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Fumaz CR, Muñoz-Moreno JA, Ferrer MJ, Ornelas A, Coll J, Clotet B. Attachment Styles, Condomless Sex, and Drugs in HIV-Positive Gay and Bisexual Men. JOURNAL OF SEX & MARITAL THERAPY 2019; 46:35-42. [PMID: 31151369 DOI: 10.1080/0092623x.2019.1626308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study evaluated whether attachment styles might be related to condomless sex, use of drugs, and adherence to antiretroviral treatment (ART) in 400 HIV-positive gay and bisexual men (GBM). With the Relationship Questionnaire, 160 men were classified as securely attached and 240 as insecurely attached (88 dismissive, 79 preoccupied, and 73 fearful). Insecurely attached GBM had more condomless sex (p = 0.04), and used more cocaine (p = 0.001), ecstasy (p = 0.03), GHB (p = 0.04), and ketamine (p = 0.04). No differences were observed in adherence to ART. Dismissively attached GBM reported more condomless sex and use of drugs than preoccupied and fearfully attached GBM. The perspective of attachment might enrich the interventions to promote heath care in GBM.
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Affiliation(s)
- Carmina R Fumaz
- Lluita contra la Sida Foundation-HIV Unit-Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Jose A Muñoz-Moreno
- Lluita contra la Sida Foundation-HIV Unit-Germans Trias i Pujol University Hospital, Badalona, Spain
- Facultat de Psicologia i Ciències de l'Educació, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Maria Jose Ferrer
- Lluita contra la Sida Foundation-HIV Unit-Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Arelly Ornelas
- Lluita contra la Sida Foundation-HIV Unit-Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Josep Coll
- AIDS Research Institute-IrsiCaixa Foundation, Badalona, Spain
| | - Bonaventura Clotet
- Lluita contra la Sida Foundation-HIV Unit-Germans Trias i Pujol University Hospital, Badalona, Spain
- AIDS Research Institute-IrsiCaixa Foundation, Badalona, Spain
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2
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Li YJ, Lu S, Lan J, Jiang F. Feel Safe to Take More Risks? Insecure Attachment Increases Consumer Risk-Taking Behavior. Front Psychol 2019; 10:874. [PMID: 31068865 PMCID: PMC6491673 DOI: 10.3389/fpsyg.2019.00874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/02/2019] [Indexed: 12/03/2022] Open
Abstract
Attachment styles, originated from early childhood experience, have been documented to influence human behaviors among adults. Drawing on life history theory, we examined whether or not, and how, attachment styles impact risk-taking behaviors beyond evolutionary valid domains, and explored the moderation role of parental status. In the consumer behavior context, three correlational studies provide convergent evidence that insecurely attached (vs. securely attached) consumers are more risk-taking in consumption situations like dining in a toilet-themed restaurant or buying genetically modified products. Specifically, insecurely attached consumers were more likely to take risks in two experiential purchase scenarios (Study 1) and this effect was not domain-specific (Study 2). In Study 3, we showed that safety perception mediated the relationship between attachment insecurity and risk-taking, which was manifested by purchase intentions toward genetically modified products. Specifically, insecurely attached individuals perceived genetically modified products to be safer and were more willing to make a purchase. Additionally, parental status moderates the relationship (Studies 2 and 3). We conclude with a discussion on the implications of attachment theory on consumer risk-taking behaviors from a life history perspective.
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Affiliation(s)
- Yuanyuan Jamie Li
- Department of Marketing and E-Commerce, Nanjing University, Nanjing, China
| | - Su Lu
- Department of Human Resource Management and Organizational Behavior, University of International Business and Economics, Beijing, China
| | - Junmei Lan
- Department of Human Resource Management and Organizational Behavior, University of International Business and Economics, Beijing, China
| | - Feng Jiang
- Department of Organization and Human Resources Management, Central University of Finance and Economics, Beijing, China
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3
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Turan B, Crockett KB, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Weiser SD, Turan JM. Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV. J Acquir Immune Defic Syndr 2019; 80:e1-e8. [PMID: 30272629 PMCID: PMC6289809 DOI: 10.1097/qai.0000000000001872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment adherence and viral suppression remain suboptimal in the United States. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others' help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes. METHODS We examined cross-sectional associations of the 2 attachment-related insecurity dimensions with antiretroviral treatment (ART) adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in 4 US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race. RESULTS Attachment-related avoidance was the only unique predictor of suboptimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts. CONCLUSIONS Interventions may need to focus on the vulnerable subpopulation with high attachment insecurity and incorporate existing strategies that address insecure attachment models.
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Affiliation(s)
| | | | - Mirjam-Colette Kempf
- Family, Community and & Health Systems, Health Behavior, Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Deborah Konkle-Parker
- Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco and Medical Service, San Francisco, CA
- Department of Veteran Affairs Medical Center, San Francisco, CA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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4
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Farias ODO, Alexandre HDO, Lima ICVD, Galvão MTG, Hanley-Dafoe R, Santos VDF. Attachment styles of People Living with HIV/AIDS. CIENCIA & SAUDE COLETIVA 2018; 25:495-504. [PMID: 32022190 DOI: 10.1590/1413-81232020252.11852018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/14/2018] [Indexed: 11/22/2022] Open
Abstract
Factors that involve the dynamics in interpersonal relationships and may have consequences in health are still little explored in people living with HIV/AIDS. The aim was to identify the evidences of literature regarding adult attachment style and HIV. It is an Integrative literature review. Seven databases were explored, using the combination of key words and Boolean connectors: "Attachment Style OR Object Attachment AND HIV". A reasonable number of articles addressed attachment among people with HIV as a mediator to post-traumatic stress disorder, depression and stress. The prevalence of insecure attachment in this group was high. Evidence was also found in relation to the attachment as an important factor to adaptation to the diagnosis of HIV, attachment and behavior in interpersonal relationships, and emphasize the possibility of changing the attachment style.
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Affiliation(s)
- Odaleia de Oliveira Farias
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160, Fortaleza, CE, Brasil.
| | - Herta de Oliveira Alexandre
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160, Fortaleza, CE, Brasil.
| | | | - Marli Teresinha Gimeniz Galvão
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160, Fortaleza, CE, Brasil.
| | | | - Vanessa da Frota Santos
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160, Fortaleza, CE, Brasil.
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5
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Starks TJ, Castro MA, Castiblanco JP, Millar BM. Modeling Interpersonal Correlates of Condomless Anal Sex among Gay and Bisexual Men: An Application of Attachment Theory. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1089-1099. [PMID: 27752852 PMCID: PMC6594544 DOI: 10.1007/s10508-016-0851-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/04/2016] [Accepted: 08/29/2016] [Indexed: 05/21/2023]
Abstract
The existing literature has identified that beliefs about the interpersonal meaning of condom use are a significant predictor of condomless anal sex (CAS). Some have suggested that condom use in this context may function as a form of nonverbal communication. This study utilized attachment theory as a framework and tested a hypothesized model linking adult attachment to CAS through communication skills and condom expectancies. An online survey was completed by 122 single, HIV-negative gay and bisexual (GB) men living in the U.S. They completed measures of adult attachment (anxious and avoidant), condom expectancies regarding intimacy and pleasure interference, communication skills, self-assessed mate value, and recent CAS with casual partners. There was a significant, positive bivariate association between anxious attachment and receptive CAS. In path model analyses, two over-arching pathways emerged. In the other-oriented pathway, anxious attachment, self-perceived mate value, and emotional communication predicted the belief that condoms interfere with intimacy. In turn, intimacy interference expectancies were positively associated with the odds of receptive CAS. In the self-oriented pathway, assertive communication skills mediated a link between avoidant attachment and the belief that condoms interfere with sexual pleasure. Pleasure interference expectancies were positively associated with the odds of insertive CAS. The findings highlight the importance of relational or interpersonal concerns in sexual risk-taking among single GB men. Attachment theory may serve as a framework for organizing these interpersonal correlates of CAS. Results are consistent with the conceptualization of condom use as a form of nonverbal attachment-related behavior. Implications for sexual health and risk-reduction interventions are explored in this context.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave, New York, NY, 10065, USA.
- Center for HIV/AIDS Educational Studies and Training, 142 West 36th Street, 9th Floor, New York, NY, 10018, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10016, USA.
| | - Michael A Castro
- Center for HIV/AIDS Educational Studies and Training, 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
| | - Juan P Castiblanco
- Center for HIV/AIDS Educational Studies and Training, 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
- City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Brett M Millar
- Center for HIV/AIDS Educational Studies and Training, 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10016, USA
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6
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Martinez O, Muñoz-Laboy M, Levine EC, Starks T, Dolezal C, Dodge B, Icard L, Moya E, Chavez-Baray S, Rhodes SD, Fernandez MI. Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:987-999. [PMID: 27633063 PMCID: PMC5352550 DOI: 10.1007/s10508-016-0835-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 05/10/2023]
Abstract
The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices.
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Affiliation(s)
- Omar Martinez
- School of Social Work, College of Public Health, Temple University, Ritter Annex, Philadelphia, PA, 19122, USA.
| | - Miguel Muñoz-Laboy
- School of Social Work, College of Public Health, Temple University, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Ethan C Levine
- School of Social Work, College of Public Health, Temple University, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Tyrel Starks
- Center for HIV Education Studies and Training, The City University of New York, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Brian Dodge
- School of Public Health, Indiana University-Bloomington, Bloomington, IN, USA
| | - Larry Icard
- School of Social Work, College of Public Health, Temple University, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Eva Moya
- School of Social Work, University of Texas-El Paso, El Paso, TX, USA
| | | | - Scott D Rhodes
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - M Isabel Fernandez
- Department of Public Health, Nova Southeastern University, Fort Lauderdale, FL, USA
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7
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Cook SH, Watkins DC, Calebs B, Wilson PA. Attachment orientation and sexual risk behaviour among young Black gay and bisexual men. PSYCHOLOGY & SEXUALITY 2016; 7:177-196. [PMID: 27570578 DOI: 10.1080/19419899.2016.1168312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This mixed methods study used an explanatory sequential design to examine the relationship between attachment and sexual behavior among young Black gay and bisexual men (YBGBM). Cross sectional online surveys and sex diaries were completed by a sample of YBGBM in New York City (n = 153) to assess the association between adult attachment insecurity and sexual risk behavior. The Experiences in Close Relationships Scale-Revised (ECR-R) was used to assess three types of adult attachment (i.e., secure, anxious, and avoidant). Participants reported condomless sex encounters, as well as serodiscordant condomless anal sex encounters, as measures of sexual risk. Quantitative findings suggested that there were few associations between attachment type and sexual risk behavior; only men with attachment avoidance were likely to engage in condomless sex. However, qualitative findings illuminated some of the social complexities of the association between attachment in childhood, attachment in young adulthood and intimate partnerships, which could be linked to young adult sexual risk behavior. The study findings highlight the need for researchers to further examine the process by which individual differences in attachment orientation are related to YBGBM's sexual behavior.
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Affiliation(s)
- Stephanie H Cook
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Psychology, The College of Literature, Sciences & Arts, University of Michigan, Ann Arbor, MI
| | - Daphne C Watkins
- School of Social Work and Medical School, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Benjamin Calebs
- Department of Psychology, The College of Literature, Sciences & Arts, University of Michigan, Ann Arbor, MI
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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8
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Sakaluk JK, Gillath O. The Causal Effects of Relational Security and Insecurity on Condom Use Attitudes and Acquisition Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:339-352. [PMID: 26566898 DOI: 10.1007/s10508-015-0618-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/27/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Research on attachment and condom use has been limited to correlational studies of self-report measures, yielding inconsistent results. Here, we examined the causal effects of attachment priming on self-reported condom use attitudes and an observational measure of condom acquisition behavior. In three experiments, participants were exposed to one of three attachment primes (security, anxiety, or avoidance) or a control prime. For Study 1, participants in the security and anxiety conditions preferred condom non-use to a greater extent, compared to participants in the avoidance condition. This effect was replicated in Study 2, and was mediated by perceptions of sexual health threat. In Study 3, the effect of security priming on condom acquisition behavior was eliminated through the use of a framing manipulation, though the effect of primed attachment on condom use attitudes was not significant. A meta-analysis, however, revealed that the predicted effects of attachment priming were consistent across the three studies, supporting the role of attachment in evaluations of condom use. Priming attachment security or anxiety leads participants to perceive their sexual partners as less of a sexual health threat, resulting in a devaluation of condom use. Primed security also reduced condom acquisition behavior, though this negative effect eliminated by framing condoms as protecting a partner's sexual health. Overall, these studies suggest that relational factors, such as attachment, require greater consideration when studying sexual health and designing interventions.
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Affiliation(s)
- John Kitchener Sakaluk
- Department of Psychology, University Toronto Mississauga, 3359 Mississauga Road, Deerfield Hall Rm. 4098, Mississauga, ON, L5L 1C6, Canada.
| | - Omri Gillath
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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9
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Polansky M, Teti M, Chengappa R, Aaron E. Risk and Protective Factors for HIV Self-disclosure among Poor African-American Women Living with HIV/AIDS. Issues Ment Health Nurs 2015; 36:171-81. [PMID: 25897863 DOI: 10.3109/01612840.2014.963209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
African-American women with HIV are among the fastest growing populations with HIV. The psychosocial factors and beliefs/attitudes associated with disclosure and other un-safe sex practices are not fully understood in this population. A total of 158 HIV-positive women receiving primary care in an HIV clinic in Philadelphia who enrolled in a safe-sex intervention, completed a baseline questionnaire on their sexual activities with male partners and psychosocial factors that were potential protective/risk factors for unsafe sex. Women who were emotionally close and monogamous with their partner were most likely to disclose their HIV status and least likely to worry they had infected their partner. Women who were non-monogamous and who did not have an emotional connection to any of their partners were least likely to self-disclose. Partners were more likely to know each other's status when the woman felt she had a responsibility to talk about the importance of staying HIV-negative.
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Affiliation(s)
- Marcia Polansky
- Drexel University, School of Public Health , Philadelphia, Pennsylvania , USA
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10
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Starks TJ, Parsons JT. Adult attachment among partnered gay men: patterns and associations with sexual relationship quality. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:107-17. [PMID: 24297659 DOI: 10.1007/s10508-013-0224-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Previous research has found secure adult attachment to be associated positively with dimensions of main partner relationship quality and negatively with sexual risk taking and sex with casual partners among heterosexuals in primary relationships. Potential associations between adult attachment and aspects of relationship functioning have received limited attention among gay men. Data were collected from both members of 344 gay male couples as part of a community survey (M age = 38.6, SD = 9.4). Participants completed a shortened version of the Adult Attachment Inventory (Collins & Read, 1990) and the Dyadic Sexual Communication Scale (Catania, 1998). They reported the frequency of sex with main partners and the number of casual male unprotected sex partners. Data were analyzed using the Actor-Partner Interdependence Model. Securely attached individuals reported the highest levels of sexual communication and men with securely attached partners were the most likely to report having sex with their partners as least once per week. Avoidantly attached men reported significantly more casual unprotected anal intercourse (UAI) partners compared to other attachment styles. Having an avoidantly attached partner was also associated with an increase in the number of UAI partners reported. Attachment style is relevant to the sexual relationship quality and sexual safety of partnered gay men. Cognitive-interpersonal intervention approaches developed to target attachment-related cognitions and behaviors may be relevant to HIV prevention efforts in this population.
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Affiliation(s)
- Tyrel J Starks
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
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11
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Psychosocial pathways to sexually transmitted infection risk among youth transitioning out of foster care: evidence from a longitudinal cohort study. J Adolesc Health 2013; 53:478-85. [PMID: 23859955 PMCID: PMC3875407 DOI: 10.1016/j.jadohealth.2013.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To test the fit of a theoretically driven conceptual model of pathways to sexually transmitted infection (STI) risk among foster youth transitioning to adulthood. The model included (1) historical abuse and foster care experiences; (2) mental health and attachment style in late adolescence; and (3) STI risk in young adulthood. METHODS We used path analysis to analyze data from a longitudinal study of 732 youth transitioning out of foster care. Covariates included gender, race, and an inverse probability weight. We also performed moderation analyses comparing models constrained and unconstrained by gender. RESULTS Thirty percent reported they or a partner had been diagnosed with an STI. Probability of other measured STI risk behaviors ranged from 9% (having sex for money) to 79% (inconsistent condom use). Overall model fit was good (Standardized Root Mean Square Residual of .026). Increased risk of oppositional/delinquent behaviors mediated an association between abuse history and STI risk, via increased inconsistent condom use. There was also a borderline association with having greater than five partners. Having a very close relationship with a caregiver and remaining in foster care beyond age 18 years decreased STI risk. Moderation analysis revealed better model fit when coefficients were allowed to vary by gender versus a constrained model, but few significant differences in individual path coefficients were found between male and female-only models. CONCLUSIONS Interventions/policies that (1) address externalizing trauma sequelae; (2) promote close, stable substitute caregiver relationships; and (3) extend care to age 21 years have the potential to decrease STI risk in this population.
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12
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Ahrens KR, Ciechanowski P, Katon W. Associations between adult attachment style and health risk behaviors in an adult female primary care population. J Psychosom Res 2012; 72:364-70. [PMID: 22469278 PMCID: PMC3816981 DOI: 10.1016/j.jpsychores.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the relationship between adult attachment style and health risk behaviors among adult women in a primary care setting. METHODS In this analysis of a population of women enrolled in a large health maintenance organization (N=701), we examined the relationship between anxious and avoidant dimensions of adult attachment style and a variety of sexual, substance-related, and other health risk behaviors. After conducting descriptive statistics of the entire population, we determined the relationships between the two attachment dimensions and health behaviors using multiple regression analyses in which we controlled for demographic and socioeconomic factors. RESULTS After adjustment for covariates, the anxious dimension of attachment style was significantly associated with increased odds of self-report of having sex without knowing a partner's history, having multiple (≥2) male partners in the past year, and history of having a sexually transmitted infection (ORs [95% CIs]=1.11 [1.03, 1.20], 1.23 [1.04, 1.45]; and 1.17 [1.05, 1.30], respectively). The avoidant attachment dimension was associated with increased odds of being a smoker and not reporting regular seatbelt use (ORs [95% CIs]=1.15 [1.01, 1.30] and 1.16 [1.01, 1.33], respectively). CONCLUSIONS Both anxious and avoidant dimensions of attachment were associated with health risk behaviors in this study. This framework may be a useful tool to allow primary care clinicians to guide screening and intervention efforts.
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Affiliation(s)
- Kym R Ahrens
- Department of Pediatrics, Seattle Children's Research Institute/University of Washington, Seattle, WA, United States.
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13
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Martin LA, Vosvick M, Riggs SA. Attachment, forgiveness, and physical health quality of life in HIV + adults. AIDS Care 2012; 24:1333-40. [DOI: 10.1080/09540121.2011.648598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Luci A. Martin
- a Department of Psychology , University of La Verne , La Verne , CA , USA
| | - Mark Vosvick
- b Department of Psychology , University of North Texas , Denton , TX , USA
| | - Shelley A. Riggs
- b Department of Psychology , University of North Texas , Denton , TX , USA
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14
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Nideröst S, Gredig D, Roulin C, Rickenbach M, the Swiss HIV Cohort Study, the Eurosupport 5 Study Group. Predictors of HIV-protection behaviour in HIV-positive men who have sex with casual male partners: a test of the explanatory power of an extended Information–Motivation–Behavioural Skills model. AIDS Care 2011; 23:908-19. [DOI: 10.1080/09540121.2010.538661] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sibylle Nideröst
- a Institute for Integration and Participation, School of Social Work , University of Applied Sciences Northwestern Switzerland , Olten , Switzerland
| | - Daniel Gredig
- a Institute for Integration and Participation, School of Social Work , University of Applied Sciences Northwestern Switzerland , Olten , Switzerland
| | - Christophe Roulin
- a Institute for Integration and Participation, School of Social Work , University of Applied Sciences Northwestern Switzerland , Olten , Switzerland
| | - Martin Rickenbach
- b Data Centre of the Swiss HIV Cohort Study , University Hospital Lausanne , Lausanne , Switzerland
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Nöstlinger C, Nideröst S, Gredig D, Platteau T, Gordillo V, Roulin C, Rickenbach M, Dias SF, Rojas D. Condom use with steady partners among heterosexual people living with HIV in Europe: testing the information-motivation-behavioral skills model. AIDS Patient Care STDS 2010; 24:771-80. [PMID: 21091237 DOI: 10.1089/apc.2010.0246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Guided by a modified information-motivation-behavioral skills model, this study identified predictors of condom use among heterosexual people living with HIV with their steady partners. Consecutive patients at 14 European HIV outpatient clinics received an anonymous, standardized, self-administered questionnaire between March and December 2007. Data were analyzed using descriptive statistics and two-step backward elimination regression analyses stratified by gender. The survey included 651 participants (n = 364, 56% women; n = 287, 44%). Mean age was 39 years for women and 43 years for men. Most had acquired HIV sexually and more than half were in a serodiscordant relationship. Sixty-three percent (n = 229) of women and 59% of men (n = 169) reported at least one sexual encounter with a steady partner 6 months prior to the survey. Fifty-one percent (n = 116) of women and 59% of men (n = 99) used condoms consistently with that partner. In both genders, condom use was positively associated with subjective norm conducive to condom use, and self-efficacy to use condoms. Having a partner whose HIV status was positive or unknown reduced condom use. In men, higher education and knowledge about condom use additionally increased condom use, while the use of erectile-enhancing medication decreased it. For women, HIV disclosure to partners additionally reduced the likelihood of condom use. Positive attitudes to condom use and subjective norm increased self-efficacy in both genders, however, a number of gender-related differences appeared to influence self-efficacy. Service providers should pay attention to the identified predictors of condom use and adopt comprehensive and gender-related approaches for preventive interventions with people living with HIV.
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Affiliation(s)
- Christiana Nöstlinger
- Institute of Tropical Medicine, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sibylle Nideröst
- University of Applied Sciences Northwestern Switzerland, School of Social Work, Olten, Switzerland
| | - Daniel Gredig
- University of Applied Sciences Northwestern Switzerland, School of Social Work, Olten, Switzerland
| | - Tom Platteau
- Institute of Tropical Medicine, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Christophe Roulin
- University of Applied Sciences Northwestern Switzerland, School of Social Work, Olten, Switzerland
| | - M. Rickenbach
- Data Centre of the Swiss HIV Cohort Study, University Hospital Lausanne, Lausanne, Switzerland
| | - Sónia F. Dias
- Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Daniela Rojas
- Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
- AIDES, MIRE (Méthodologie, Innovation, Recherche, Evaluation), Paris, France
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Kershaw TS, Milan S, Westdahl C, Lewis J, Rising SS, Fletcher R, Ickovics J. Avoidance, anxiety, and sex: the influence of romantic attachment on HIV-risk among pregnant women. AIDS Behav 2007; 11:299-311. [PMID: 16865541 DOI: 10.1007/s10461-006-9153-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Most unprotected sex occurs in close relationships. However, few studies examine relational factors and sexual risk among high-risk populations. Romantic Attachment Theory states that individuals have cognitive working models for relationships that influence expectations, affect, and behavior. We investigated the influence of attachment avoidance and anxiety on sexual beliefs (e.g., condom use beliefs, self-efficacy), behavior (e.g., condom use, multiple partners, unprotected sex with risky partners), and sexually transmitted infections (STIs) among 755 high-risk, young pregnant women (ages 14-25) recruited from urban prenatal clinics. Attachment anxiety predicted sexual beliefs, condom use, and unprotected sex with risky partners controlling for demographic variables. Sexual beliefs did not mediate the relationship between attachment orientation and sexual behavior. Current relationship with the father of the baby did mediate the effect of attachment anxiety on multiple partners and STIs. Results indicate the importance of including general relational factors, such as attachment, in HIV prevention.
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Affiliation(s)
- Trace S Kershaw
- Department of Epidemiology and Public Health, and Center for Interdisciplinary Research on AIDS, Yale University, 60 College St., New Haven, CT 06510, USA.
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