Self-Esteem and “At Risk” Women: Determinants and Relevance to Sexual and HIV-Related Risk Behaviors

Strategies for increasing impact, engagement, and accessibility in HIV prevention programs: suggestions from women in urban high HIV burden counties in the Eastern United States (HPTN 064)

BACKGROUND

Merely having the tools to end HIV is insufficient. Effectively ending the epidemic necessitates addressing barriers that impede engagement in biomedical and behavioral prevention and wide scale implementation and utilization of existing interventions. This qualitative study identifies suggestions for increasing access to, engagement in, and impact of HIV prevention among women living in cities in high HIV burden counties in the eastern US.

METHODS

Data analyzed for the current study were collected via a qualitative sub-study within the HIV Prevention Trials Network Study 064 (HPTN 064), a multisite observational cohort study designed to estimate HIV incidence among women residing in communities with elevated HIV prevalence who also reported personal or partner characteristics associated with increased risk of HIV acquisition. Focus group and interview participants in the qualitative sub-study (N = 288) were from four cities in the eastern US.

RESULTS

Thematic analyses revealed four themes describing women's most frequently stated ideas for improving prevention efforts: 1) Promote Multilevel Empowerment, 2) Create Engaging Program Content, 3) Build "Market Demand", and 4) Ensure Accessibility. We conducted additional analyses to identify contradictory patterns in the data, which revealed an additional three themes: 1) Address Structural Risk Factors, 2) Increase Engagement via Pleasure Promotion, 3) Expand Awareness of and Access to Prevention Resources.

CONCLUSIONS

Findings may be useful for enhancing women's engagement in and uptake of behavioral and biomedical HIV prevention resources, improving policy, and addressing multilevel risk factors.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT00995176 , prospectively registered.

Perceived Value of Microenterprise for Low-Income Women Living with HIV in Alabama

We characterized the potential benefits and risks of participating in a microenterprise program targeting low-income women living with HIV (WLWH) in Alabama; and described potential mechanisms through which microenterprise programs could influence sexual risk behaviors and engagement in HIV care. Fourteen stakeholders and 46 WLWH (89% African American) participated in the qualitative study. Data were collected using in-depth interviews (stakeholders) and focus group discussions (WLWH). NVivo qualitative software was used for the management and analysis of the data. The data revealed four main mechanisms through which microenterprise programs could potentially improve health outcomes: (1) social support and encouragement from other women, (2) improvement in self-esteem, (3) creating structure in the women's lives, and (4) financial strengthening. Potential risks included unwanted disclosure of HV status, stigma and loss of insurance benefits. Microenterprise programs have the potential to be acceptable and may contribute to improved health and social outcomes among low-income WLWH in Alabama.

Sexual self-schema: a cognitive schema and its relationship to choice of contraceptive method among Polish women

Objectives: The aim of the study was to examine sexual self-schema in women using different methods of contraception. Methods: Women (N = 560) aged 18-55 years were divided into two groups: those who used hormonal contraception (n = 285) and those who used non-hormonal contraception (n = 275). Participants were assessed using the Sexual Self-Schema Scale (SSSS), the Well-Matched Marriage Questionnaire and the Hospital Anxiety and Depression Scale and were also asked to fill in a structured questionnaire, giving information on their socioeconomic status, reproductive and medical history, sexual behaviours, psychosexual orientation, sexual experience and type of contraception used. Results: Women in the hormonal group scored lower on romantic, passionate and direct subscales of the SSSS, compared with women in the non-hormonal group. Of the total sample, 35% were classified as positive schematic. Women in the hormonal group were found to be more negative schematic and aschematic as well as less co-schematic compared with women in the non-hormonal group. Furthermore, women in the hormonal group were significantly less religious and perceived their self-evaluated weight to be higher compared with women in the non-hormonal group. Logistic regression revealed that negative schematic (odds ratio [OR] 6.6) and aschematic women (OR 3.7), as well as women with more deliveries (OR 1.6), were more likely to choose hormonal contraception. Conclusion: A sexual self-schema might be a relevant factor affecting the choice of contraceptive method. All women seeking hormonal contraception who are aschematic or negative schematic should consult with a sexual medicine specialist, because those individuals may have more profound reasons underlying their need for this type of contraception.

Understanding condom use among unmarried female migrants: a psychological and personality factors modified information-motivation-behavioral skills model

BACKGROUND

In China, unmarried female migrants are vulnerable to sexual and reproductive health risks. One effective protection strategy is promoting consistent condom use (CCU).

METHODS

We conducted a cross-sectional study to apply the information-motivation-behavioral skills (IMB) model and modified it by addition of psychological and personal factors to examine the related factors of CCU and provide suggestions for intervention among unmarried female migrants.

RESULTS

Of all 903 eligible participants, only 13.8% of participants reported CCU in the past six months. Both the IMB model and the modified IMB model provided acceptable fit to the data. In both models, information had no direct or indirect influence on CCU (p > 0.05). However, behavioral skills had a positive effect on CCU (β = 0.344, p < 0.001 and β = 0.330, p < 0.001). Moreover, motivation contributed to CCU indirectly by affecting behavioral skills (β = 0.800, p < 0.001) and had no direct influence (p > 0.05). In the modified model, psychological and personality factors influenced CCU directly (β = - 0.100, p = 0.005).

CONCLUSIONS

Our results highlight the importance of conducting CCU promotion among unmarried female migrants. Future intervention strategies should focus on both the traditional IMB model constructs and the added psychological and personality factors.

Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices

Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention. Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16-44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff. The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, binge-drinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut <16 years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%). 2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk.

Sexual Assault and Sexual Risk Behaviors Among Lower-Income Rural Women: The Mediating Role of Self-Worth

Sexual victimization is associated with risky sexual behaviors. Limited research has examined mechanisms via which victimization affects risk behaviors, particularly following different types of sexual victimization. This study examined self-worth as a mediator of the relationship between sexual victimization history: contact childhood sexual abuse (CSA), completed rape in adolescence/adulthood (adolescent/adulthood sexual assault [ASA]), and combined CSA/ASA, and two sexual risk behaviors: past year partners and one-time encounters. Participants were diverse (57.9% African American), low-income women recruited from an OB-GYN waiting room (n = 646). Women with a history of sexual victimization, 29.8% (n = 186) reported lower self-worth, t(586) = 5.26, p < .001, and more partners, t(612) = 2.45, p < .01, than nonvictims. Self-worth was a significant mediator only among women with combined CSA/ASA histories in both risk behavior models.

Religiosity, spirituality, and HIV risk behaviors among African American women from four rural counties in the southeastern U.S

In a cross-sectional survey of 1,013 African American women from rural Alabama and North Carolina, we examined the relationship of (1) organizational religiosity (i.e., religious service attendance), (2) non-organizational religiosity (e.g., reading religious materials), and (3) spirituality with these outcomes: women's reports of their sexual behaviors and perceptions of their partners' risk characteristics. Women with high non-organizational religiosity, compared with low, had fewer sex partners in the past 12 months (adjusted prevalence ratio (aPR): 0.58, 95% confidence interval (CI): 0.42, 0.80) and were less likely to have concurrent partnerships (aPR: 0.47, 95% CI: 0.30, 0.73). Similar results were observed for spirituality, and protective but weaker associations were observed for organizational religiosity. Weak associations were observed between organizational religiosity, non-organizational religiosity, and spirituality with partners' risk characteristics. Further exploration of how religiosity and spirituality are associated with protective sexual behaviors is needed to promote safe sex for African American women.

Predictors of Condom Use Among Iranian Women at Risk of HIV

Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.

Gang membership and marijuana use among African American female adolescents in North Carolina

The southeastern US sustains the highest high school dropout rates, and gangs persist in underserved communities. African American female adolescents who drop out of school and are gang members are at substantial risk of exposure to severe violence, physical abuse, and sexual exploitation. In this study of 237 female African American adolescents 16-19 years of age from North Carolina who dropped out or considered dropping out, 11% were current or past gang members. Adolescents who reported gang membership began smoking marijuana at a mean age of 13, whereas those who reported no gang membership began at a mean age of 15 years (P<0.001). The mean ages of first alcohol use were 14 years and 15 years for gang members and non-gang members, respectively (P=0.04). Problem alcohol use was high in both groups: 40% and 65% for non-gang and gang members, respectively (P=0.02). Controlling for frequent marijuana use and problem alcohol use, adolescents who reported gang membership were more likely than non-gang members to experience sexual abuse (odds ratio [OR] =2.60, 95% confidence interval [CI] [1.06, 6.40]), experience physical abuse (OR =7.33, 95% CI [2.90, 18.5]), report emotional abuse from their main partner (OR =3.55, 95% CI [1.44, 8.72]), run away from home (OR =4.65, 95% CI [1.90, 11.4]), get arrested (OR =2.61, 95% CI [1.05, 6.47]), and report violence in their neighborhood including murder (OR =3.27, 95% CI [1.35, 7.96]) and fights with weapons (OR =3.06, 95% CI [1.15, 8.11]). Gang members were less likely to receive emotional support (OR =0.89, 95% CI [0.81, 0.97]). These findings reinforce the urgent need to reach young African American women in disadvantaged communities affiliated with gangs to address the complexity of context and interconnected risk behaviors.

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity

OBJECTIVE

Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners.

METHOD

A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance.

RESULTS

Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning.

Relationship Power, Sexual Decision Making, and HIV Risk Among Midlife and Older Women

The number of midlife and older women with HIV/AIDS is high and increasing, especially among women of color. This article addresses these demographic realities by reporting on findings about self-esteem, relationship power, and HIV risk from a pilot study of midlife and older women. A purposive sample (N = 110) of ethnically, economically, and educationally diverse women 40 years and older from the Greater Los Angeles Area was surveyed to determine their levels of self-esteem, general relationship power, sexual decision-making power, safer sex behaviors, and HIV knowledge. Women with higher levels of self-esteem exercised greater power in their relationships with their partner. Women with higher levels of general relationship power and self-esteem tend to exercise greater power in sexual decision making, such as having sex and choosing sexual acts. Income and sexual decision-making power were statistically significant in predicting the use of condoms. Implications and recommendations for future HIV/AIDS research and intervention targeting midlife and older women are presented.

HIV sexual risk behavior in older black women: a systematic review

BACKGROUND

Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk?

METHODS

CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus.

RESULTS

Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies.

CONCLUSION

Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal.

"I am proud of myself, just the way I am" (Mwen fyé de tét mwen, jan mwen ye ya): a qualitative study among young Haitian women seeking care for sexually transmitted infections (STIs) in Haiti

Haitian women are twice as likely as men to have HIV/AIDs. Factors underlying the feminization of HIV are complex. Self-esteem is an important correlate of sexual behavior. However, its meaning and impact on health behaviors may be influenced by cultural factors. This qualitative study took place in Haiti 4 months after the 2010 earthquake and examines the meaning of self-esteem among young Haitian women seeking treatment for a recurrent sexually transmitted infection (STI). The meaning of self-esteem was derived from a sense of gratitude and was rooted in their ability to provide for family. This may have led to behaviors such as not using condoms or having sex with partners in concurrent relationships. This article highlights the resilience and resourcefulness of Haitian women, provides insight into how women with apparent positive self-images were led to make choices that placed them at high risk for contracting HIV, and concludes with recommendations for future interventions.

Early life emotional neglect and HIV risk taking among men using the Internet to find other men for unprotected sex

PURPOSE

Using a Syndemics Theory conceptual model, this study examines the relationship between emotional neglect experiences during childhood and/or adolescence and involvement in HIV risk taking in a sample of adult men who actively seek partners for unprotected sex via the Internet.

METHODS

The study was based on a national random sample of 332 MSM who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Structural equation analysis was undertaken to examine the specific nature of the relationships involved in understanding HIV risk practices.

RESULTS

Emotional neglect was highly prevalent among the men participating in this study. Emotional neglect experiences were not found to be related directly to involvement in HIV risk taking in adulthood. Emotional neglect, was found to be an important variable in the overall structural equation. Its effect on HIV risk taking was indirect, operating principally by having a negative impact upon self-esteem, which in turn had a negative effect on attitudes toward condom use, which in turn were related strongly and directly to risk taking.

CONCLUSIONS

Childhood experiences with emotional neglect are relevant to understanding HIV risk practices among MSM in adulthood, but the relationship is not as simple as usually conceptualized. Rather, emotional neglect appears to impact risk taking indirectly, through its effects on mental health functioning, which in turn affects risk-related attitudes.

Risky relationships: targeting HIV prevention for women offenders

HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.

Association of depression with social support and self-esteem among HIV positives

BACKGROUND

Depression in Human Immunodeficiency Virus (HIV) positives has implications such as poor drug compliance, lower quality of life, faster progression to full blown Acquired Immunodeficiency Syndrome (AIDS) and higher mortality.

AIMS

To assess depression, social support and self-esteem in HIV positives and to find out the association of depression with social support and self-esteem among HIV positive patients.

SETTING AND DESIGN

Kasturba Medical College (KMC) Hospital, a tertiary care hospital, Mangalore, India and cross-sectional design.

METHODS AND MATERIALS

Study constituted of 105 HIV positive subjects; depression was assessed using BDI (Beck depression inventory), social support was assessed using Lubben social network scale and self-esteem was assessed using Rosenberg self-esteem scale.

STATISTICAL ANALYSIS

Kappa statistics was used to measure the agreement of depression assessed by BDI with clinical diagnosis of depression. Logistic regression analyses were done to find out predictors of depression among HIV positives. All analyses were conducted using Statistical Package for Social Sciences (SPSS) version 11.5.

RESULTS

Depression was found to be present in 43.8% of HIV positives. Among the study subjects, 10.5% had high risk for isolation and low self-esteem was found only among 5.7%. In univariate analysis both gender and self-esteem were significantly associated with depression whereas in multivariate analysis only self-esteem was found to be significantly associated with depression.

CONCLUSION

The present study shows a high prevalence of depression in HIV positive patients along with the importance of self-esteem.

Psychosocial risk factors for inconsistent condom use in young people with first episode psychosis

There is evidence of high rates of unprotected sex among young people with first episode psychosis compared to their peers. Little research has explored factors associated with condom use in this population. The current study examined the association between previously identified psychosocial risk factors and condom use in young people with early psychosis and their peers. Sixty-seven sexually active young people with first episode psychosis and 48 sexually active control participants matched on a number of sociodemographic factors completed a self-report survey. Increased probability of inconsistent condom use was associated with clinical status, younger age, unemployment, and the absence of peer support for condom use. Psychological distress, self-esteem, social support, substance use, and impulsivity were not associated with condom use. The results suggest that sexual risk-reduction interventions for young people with psychosis should target peer norms, particularly among those who are younger and unemployed.

The moderating effect of sexual pressure on young urban women's condom use

The purpose of this study was to examine whether women's experiences of sexual pressure moderated the relationship between sexual empowerment determinants and condom use in a sample of 100 high-risk women, ages 19-25. Five sexual empowerment determinants of condom use were identified from the literature: HIV knowledge, self-esteem, condom self-efficacy, positive attitudes toward condom use, and condom negotiation skills. Linear and logistic regression analyses revealed that positive attitudes toward condom use and condom negotiation skills were significant predictors of condom use. These relationships, however, were moderated by sexual pressure. Findings indicate that women's experiences with sexual pressure have the potential to decrease the likelihood of condom use, even though other sexually protective behaviors may be exhibited.

Condom use among young women: modeling the theory of gender and power

OBJECTIVE

This study sought to articulate pathways between constructs from the theory of gender and power and their associations with sexual behavior.

DESIGN

The data were collected preintervention during a randomized controlled HIV prevention trial. Participants were 701 sexually active, unmarried African American females, aged 14-20, who were not pregnant, and were recruited from three health clinics in a southeastern US city. Structural equation modeling was used for the analyses.

MAIN OUTCOME MEASURE

Self-reported condom use.

RESULTS

Theoretical associations yielded a well-fitting structural model across initial and cross-validation samples. A significant amount of variance was explained for the variables of condom use (R2 = .31, .18), partner communication (R2 = .30, .26), substance use during sex (R2 = .32, .51), and negative personal affect (R2 = .36, .48). Partner communication (.35, .38) was the strongest predictor of condom use, negative personal affect (-.41, -.37) was the strongest predictor of partner communication, and physical risk (.54, .54) was the strongest predictor of negative personal affect.

CONCLUSION

This model provides evidence to support both direct and indirect associations between social and behavioral risk factors and condom use. Associations between theory of gender and power constructs and condom use can facilitate future development and analyses of interventions based on this theory.

Associations between religious involvement and behavioral risk factors for HIV/AIDS in American women and men in a national health survey

BACKGROUND

Acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is a leading cause of death.

PURPOSE

We tested the hypothesis that religious variables would be inversely associated with prevalence of HIV/AIDS risk factors.

METHODS

A 2002 national survey included 9,837 individuals aged 15-44 years with complete data on religious involvement, sexual, and drug use behaviors.

RESULTS

Women who never attended services had over two times greater odds of reporting HIV risk factors than those attending weekly or more after adjusting for age and race/ethnicity (p < 0.0001) and over 60% greater after adjusting for multiple confounders, but no significant association was seen in men. Mainline Protestants had lower odds of reporting risk factors than those with no affiliation. No significant independent associations were found with importance of religion.

CONCLUSIONS

Women with public religious involvement had lower prevalence of any HIV risk factors while only affiliation was so associated in men.

Self-esteem and HIV risk practices among young adult ecstasy users

This study examines the role that self-esteem plays in HIV-related risk taking among users of the drug, Ecstasy. The first part of the analysis focuses on the relationship of self-esteem to HIV risk-taking. The second part examines predictors of self-esteem in this population. Conducted between 2002 and 2004, the research is based on a sample of 283 young adult Ecstasy users who completed approximately two-hour-long, face-to-face interviews via computer-assisted structured interviews. Study participants were recruited in the Atlanta, Georgia metropolitan area using targeted sampling and ethnographic mapping. Results indicated that self-esteem is associated with a variety of risky practices, including: the number of sex partners that people had, individuals' likelihood of having multiple sex partners, the number of different illegal drugs people used, and their condom use self-efficacy. The multivariate analysis conducted to ascertain the factors that impact participants' levels of self-esteem yielded six factors: educational attainment (positive), coming from a family-of-origin whose members got along well (positive), the extent of alcohol problems (negative), the number of positive effects experienced as a result of Ecstasy use (positive), the number of negative effects experienced as a result of Ecstasy use (negative), and the extent of experiencing symptoms of post-traumatic stress disorder (negative).

Relationship between mental disorders/suicidality and three sexual behaviors: results from the National Comorbidity Survey Replication

The present study examined the relationship between sexual behaviors and mental disorders and suicidality in the National Comorbidity Survey Replication, a representative sample of adults ages 18 years and older (N = 5,692). The World Health Organization Composite International Diagnostic Interview was used to make DSM-IV based disorder diagnoses. Participants were also asked about suicidality and sexual behaviors. Multiple logistic regression analyses adjusted for sociodemographic variables were used to examine the relationships of three sexual behaviors (age of first intercourse, number of past year partners, and past year condom use) with 15 mental disorders (clustered into any mood, anxiety, substance use, and disruptive behavior groups) and suicidality (ideation and attempts). Compared to ages 15-17, those with age of first intercourse between 12 and 14 had increased rates of lifetime disruptive behavior, substance use, and any mental disorder, and suicidal ideation and attempts (adjusted odds ratio (AOR) range, 1.46-2.01). Those with age of first intercourse between ages 18-25 and 26-35 were at decreased likelihood of several lifetime disorder groups (AOR range, 0.19-0.81). Individuals who had two or more sexual partners in the past year had increased rates of all past year disorder groups examined (AOR range, 1.44-5.01). Never married participants who rarely/never used condoms were more likely than those who always used condoms to experience any mood, substance use, and any mental disorder, and suicide attempts (AOR range, 1.77-8.13). Future research should longitudinally examine these associations and account better for possible familial and personality confounders.

DRUG RISK: A CROSS-SECTIONAL EXPLORATION OF THE INFLUENCE OF FAMILY-OF-ORIGIN AND CURRENT SITUATIONAL CIRCUMSTANCES

The main objective of this paper is to investigate potential predictors of drug risk among a community-based sample of individuals who are exposed to illicit drugs. The four domains of interest are individual socio-demographic and social-psychological attributes, current situational circumstances and family-of-origin characteristics. Interviews were conducted with 242 individuals who were recruited in Atlanta, Georgia. Initial descriptive analyses were followed by multivariate analyses. The final model predicted 60% of the variance in drug risk. Current situational circumstances were statistically significant regarding drug risk. Family-of-origin characteristics also were significant, even when entered into the predictive model after current situational circumstances. In addition to individual social-psychological characteristics such as depression and self-esteem, the impact of childhood emotional abuse is noted. The findings indicate a need for considering proximal as well as more distal influences on drug risk behavior when designing drug use prevention and intervention programs.

Sexual dysfunctions and suicidality in patients with bipolar disorder and unipolar depression

INTRODUCTION

Impairment in sexual function is frequent and underestimated in patients with mental disorders, particularly in those with mood disorders. Few studies have examined the relationship between sexual dysfunctions and the clinical characteristics of mood disorders.

AIM

The aim of the present study was to explore the frequency of sexual dysfunctions in patients with bipolar I disorder (BD) and unipolar depression (UD) with respect to control subjects, as well as their relationship with suicidality.

MAIN OUTCOME MEASURES

Assessments included: the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (SCID-I/P), the 24-item Brief Psychiatric Rating Scale and the Mood Spectrum Self-Report, a questionnaire exploring lifetime mood spectrum symptomatology including symptoms of sexual functioning and suicidality.

METHODS

A consecutive sample of 142 patients (60 BD and 82 UD) and a comparison group of 101 control subjects were recruited in a multicenter study involving 11 academic departments of psychiatry.

RESULTS

Lifetime impairment in the sexual response cycle, including desire, excitement, and ability to achieve orgasm, was significantly more common in patients with mood disorders compared with control subjects. Increase in sexual activity and promiscuity were significantly more common in patients with BD vs. the other two groups. Lifetime dysfunctions in all three phases of the sexual response cycle explored were significantly associated with lifetime suicide attempts in patients with BD and with thoughts of death in patients with UD. In BD patients, the lifetime presence of periods with frequent changes of sexual partners was significantly associated with thoughts of death.

CONCLUSIONS

Our findings suggest the importance of assessing sexual dysfunctions in patients with either BD or UD, as they may be clinically helpful in identifying phenotypes of mood disorders characterized by high suicidality.

An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults

Despite the recent increase in the number of HIV infections in Central and Eastern Europe, patterns of sexual behavior have not been extensively researched, particularly among young people. The aim of the present study was to provide a comprehensive assessment of HIV/AIDS-related vulnerability and sexual risk-taking among young adults in Croatia. Data were collected in 2005 using a nationally representative, multi-stage stratified probability sample (n = 1,093) of women and men aged 18-24 years. The focus in this article was on predictors of sexual risk-taking measured by a composite risky sexual behaviors scale. Using hierarchical regression models, we analyzed gendered effects of community, family, peer group, and individual level factors. For both men and women, peer pressure, sensation seeking, personal risk-assessment, behavioral intention, condom use at first sexual intercourse, and sexual victimization were significant predictors of sexual risk-taking behaviors. A number of predictors were gender-specific: sexual assertiveness and condom self-efficacy for women and parental monitoring, traditional morality, HIV knowledge, and talking about sex with partner for men. Documenting substantial prevalence of potentially risky sexual behaviors among young people in Croatia, the findings call for prevention and intervention efforts that should focus on individual capacity building for responsible sexual behavior.

HIV risk practices sought by men who have sex with other men, and who use internet websites to identify potential sexual partners

Men who have sex with men (MSM) account for the largest number of persons diagnosed with AIDS in the USA, with higher than average rates of drug use and unprotected sex being cited as the principal reasons underlying their high rates of HIV infection. Recent evidence has suggested that the use of websites specifically designed to promote unsafe sexual practices may be particularly common among MSM, thereby fostering their risky behaviours. In light of these findings, the present study is based on a content analysis of 1316 ads/profiles posted on one of the most popular MSM websites that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence. Data were collected between September 2006 and January 2007. Rates of advertised for high-risk sexual behaviours were very high, particularly for oral sex involving ejaculation into the mouth (88.0% for receptive oral sex, 77.4% for insertive oral sex), anal sex involving ejaculation into the anus (79.7% for insertive anal sex, 69.4% for receptive anal sex), multiple partner sex (77.9%) and felching (16.5%). A multivariate analysis of the correlates of sexual risk preferences identified seven factors that were related to a propensity towards enhanced sexual risk: younger age (beta = 0.12, P = 0.0001), not being African American (beta = 0.05, P = 0.0341), self-identification as a sexual 'bottom' (beta = 0.20, P = 0.0001), not caring about one's potential sex partners' HIV serostatus (beta = 0.15, P = 0.0001), preferring to have sex while under the influence of drugs (beta = 0.08, P = 0.0022), a greater involvement in and commitment to the use of the website to locate potential unprotected sex partners (beta = 0.16, P = 0.0001) and not being HIV-negative (beta = 0.08, P = 0.0081). The HIV intervention-related implications of these findings are discussed.

Relationship of stigma to HIV risk among women with mental illness

Urban women with severe mental illness (SMI) are vulnerable to stigma and discrimination related to mental illness and other stigmatized labels. Stigma experiences may increase their risk for negative health outcomes, such as HIV infection. This study tests the relationship between perceived stigma and HIV risk behaviors among women with SMI. The authors interviewed 92 women attending community mental health programs using the Stigma of Psychiatric Illness and Sexuality Among Women Questionnaire. There were significant relationships between personal experiences of mental illness and substance use accompanying sexual intercourse; perceived ethnic stigma and having a riskier partner type; and experiences of discrimination and having a casual or sex-exchange partner. Higher scores on relationship stigma were associated with a greater number of sexual risk behaviors. The findings underscore the importance of exploring how stigma attached to mental illness intersects with other stigmatized labels to produce unique configurations of HIV risk. HIV risk reduction interventions and prevention research should integrate attention to stigmatized identities in the lives of women with SMI.

Condom Use Self-Efficacy among Young Adult Ecstasy Users

Relying upon a sample of 283 young adult ecstasy users, this research examines three primary research questions: How high/low are young adult ecstasy users' levels of condom use self-efficacy? How does condom use self-efficacy relate to actual condom use in this population? What factors underlie condom efficacy levels in this population? The study entailed face-to-face interviews that were completed with the use of computer-assisted structured interviews (i.e., CASI). Study participants were recruited in the Atlanta, Georgia metropolitan area between August 2002 and August 2004 using a targeted sampling and ethnographic mapping approach. Interviews took approximately two hours to complete. Condom use self-efficacy levels were found to be fairly high in this population. A strong, direct relationship was observed between condom use self-efficacy and actual condom use. Using a multiple regression approach, five factors were found to be predictive of greater condom use self-efficacy in this population. These were educational attainment, amount of communication in one's family of origin, having asked about one's most recent casual sex partner's HIV serostatus, no prior drug treatment, and level of self-esteem.

Young adult Ecstasy users and multiple sexual partners: understanding the factors underlying this HIV risk practice

The purposes of this study are to (1) examine the extent to which young adult Ecstasy users recently reported having had multiple sex partners and (2) identify the factors predictive of engaging in this behavior. Potential predictors included demographic characteristics, background and experiences measures, childhood maltreatment experiences, substance use variables, and measures assessing psychological/psychosocial functioning. This research is based on a sample of 283 young adult recurrent users of the drug, Ecstasy. Study participants were recruited in Atlanta, Georgia between August 2002 and August 2004 using a targeted sampling and ethnographic mapping approach. Interviews took approximately two hours to complete. Nearly one-third of the study participants had more than one sex partner during the preceding month, and sexual protection rates tended to be low. Multivariate logistic regression analysis revealed seven predictors associated with an increased likelihood of having multiple sex partners: (1) being nonwhite, (2) knowing someone who was HIV-positive, (3) younger age of first sexual experience, (4) using Ecstasy for its touch-enhancing qualities, (5) higher self-esteem, (6) handling disagreements more dysfunctionally, and (7) not being involved in a romantic relationship. The HIV prevention- and intervention-related implications of these findings are discussed.

Predictors of suicidal ideation among "at risk" cocaine-using African American women

The focus of this study was to identify factors that differentiate women drug abusers who had experienced suicidal ideation from those who did not. Face-to-face interviews were conducted with 221 cocaine-using women in Atlanta, GA, 88 (39.8%) of whom reported thinking about committing suicide at least once during the 90 days prior to interview and 133 (60.2%) of whom did not. Multivariate logistic regression was used to identify predictors of suicidal ideation, and post hoc goodness-of-fit tests were conducted to assess the robustness of final models derived. Model 1 excluded all psychosocial functioning measures and Model 2 included these items. Both models showed that suicidal ideation was more common among women who were unemployed, had been abused sexually, engaged in sexual relations to cope with stresses, or had less helpful relatives. In addition, Model 1 revealed a heightened risk for women experiencing financial problems and those who had a previous mental health diagnosis, whereas Model 2 showed an elevated risk among women who experienced anxiety and those who had lower levels of self-esteem. These findings suggest the need for prevention and intervention programs that target at-risk women, and for such programs to include an emphasis on suicidal ideation in addition to focusing on risk factors that are addressed more commonly.