispanic men who have sex with men (HMSM) experience HIV risk-related and mental health disparities. The relationship of mental health (i.e., depressive symptoms and anxiety) on sexual risk behaviors of HMSM has been reported. However, little is known about the influence of impulsivity and compulsivity on sexual risk behaviors. A cross-sectional study explored these factors among 150 HMSM in the El Paso, Texas area utilizing standardized measures, in a cross-sectional study. Regression analysis determined the influence of sexual impulsivity and compulsivity, and demographic variables on sexual risk behaviors, indicating interventions should target these behaviors to mitigate sexual risk among HMSM.

Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample

BACKGROUND

Hypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain.

AIM

The present study was an independent psychometric examination of 2 of the most commonly used measures of Compulsive Sexual Behavior Disorder; specifically, the gender invariance of the latent structure, reliability (test retest, internal consistency), and external correlates (concurrent validity) of these measures.

METHODS

The Sexual Compulsivity Scale and the Hypersexual Behavior Inventory were completed by 2 nonclinical online community samples of cisgender women (ns = 525 and 359), cisgender men (ns = 419 and 364), and transgender or non-binary individuals (ns = 38 and 11).

OUTCOMES

Criterion based measures of sexual history and total sexual outlet (number of orgasms per week) were gathered to validate Sexual Compulsivity Scale and Hypersexual Behavior Inventory total and factor scores.

RESULTS

Results supported the factorial validity of both assessment measures: correlated 3 factor solutions were established through exploratory factor analysis of 1 sample, and confirmatory factor analysis in the second sample. Multiple group confirmatory factor analysis, conducted on the 2 combined samples, also supported the gender invariance of the 3-factor solutions. Additional basic psychometric indices of test-retest and internal consistency reliability and criterion-related (concurrent) validity conducted across the 2 online samples were supported.

CLINICAL IMPLICATIONS

Common measures of hypersexuality have potential for use in its assessment, treatment, and management.

STRENGTHS & LIMITATIONS

Study strengths include: the inclusion of 2 fairly large and diverse online samples, thorough checks for insufficient effort/validity of responding, validity and reliability methodology (ie, measurement at multiple time points, obtaining behavioral indicators of sexual health), and a comprehensive set of psychometric analyses to inform conclusions regarding the external validity, reliability, and latent structure of hypersexuality measures across gender groups. Study limitations include: potential concerns related to validity and accuracy of responding owing to a reliance on self-report, the potential for selection bias, and limiting the examination of the latent structure of hypersexuality to cisgender men and women such that the results may not generalize to gender diverse populations.

CONCLUSION

Hypersexuality is a multidimensional construct, with a common latent structure among cisgender men and women, consistency in measurement over time, and meaningful concurrent associations with behavioral criteria that have relevance for sexual health. Olver ME, Kingston DA, Laverty EK, et al. Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample. J Sex Med 2022;19:331-346.

Tina's ParTy line: Polysubstance use patterns in sexual minority men living with HIV who use methamphetamine

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.

The prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending antiretroviral therapy clinic in Gambella town, Southwest Ethiopia, 2020

INTRODUCTION

Sexual compulsivity is a concealed psychiatric disease marked by intrusive thoughts followed by ritualized sexual acts. In Ethiopia, the prevalence of HIV/AIDS has recently increased. Furthermore, sexual compulsivity among adults living with HIV/AIDS receives less attention, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending ART clinic in Gambella town, Southwest Ethiopia, 2020.

METHOD

A hospital-based study employing cross-sectional design and simple random sampling technique was used to select the study participants. Data were collected by using interview technique. A 10 item Sexual Compulsivity Scale (SCS) questionnaire was used to assess sexual compulsivity. The translated version of the questionnaire was used for data collection. Bivariate and multivariable logistic regression was conducted to determine factors associated with the outcome variable at p-value < 0.05 with a 95% confidence interval.

RESULT

Out of 300 respondents, 27% (24.3, 29.2) of them were scored above the mean score of the Sexual Compulsivity Scale. Age less than 31 years old, widowed, involving in risky sexual behaviors, current substance use, not received any skill training about safer sex behaviors, and not attending support group discussion on HIV prevention were significantly associated with sexual compulsivity.

CONCLUSION

Almost one fourth of the respondents have high score for Sexual Compulsivity Scale score. Therefore, there is a need of routine sexual behavior screening program and collaboration with mental health workers for addressing the problem. Furthermore, the emphasis should be given on the identified high-risk categories.

Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States

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.

Immigrant Generational Differences in Social Support and Sexual Risk Behaviors Among Men Who Have Sex With Men in Seattle, Washington

Different immigrant generations may encounter distinct sexual opportunities with implications for HIV transmission. Yet, few studies have examined how immigrant generational status is associated with sexual risk behaviors among men who have sex with men (MSM). We explored relationships between immigrant generational status, social support, and sexual risk behaviors among English-speaking MSM using data from surveys conducted in Seattle, Washington, in 2014 (n = 323). We compared the sexual risk behaviors and social support of first-generation, second-generation, and third- and higher-generation MSM, and examined whether immigrant generational status and social support were associated with sexual risk behaviors using logistic regression models. Second-generation MSM reported lower friend social support than first- or third- and higher-generation MSM (p < .05). However, immigrant generational status was not associated with sexual risk behavior outcomes, even after accounting for social support. Results suggest that differences in immigration processes such as acculturation may be more predictive of risk behaviors than generational status alone.

Sex, Drugs, and Impulse Regulation: A Perspective on Reducing Transmission Risk Behavior and Improving Mental Health Among MSM Living With HIV

Unprotected sexual contact continues to be a main cause of HIV transmission and poses certain key populations at increased risk for HIV infection. One of the populations at high risk are men who have sex with men. A subset of MSM engages in chemsex, whereby consumption of illicit drugs is used to facilitate or enhance sexual activity. This practice can have several negative consequences, such as sexually transmitted infections (including HIV) and mental health problems (including compulsive sexual behavior, addiction, and mood disorders). In this article, we provide our perspective on the current situation that medical professionals dealing with MSM living with HIV often feel empty-handed in how to deal with these behavioral and psychological issues. Close collaboration between somatic and mental health professionals is key to address treatment needs of people living with HIV, regarding the negative consequences of chemsex and their overall quality of life. In this article, we discuss possibilities for psychological treatment, including behavioral skills training to improve impulse control and reduce compulsive sexual behaviors among MSM living with HIV who persistently engage in sexual transmission risk behavior, based on our experience with implementing such an intervention. Important barriers and facilitators for further implementation of behavioral interventions will be discussed. Reduction of HIV transmission risk behavior is needed to achieve the WHO aim to end HIV as a public health threat by 2030. We propose that close collaboration between somatic and mental health professionals and implementation of behavioral interventions for risk populations are key to achieve this goal.

Substance Use as a Mechanism for Social Inclusion among Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada

Background: Previous research demonstrates that substance use preferences and social-sexual environments are highly interrelated for gay, bisexual, and other men who have sex with men (gbMSM). Objective: We conducted a qualitative study to explore the socio-cultural context of substance use among local gbMSM communities in Metro Vancouver, Canada. Methods: Twenty gbMSM were purposively sampled from the larger Momentum Health Study cohort, a sexual health study of gbMSM in Greater Vancouver. Participants were demographically diverse in terms of HIV serostatus, age, income, ethnicity, and area of residence within the city and neighboring suburbs. Community maps generated by participants during formative research served as prompts for semi-structured interviews which were audio recorded and transcribed verbatim. Thematic analysis identified three themes of common experience. Results: First, participants indicated that substance use is intrinsically social in Vancouver gbMSM communities and that it functions as both a means of social inclusion and exclusion. Second, a distinction was made between types of substances and the location and context of their use, with specific substances having particular uses and meanings. Third, analysis suggested that gbMSM change their substance use over the life course and that this is affected by shifting priorities as people age. Discussion: For Vancouver gbMSM communities, substance use serves several social-cultural functions and can simultaneously serve as both a potential facilitator and barrier for community connection. Future research and health programing should consider venue and context specific messaging and recognize the heterogeneity of substance use within the larger gbMSM population.

Sexual compulsivity and its relationship with condomless sex among unmarried female migrant workers in Shanghai, China: a cross-sectional study

Background

Individuals with high sexual compulsivity are preoccupied with their sexual desire to such an extent that it interferes with their normal daily life and can inhibit self-control. Previous studies have found a close association between sexual compulsivity and condomless sex among different populations; however, no studies have investigated this among unmarried female migrant workers in China. This study aimed to validate the Sexual Compulsivity Scale (SCS) for appropriate use and examine the association between sexual compulsivity and condomless sex in this target population.

Methods

In 2015, we recruited 1325 unmarried female migrant workers in Shanghai, China. Information about sociodemographics, sexual compulsivity, and condomless sex were collected using a structured questionnaire. Exploratory factor analysis and reliability analysis were performed to validate the Chinese version of the SCS. Multiple logistic regression analyses were used to examine the association between sexual compulsivity and condomless sex.

Results

The prevalence of condomless sex in the previous 6 months was 66.8% among all participants. The SCS was proven internally consistent for the overall scale (Cronbach’s α = 0.89), and two factors, Social Disruptiveness (Cronbach’s α = 0.87) and Perceived Self-Control (Cronbach’s α = 0.84), were extracted. With mean total score of 18.25 (standard deviation = 4.94) after adjusting for significant sociodemographic factors, the SCS total scores (adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 1.02–1.07) and two subscale scores (AOR = 1.07, 95% CI = 1.02–1.13; AOR = 1.06, 95% CI = 1.02–1.10) were all related to inconsistent condom use with partners in the previous 6 months.

Conclusions

The Chinese version of the SCS was found to be well adaptable for use among unmarried Chinese female migrant workers and a potential predictor for condomless sex. In addition to safe sex interventions, counselling on managing sexually compulsivity should also be provided in this population.

Correlates of Serodiscordant Condomless Anal Intercourse Among Virologically Detectable HIV-Positive Young Men Who Have Sex with Men

Sexual transmission risk occurs in the context of serodiscordant condomless anal intercourse (CAI) where the seropositive partner is virologically detectable (VL+) and/or seronegative partner is not on PrEP. We analyzed correlates of serodiscordant CAI among 688 VL+ young men who have sex with men (YMSM). In multivariable analyses, serodiscordant CAI was associated with a receiving a HIV diagnosis in the past 6 months, greater depressive symptoms, and cocaine use during the past 90 days. Although HIV+ YMSM currently experience disparities across the continuum of care, those new to care may need support adopting risk reduction strategies with their sexual partners.

A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China

Background

HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China.

Methods

A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants’ sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses.

Results

After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004–1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033–1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042–1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984–1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex.

Conclusions

The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive–behavioral intervention programs are needed.

Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment

BACKGROUND

Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative.

METHODS

In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target blood alcohol concentration = 0.080%), placebo alcohol (target blood alcohol concentration = 0.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/nonaroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex.

RESULTS

A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274) = 9.43, P = 0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274) = 1.86, P = 0.174).

CONCLUSIONS

The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts.

Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory

INTRODUCTION

One of the major obstacles to conducting epidemiologic research and determining the incidence and prevalence of compulsive sexual behavior (CSB) has been the lack of relevant empirically derived cut points on the various instruments that have been used to measure the concept.

AIM

To further develop the Compulsive Sexual Behavior Inventory (CSBI) through exploring predictive validity and developing an empirically determined and clinically useful cut point for defining CSB.

METHODS

A sample of 242 men who have sex with men was recruited from various sites in a moderate-size Midwestern city. Participants were assigned to a CSB group or a control group using an interview for the diagnosis that was patterned after the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. The 22-item CSBI was administered as part of a larger battery of self-report inventories.

MAIN OUTCOME MEASURES

Receiver operating characteristic analyses were used to compute area-under-the-curve measurements to ascertain the predictive validity of the total scale, the control subscale, and the violence subscale. Cut points were determined through consensus of experts balancing sensitivity and specificity as determined by receiver operating characteristic curves.

RESULTS

Analyses indicated that the 22-item CSBI was a good predictor of group membership, as was the 13-item control subscale. The violence subscale added little to the predictive accuracy of the instrument; thus, it likely measures something other than CSB. Two relevant cut points were found, one that minimized false negatives and another, more conservative cut point that minimized false positives.

CONCLUSION

The CSBI as currently configured measures two different constructions and only the control subscale is helpful in diagnosing CSB. Therefore, we decided to eliminate the violence subscale and move forward with a 13-item scale that we have named the CSBI-13. Two cut points were developed from this revised scale, one that is useful as a clinical screening tool and the other, more conservative measurement that is useful for etiologic and epidemiologic research. Miner MH, Raymond N, Coleman E, Swinburne Romine R. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory. J Sex Med 2017;14:715-720.

Testing the Effectiveness of Cognitive Analytic Therapy for Hypersexuality Disorder: An Intensive Time-Series Evaluation

The evidence base for treatment of hypersexuality disorder (HD) has few studies with appropriate methodological rigor. This study therefore conducted a single case experiment of cognitive analytic therapy (CAT) for HD using an A/B design with extended follow-up. Cruising, pornography usage, masturbation frequency and associated cognitions and emotions were measured daily in a 231-day time series. Following a three-week assessment baseline (A: 21 days), treatment was delivered via outpatient sessions (B: 147 days), with the follow-up period lasting 63 days. Results show that cruising and pornography usage extinguished. The total sexual outlet score no longer met caseness, and the primary nomothetic hypersexuality outcome measure met recovery criteria. Reduced pornography consumption was mediated by reduced obsessionality and greater interpersonal connectivity. The utility of the CAT model for intimacy problems shows promise. Directions for future HD outcome research are also provided.

Feasibility of an Emotion Regulation Intervention to Improve Mental Health and Reduce HIV Transmission Risk Behaviors for HIV-Positive Gay and Bisexual Men with Sexual Compulsivity

Gay and bisexual men (GBM) report high rates of sexual compulsivity (SC), yet no empirically based treatments exist. An intervention based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders was pilot tested in a sample of 13 HIV-positive GBM with SC. 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. The Unified Protocol may be useful in improving the health of HIV-positive GBM, however challenges with session attendance must be addressed. 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.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Moral and Sexual Disgust Suppress Sexual Risk Behaviors among Men Who Have Sex with Men in China

Increasingly more men who have sex with men (MSM) are engaging in sexual risk taking in China in recent years. Given the high rates of HIV infection among MSM in China, it is urgent that we understand the factors that influence MSM's practice of sexual risk taking. Disgust sensitivity, which elicits a behavioral avoidance response, has the potential to influence risky sexual behavior. The present study examined the relationship between disgust sensitivity and sexual risk behavior among MSM in China. Men (n = 584) who reported having anal intercourse in the previous 6 months were recruited from the Internet. Two indicators of sexual risk behaviors were measured: condom use and the number of sex partners. The results indicated that moral disgust was positively associated with condom use, with MSM who had higher moral disgust being more likely to use condoms than others did. Sexual disgust was positively associated with the number of sex partners, with MSM who had higher sexual disgust having fewer male sex partners than others did. Sexual and moral disgust sensitivity significantly predicted HIV testing. Our study verified that sexual and moral disgust suppressed sexual risk behaviors and promoted HIV testing. Moral and sexual education should be incorporated in future strategies for HIV prevention and encouragement of safe sex behaviors among MSM in China.

Behavioral risk assessment for infectious diseases (BRAID): Self-report instrument to assess injection and noninjection risk behaviors in substance users

BACKGROUND

Infectious diseases such as Human Immunodeficiency Virus and Hepatitis C are a significant problem among substance abusers. Current risk behavior measures [e.g., HIV Risk Taking Behaviour Scale (HRBS) and Risk Assessment Battery (RAB)] were developed for injection drug users and do not include newly identified risks or noninjection drug use behaviors. This study developed and provided initial, internal validation of the Behavioral Risk Assessment for Infectious Diseases (BRAID) to assess infectious disease risk behaviors among alcohol and other drug users.

METHODS

A self-report measure was developed from literature regarding risk behaviors. Participants (total N=998) with alcohol/substance use disorder completed the measure in 2 phases to establish initial psychometric validity.

RESULTS

Phase 1 (N=270) completed 65 self-report questions; factor analysis revealed a 12-item solution with 5 factors (Unprotected Sex with Risky Partners, Injection Use, Sex on Cocaine/Crack, Condom Availability, and Intranasal Drug Use). Infectious disease history was positively associated with Injection Use (Sample 1) and Unprotected Sex with Risky Partners (Sample 2) and negatively associated with Intranasal Drug Use (Samples 1 and 2). Phase 2 (N=728) added additional injection-related items and confirmed the factor structure of the existing BRAID.

CONCLUSIONS

The BRAID is a 5-factor, 14-item self-report measure of past 6 month risk behaviors that is composed of noninjection and injection risk behaviors and was psychometrically confirmed. Though additional external (convergent/divergent) validation is needed, this report provides preliminary support for the use of the BRAID to assess infectious disease risk in substance users.

Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV

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.

Depression, Compulsive Sexual Behavior, and Sexual Risk-Taking Among Urban Young Gay and Bisexual Men: The P18 Cohort Study

Young gay, bisexual, and other men who have sex with men (YMSM) are at increased likelihood of experiencing depression and engaging in condomless sexual behaviors. The goal of the current investigation was to examine the relationship between negative mood and compulsive sexual behavior (CSB) and to assess for their individual and combined influence on sexual risk-taking behavior among a diverse sample of YMSM in New York City (the P18 Cohort Study). We first analyzed sociodemographic, depressive symptoms, CSB, and sexual risk-taking from the cross-sectional data of 509, 18- or 19-year-old YMSM recruited using non-probability sampling. We found a significant positive correlation between CSB and depression and between CSB and frequency of condomless anal sex acts reported over the last 30 days. Multivariate results found that the presence of both depression and CSB contributed to elevated sexual risk-taking among these urban YMSM. Clinical implications include the importance of assessing for CSB when depression is present and vice versa in order to improve HIV prevention. Informed by minority stress theory and syndemic theory, our results suggest that interventions focused on the health of YMSM recognize that mental health and social context all interact to increase physical health vulnerability vis-a-vis sexual behaviors, depression, and CSB. Thus, HIV prevention and intervention programs need to incorporate mental health components and services that address these needs.

Changes in Familiarity with and Willingness to Take Preexposure Prophylaxis in a Longitudinal Study of Highly Sexually Active Gay and Bisexual Men

PURPOSE

For gay and bisexual men (GBM), research suggests that familiarity with preexposure prophylaxis (PrEP) has been increasing since being approved by the United States Food and Drug Administration in 2012. 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.e., reduced condom use) were one to start PrEP; however, again, it is unclear how risk compensation may have changed over time.

METHODS

We conducted baseline and 12-month assessments with 158 highly sexually active HIV-negative GBM in New York City who were assessed between 2011 and 2014. 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).

RESULTS

Familiarity with PrEP increased over time (both between and within participants); however, willingness to take PrEP did not change (neither between nor within participants). Few men believed taking PrEP would cause their condomless anal sex (CAS) to increase and this did not change over time. However, a majority believed PrEP would increase temptation for CAS, and this did not change over time within participants. Sexual compulsivity symptomology was associated with higher willingness to take PrEP and perceiving that PrEP would increase one's temptations for CAS. Furthermore, recent CAS was associated with greater willingness to take PrEP, a perception that PrEP would increase one's likelihood to engage in CAS, and a perception that being on PrEP would increase one's temptation for CAS.

CONCLUSIONS

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. Men who engaged in CAS were interested in PrEP and preexisting patterns of sexual behavior may be the primary determinant of CAS while on PrEP.

Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups-Neither SC nor HD; SC only, and Both SC and HD-that capture distinct levels of severity across the SC/HD continuum. We examined data from 370 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. Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. 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. Our findings support the validity of a three-group classification system of SC/HD severity in differentiating psychosexual and HIV-related sexual risk behavior outcomes in a sample of GBM who report similarly high levels of sexual activity. 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.

Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention

Although alcohol consumption is frequently perceived as a driver of condomless sex and subsequent HIV acquisition, the causal nature of this relationship remains unclear, and little is known about alcohol's direct versus indirect impact on the sexual risk dynamics of those who are HIV-positive. To address this gap, we present the protocol for an in-progress NIAAA-funded controlled experiment, wherein a sample of HIV-positive men-who-have-sex-with-men (MSM) undergoes an alcohol consumption manipulation (alcohol/placebo/control) and sexual arousal induction (sexually aroused/non-aroused), and then reports intentions to engage in condom-protected and condomless sexual acts with hypothetical sexual partners differing in HIV serostatus (HIV+/HIV-/HIV status unknown), condom use preference (use/don't use/not stated), and physical attractiveness (attractive/unattractive). Study outcomes will identify alcohol's impact on HIV-positive MSM's condomless sex intentions in the context of experimentally-manipulated factors as well as risk-relevant personality traits and alcohol-related expectancies. Detailed experimental procedures, ethical considerations, and potential implications for HIV prevention are discussed.

Sexual Compulsivity Scale, Compulsive Sexual Behavior Inventory, and Hypersexual Disorder Screening Inventory: Translation, Adaptation, and Validation for Use in Brazil

Epidemiological, behavioral, and clinical data on sexual compulsivity in Brazil are very limited. This study sought to adapt and validate the Sexual Compulsivity Scale (SCS), the 22-item version of the Compulsive Sexual Behavior Inventory (CSBI-22), and the Hypersexual Disorder Screening Inventory (HDSI) for use in Brazil. A total of 153 participants underwent psychiatric assessment and completed self-reported measures. The adaptation process of the instruments from English to Portuguese followed the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The reliability and validity of the HDSI criteria were evaluated and the construct validity of all measures was examined. For the SCS and HDSI, factor analysis revealed one factor for each measure. For the CSBI-22, four factors were retained although we only calculated the scores of two factors (control and violence). All scores had good internal consistency (alpha >.75), presented high temporal stability (>.76), discriminated between patients and controls, and presented strong (ρ > .81) correlations with the Sexual Addiction Screening Test (except for the violence domain = .40) and moderate correlations with the Impulsive Sensation Seeking domain of the Zuckerman Kuhlman Personality Questionnaire (ρ between .43 and .55). The sensitivity of the HDSI was 71.93 % and the specificity was 100 %. All measures showed very good psychometric properties. The SCS, the HDSI, and the control domain of the CSBI-22 seemed to measure theoretically similar constructs, as they were highly correlated (ρ > .85). The findings support the conceptualization of hypersexuality as a cluster of problematic symptoms that are highly consistent across a variety of measures.

Is Hypersexuality Dimensional or Categorical? Evidence From Male and Female College Samples

The recent attempt to introduce hypersexual disorder into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has increased empirical scrutiny of the construct. Consensus on its definition and underlying structure remains elusive. Whereas some conceptualizations favor a categorical latent structure, others speculate that hypersexual behavior is dimensional. Research on the latent structure of hypersexual behavior, however, has been sparse. This is unfortunate, because determination of the latent structure can contribute to more accurate assessment, diagnosis, and understanding of etiological process. To date the only study on hypersexuality's latent structure found consistent evidence of a dimensional structure for males but less clear results for females. In the present study the Multidimensional Inventory of Development, Sex, and Aggression (MIDSA), a self-report, contingency-based inventory, was administered to 1,146 college students. Four indices of hypersexual behavior and six indices of sexual compulsivity were analyzed, using three taxometric methods (mean above minus below a cut [MAMBAC], maximum covariance [MAXCOV], and latent mode factor analysis [L-Mode]). Evidence supported a dimensional latent structure for hypersexuality in male and female samples. Future assessments of hypersexuality must focus on adequate reliability and discriminant validity across the continuum of sexual behavior rather than on attempts to differentiate between arbitrarily developed diagnostic categorizations.

Compulsive sexual behavior: a review of the literature

BACKGROUND AND AIMS

Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual's life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options.

METHODS

We reviewed the literature regarding the clinical aspects of CSB and treatment approaches.

RESULTS

The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm.

CONCLUSIONS

Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology.

Relationship between sexual compulsivity and sexual risk behaviors among Chinese sexually active males

Compulsivity is defined as "an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions." Sexual compulsivity has been shown to be associated with some high risk sexual behaviors related to HIV and sexually transmitted infection (STI). In some Western countries, the 10-item Sexual Compulsivity Scale (SCS) has been developed to assess people's sexual compulsivity but no Chinese version has been validated. This study validated the Chinese version of the SCS and investigated its associations with specific sexual behaviors. In 2008, a random telephone survey was conducted in the sexually active male general population in Hong Kong, interviewing 1,048 participants. The Chinese version of the SCS was found to be internally consistent (Cronbach's α = 0.88 for the overall scale), with a mean total score of 20.7 (SD = 4.7). An exploratory factor analysis procedure extracted two factors that were named Controllability and Functional Consequences. Higher SCS scores were associated with multiple female sexual partnerships in the last 6 months, having had sex with either non-regular partner(s) or female sex worker(s) in the last 6 months, having contracted STI in the last 6 months, and inconsistent condom use with either non-regular partner(s) or female sex worker(s) in the last 6 months. The scale can be used to assess sexual compulsivity among sexually active Chinese men in Hong Kong. It can potentially be used in other Chinese communities. Further confirmatory studies are warranted.

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay-oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero-discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R-UAI) and 37% reported insertive anal intercourse (I-UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I-UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I-UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.

An item response theory analysis of the sexual compulsivity scale and its correspondence with the hypersexual disorder screening inventory among a sample of highly sexually active gay and bisexual men

INTRODUCTION

Numerous scales and assessments are available to assess sexual compulsivity (SC).

AIM

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).

METHODS

SCS data from a sample of 202 GBM who are highly sexually active but who vary in their experiences of SC symptoms were modeled using Samejima's polytomous graded response IRT model. To describe the performance of the SCS relative to the Hypersexual Disorder Screening Inventory (HDSI), SCS scores were compared with participants' corresponding HDSI results to determine sensitivity, specificity, positive and negative predictive values, and accuracy.

MAIN OUTCOME MEASURES

This study examined the correspondence between the SCS and the HDSI, a diagnostic instrument for the screening of hypersexuality.

RESULTS

IRT analyses indicated that, although two of the SCS items had low reliability, the SCS as a whole was reliable across much of the SC continuum. Scores on the SCS and the HDSI were highly correlated; however, no potential cutoffs on the SCS corresponded strongly with the polythetic scoring criteria of the HDSI.

CONCLUSION

Comparisons of SCS scores with HDSI results indicated that the SCS itself could not serve as a substitute for the HDSI and would incorrectly classify a substantial number of individuals' levels of hypersexuality. However, the SCS could be a useful screening tool to provide a preliminary screening of people at risk for meeting criteria on the HDSI. Combining the SCS and the HDSI may be an appropriate evaluation strategy in classifying GBM as negative on both (i.e., "non-hypersexual/non-SC"), positive on the SCS only (i.e., "at risk"), and positive on both the SCS and the HDSI (i.e., "problematic hypersexuality/SC").

Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil

INTRODUCTION

There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated.

AIMS

This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil.

METHODS

The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments.

MAIN OUTCOME MEASURES

The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale.

RESULTS

Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P<0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P<0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P=0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P<0.05) and scored significantly lower on the self-directedness character dimension (P<0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P=0.001).

CONCLUSIONS

Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men.

Normal, Problematic and Compulsive Consumption of Sexually Explicit Media: Clinical Findings using the Compulsive Pornography Consumption (CPC) Scale among Men who have Sex with Men

To assess problematic sexually explicit media (SEM) consumption, and to identify clinically meaningful cut-off points, we examined clinical correlates using the new Compulsive Pornography Consumption (CPC) scale among 1165 participating MSM. Building on scale practices in measuring compulsive sexual behavior, two cut-off points were identified. While most (76-80%) MSM do not report compulsive symptoms, about 16-20% report levels of problematic SEM consumption, including 7% with extreme scores consistent with DSM criteria for compulsive disorders. Demographic, sexual, and HIV risk differences were identified between the three groups. Researchers and clinicians are encouraged to consider using the CPC scale for comprehensive assessment of compulsive sexual behavior.

Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older

We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates of adherence in a sample of gay, bisexual, and other non-gay or -bisexual identified men who have sex with men aged 50 and over. As part of a cross-sectional study we recruited a community-based sample of 199 men and assessed adherence to current ART medications along four domains: (1) missing doses in the past 4 days, (2) taking doses on the specified schedule in the past 4 days, (3) following instructions about how to take the medications (e.g., to take medications with food), and (4) missing doses in the last weekend. A total adherence score was also computed. Bivariable analyses indicated negative associations between depression, sexual compulsivity, and HIV-related stigma with each of the individual adherence variables and the composite adherence score, while an older age was found to be protective. In multivariable analyses, controlling for age and educational attainment, a higher likelihood of missing doses and failing to follow instructions were related to higher levels of HIV-related stigma, while dosing off-schedule and missing doses on weekends was associated with higher levels of sexual compulsivity. These results indicate that psychosocial burdens undermine the adherence behaviors of older HIV-positive sexual minority men. Programming and services to address this compromising health behavior must embrace a holistic approach to health as informed by syndemics theory, while attending to the developmental and age-specific needs of older men.

Personality as a predictor of unprotected sexual behavior among people living with HIV/AIDS: a systematic review

The present investigation involved a systematic literature review to (1) identify associations between personality constructs and unprotected sex among people living with HIV/AIDS (PLWH); (2) assess patterns of direct versus indirect personality-risky sex associations; and (3) explore possible differences in personality-risky sex associations among PLWH versus non-infected populations. Among the 26 studies yielded through the systematic search, sensation seeking and sexual compulsivity were the constructs most frequently examined, with fewer studies investigating traditional personality typologies. Personality constructs that were more conceptually proximal to the sexual act, such as sexual compulsivity and sex-related sub-components of sensation seeking, showed relatively direct associations with unprotected sex, whereas more conceptually distal constructs such as generalized impulsivity demonstrated only weak or indirect associations. Associations were also frequently mediated by other risk factors, including perceived responsibility and substance use. These findings have implications for the development of interventions to reduce high risk sexual behavior among PLWH.

Hypersexual behavior and HIV sex risk among young gay and bisexual men

Hypersexual behavior has been identified as a sexual risk correlate among gay and bisexual men (GBM). The Hypersexual Behavior Inventory (HBI) has been shown to be a reliable and valid measure of hypersexual behavior in clinical populations, yet it has not been used to assess hypersexual behavior in nonclinical samples. We examined the psychometric properties of the HBI with survey data recorded between December 2009 and March 2010 in a sample of young men (N = 366, M = 21.46 years old, SD = 1.95) who self-identified as gay (89%) or bisexual (11%) and assessed its association with unprotected receptive anal intercourse (URAI) partners and occasions. Using cross-sectional data of single, sexually active young GBM (YGBM), we used confirmatory factor analyses to test the HBI's three-factor structure. Using negative binomial regressions, we then tested the association between the HBI subscales and sexual risk. After accounting for covariates, we found that sexual control was a risk factor for URAI partners and occasions, and coping was found to be a protective factor for URAI occasions. In light of our findings, we discuss the importance of reexamining the theoretical assumptions of hypersexual behavior and propose HIV prevention strategies that may reduce young GBM's vulnerability to HIV infection.

A psychometric investigation of the hypersexual disorder screening inventory among highly sexually active gay and bisexual men: an item response theory analysis

INTRODUCTION

The Hypersexual Disorder Screening Inventory (HDSI) was designed as an instrument for the screening of hypersexuality by the American Psychiatric Association's taskforce for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

AIM

Our study sought to conduct a psychometric analysis of the HDSI, including an investigation of its underlying structure and reliability utilizing item response theory (IRT) modeling, and an examination of its polythetic scoring criteria in comparison to a standard dimensionally based cutoff score.

METHODS

We examined a diverse group of 202 highly sexually active gay and bisexual men in New York City. We conducted psychometric analyses of the HDSI, including both confirmatory factor analysis of its structure and IRT analysis of the item and scale reliabilities.

MAIN OUTCOME MEASURES

We utilized the HDSI.

RESULTS

The HDSI adequately fit a single-factor solution, although there was evidence that two of the items may measure a second factor that taps into sex as a form of coping. The scale showed evidence of strong reliability across much of the continuum of hypersexuality, and results suggested that, in addition to the proposed polythetic scoring criteria, a cutoff score of 20 on the severity index might be used for preliminary classification of HD.

CONCLUSION

The HDSI was found to be highly reliable, and results suggested that a unidimensional, quantitative conception of hypersexuality with a clinically relevant cutoff score may be more appropriate than a qualitative syndrome comprised of multiple distinct clusters of problems. However, we also found preliminary evidence that three clusters of symptoms may constitute an HD syndrome as opposed to the two clusters initially proposed. Future research is needed to determine which of these issues are characteristic of the hypersexuality and HD constructs themselves and which are more likely to be methodological artifacts of the HDSI.

Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil

This study examined compulsive sexual behavior (CSB) and psychopathology in a treatment-seeking sample of men in São Paulo, Brazil. Eighty-six men (26% gay, 17% bisexual, 57% heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction completed assessments consisting of the Mini International Neuropsychiatric Interview, a structured clinical interview for DSM-IV Axis I Disorders-Clinical Version (segment for Impulse Control Disorder), Sexual Compulsivity Scale (SCS), and questions about problematic CSB. The average SCS score for our sample was above the cut-off score reported in other studies, and 72% of the sample presented at least one Axis I psychiatric diagnosis. There were no differences among gay, bisexual, and heterosexual men on SCS scores and psychiatric conditions, but gay and bisexual men were more likely than heterosexual men to report casual sex and sex with multiple casual partners as problematic behaviors. SCS scores were associated with psychiatric co-morbidities, mood disorder, and suicide risk, but diagnosis of a mood disorder predicted higher SCS scores in a regression analysis. The study provides important data on the mental health needs of men with CSB in São Paulo, Brazil.

Sexual partnership types as determinant of HIV risk in South African MSM: an event-level cluster analysis

While individual determinants of HIV risk among MSM have been widely studied, there is limited understanding of how relational characteristics determine sexual risk. Based on data collected among 300 South African men who have sex with men (MSM) and using cluster analysis, this study developed a typology of four partnership types: the "Race-Economic Similar," "Age-Race-Economic Discordant," "Non-regular Neighbourhood," and "Familiar" partnership types. Support for the meaningfulness of these types was found through associations of these partnership types with participant characteristics and characteristics of the last anal sex event. Furthermore, in a multivariate analysis, only partnership type independently predicted whether the last anal sex event was unprotected. Findings of the study illustrate the importance of taking into account the relational context in understanding unprotected sexual practices and present ways to target intervention efforts as well as identify relationship specific determinants of unprotected sex.

A pandemic of the poor: social disadvantage and the U.S. HIV epidemic

The U.S. HIV/AIDS epidemic has evolved over the past 30 years and is now concentrated in socially marginalized and disenfranchised communities. The health disparities in this epidemic are striking, with most HIV infections occurring in sexual minorities and communities of color. While widely recognized, the health disparities in HIV and AIDS are not often discussed. In this article, we examine the factors underlying health disparities in the U.S. HIV epidemic. We first discuss the interlocking relationships between biological, social, and behavioral factors that drive HIV/AIDS epidemics. Guided by a well-established conceptual model of health disparities, we then describe the social positions of those most affected by HIV and AIDS, particularly racial and gender groups. Structural and economic conditions-including environmental resources, constraints, access to care, and psychosocial influences-are examined in relation to HIV disease trajectories. Greater attention to contextual factors and comorbidities is needed to reduce the health disparities in HIV/AIDS.

Sexual compulsivity scale: adaptation and validation in the spanish population

Sexual compulsivity has been studied in relation to high-risk behavior for sexually transmitted infections. The aim of this study was the adaptation and validation of the Sexual Compulsivity Scale to a sample of Spanish young people. This scale was applied to 1,196 (891 female, 305 male) Spanish college students. The results of principal components factor analysis using a varimax rotation indicated a two-factor solution. The reliability of the Sexual Compulsivity Scale was found to be high. Moreover, the scale showed good temporal stability. External correlates were examined through Pearson correlations between the Sexual Compulsivity Scale and other constructs related with HIV prevention. The authors' results suggest that the Sexual Compulsivity Scale is an appropriate measure for assessing sexual compulsivity, showing adequate psychometric properties in the Spanish population.

From prediction error to incentive salience: mesolimbic computation of reward motivation

Reward contains separable psychological components of learning, incentive motivation and pleasure. Most computational models have focused only on the learning component of reward, but the motivational component is equally important in reward circuitry, and even more directly controls behavior. Modeling the motivational component requires recognition of additional control factors besides learning. Here I discuss how mesocorticolimbic mechanisms generate the motivation component of incentive salience. Incentive salience takes Pavlovian learning and memory as one input and as an equally important input takes neurobiological state factors (e.g. drug states, appetite states, satiety states) that can vary independently of learning. Neurobiological state changes can produce unlearned fluctuations or even reversals in the ability of a previously learned reward cue to trigger motivation. Such fluctuations in cue-triggered motivation can dramatically depart from all previously learned values about the associated reward outcome. Thus, one consequence of the difference between incentive salience and learning can be to decouple cue-triggered motivation of the moment from previously learned values of how good the associated reward has been in the past. Another consequence can be to produce irrationally strong motivation urges that are not justified by any memories of previous reward values (and without distorting associative predictions of future reward value). Such irrationally strong motivation may be especially problematic in addiction. To understand these phenomena, future models of mesocorticolimbic reward function should address the neurobiological state factors that participate to control generation of incentive salience.