Abstract by author: This study examined relationships among purpose in life, death anxiety, and HIV-related life changes for gay and bisexual men living with the human immunodeficiency virus (HIV). It was hypothesized that purpose in life would be significantly and inversely correlated with death anxiety and significantly and positively correlated with HIV-related life changes. It was also hypothesized that health status would demonstrate an effect on the main variables.
Additionally, the study is the first known to utilize HIV-related life changes, including improvement, as a main variable. The sample consisted of 72 gay or bisexual men with HIV (48 with AIDS, 24 without AIDS). The majority of the men were white, well educated, and in their 40s. Participants voluntarily selected research materials from one of five private medical clinics.
Measures included a demographic questionnaire,
the Purpose in Life Test, the Templer/McMordie Death Anxiety Scale, the
Marlowe-Crowne Social Desirability Scale, and a measure assessing HIV-related
life changes constructed for the purposes of this study. Results of this
study were not
consistent with the hypotheses of a significant inverse association between purpose in life and death anxiety or of a significant inverse association between death anxiety and HIV- related life changes. Additionally, results failed to show significant differences along the main measures as an effect of health status. Results were consistent, however, with prediction of a positive and significant correlation between purpose in life and HIV-related life changes. Importantly, results did demonstrate notable reliability for the HIV-Related Life Changes Questionnaire and participants indicated significant degrees of improvement in the majority of life areas surveyed.
In general, the findings of this study were not consistent with the negative relationship predicted between purpose in life and death anxiety as proposed by Viktor Frankl. However, this study demonstrates a significant and intriguing relationship between purpose in life and HIV-related life changes. Furthermore, the study empirically demonstrates that, although not necessarily causal, many men report life improvement even after HIV-infection. Limitations and treatment implications are discussed as well as recommendations for future research.
Moeller S (1996).The caregiving experiences of gay men whose partners are living with Acquired Immunodeficiency Syndrome. M.S. Thesis, University of Alaska, Anchorage, MAI, Vol. 35-03, p. 794, 65 pages.
Abstract by author: This qualitative study explored the caregiving experience of five gay men who provided care for their partners living with AIDS. Interviews took place in the homes of the participants and the data were transcribed verbatim. Content analysis was used to analyze the data. Four categories emerged to answer the main research question: What are the caregiving experiences of gay men whose partners are living with AIDS? The categories included: interacting with others, coping measures, managing disease, and experiencing loss. The first category, interacting with others, demonstrated the rich connectedness that the partner/caregiver has with family, friends and community. In the next category, coping measures, participants explored the changes in their caregiver role as the demands in caregiving increase. Caregivers discussed some of the strategies used to reduce caregiver stress. In the third category, managing disease, caregivers discussed their needs and concerns as the progression of symptoms became ever more increasing. Experiencing loss was the last category. The participants described their insights and feelings about loss and facing death.
Moon MW (1995). Risk factors for HIV infection in runaway and homeless adolescents in San Francisco. Ph.D. Thesis, University of California, San Francisco, DAI Vol. 56-08B, p. 4243, 135 pages.
Abstract by author: This study was designed to examine historical and environmental risk factors for HIV in homeless and runaway adolescents. The study sample was comprised of 66 gay, bisexual, transgender and "questioning" male adolescents who were tested for HIV in 1993 and 1994 at two clinics for homeless and runaway youth in San Francisco. Subjects were age 15 to 21, with a mean age of 18.6. The research design was a case-control study with 22 HIV positive cases and 44 randomly selected HIV negative controls.
Data were collected by review of existing medical record forms. Significant differences (p < 0.05) were seen between the cases and the controls on variables which measured having been voluntarily sexually active for more than 6 years, self-identifying as gay (as compared to identifying as bisexual, transgender, or questioning), history of depression, allergies to medications, and history of asthma. Significant differences were seen at the p < 0.10 level for current use of cocaine, history of being in treatment, having a recent life change, and involvement in a community organization.
Using logistic regression modeling, the two best predictors of HIV status in this sample were number of years voluntarily sexually active (odds ratio = 1.32) and self-identifying as gay (odds ratio = 5.37). As a whole, the sample reported high incidence of drug use, history of sexual abuse and physical abuse, and needle use. The data show that runaway and homeless adolescent males engage in multiple risky activities which may lead to HIV infection. These findings underscore the importance of candid discussions between providers and adolescents in the clinical setting regarding risk factors for HIV. The findings also support the need for developing, testing, and implementing interventions to prevent HIV in this population.
Morrow KM (1996). Culture-specific HIV/AIDS prevention programming for lesbian and bisexual women. PH.D. Thesis, Western Michigan University, DAI, Vol. 57-07B, p. 4331, 145 pages.
Abstract by author: HIV/AIDS prevention research continues to target populations in which AIDS is already responsible for a significant number of deaths. Since an AIDS diagnosis often indicates the transmission of HIV several years earlier, targeting groups currently manifesting AIDS neglects those groups which may be at risk for transmission of HIV today. Among the lowest incidence in known cases of AIDS are women who have sex with women. Despite a preponderance of biomedical research which implicates vaginal secretions and blood products as vehicles in HIV transmission, there remains only a minimal effort to educate these women regarding their risk of HIV or STD infection. The present study utilized a programmatic line of exploratory research designed to: (1) assess the potential risk of exposure to HIV/STDs within a community of women who have sex with women, (2) develop a culture specific prevention program, and (3) implement and evaluate such a program. Results from Study #1 suggest that women who have sex with women are at risk for STDs and HIV via their sexual behavior. Study #2 determined the cultural aspects of prevention unique to this community. Study #3 implemented and evaluated a prevention program.
The program consisted of a workshop designed to affect knowledge, attitudes, and risk perceptions, as well as precautionary sexual behavior through the training of safer sex skills. The workshop was followed-up by peer support meetings designed to address social norm change and problem-solving related to maintenance of behavioral change. Dependent variables included self-report measures of HIV/STD-related knowledge, risk perceptions, and attitudes, as well as self-reports of frequency of engagement in risky sexual behaviors. Results indicated that this sample of lesbian and bisexual women were quite knowledgeable with regard to general HIV/AIDS knowledge and that their risk perceptions were affected by their participation in the program. The sample's attitudes toward safer sex improved following their participation in the intervention. Frequencies of engagement in risky sexual behaviors varied across individual subjects: however, there appeared to be an indication of decreased risk among those who participated in the prevention program.
Moss PM (1997). A study of social support and social networks of gay men at risk for HIV infection. D.N.Sc. Thesis, Rush University, College of Nursing, DAI, Vol. 58-08A, p. 3321, 133 pages.
Abstract by author: This research study examined the social networks and social support of gay and bisexual men in order to determine the relationship of these variables to risk- taking behaviors. The men for this study were also part of an investigation of high risk behavior sponsored by the Centers for Disease Control (CDC). The participants for the study (n = 199) were recruited from a neighborhood Sexually Transmitted Disease (STD) clinic in a large metropolitan area. Information on their social networks and perceptions of social support was gathered by using the Social Network Inventory. Social network and social support variables from this questionnaire were correlated with the risk scores calculated from responses to questions on risk-taking behaviors. Few relationships were found among the variables social support, social relationships and risk- taking behaviors. The overall amount of social support reported by all the participants varied only slightly between kin and nonkin. However, emotional support from friends rather than from family was associated with lower risk-taking behaviors. Participants who reported more emotional support from friends and roommates also reported less risk-taking behaviors. A relationship also existed for more instrumental support from coworkers and higher risk- taking behaviors.
Results of this study demonstrated a relationship between friends, roommates and lower risk-taking sexual behavior. Therefore, gathering information concerning the individuals' network or support provided is an ineffective strategy for the nurse clinician doing preventive health teaching. However, friends are important to gay men, they should be included in the plan of care for patients with HIV disease. In addition, in spite of the fact that fewer participants named kin than nonkin in the network in this study, the total amount of support provided by kin vs nonkin relationships did not differ significantly. Therefore, nonkin members may serve as family when illness occurs. Definitions of high risk and low risk behavior differ among researchers and sexually active individuals. Nurses should question the individual about specific sexual practices and numbers of partners rather than relying on definitions of risky sexual behaviors.
Myers WW (1994). AIDS in Nicaragua: coming home to die. M.P.H. Thesis, New York Medical College, MAI Vol. 32-04, p. 1180, 87 pages.
Abstract by author: Questionnaires from the 28 living AIDS cases in Nicaragua were reviewed and analyzed and produced the following findings: 93% were male, 7% female; male mean age was 35 years; the group with the highest prevalence was 30-39 year olds. The typical patient was a heterosexual male with multiple sex partners, a professional or white collar worker who had lived outside of the country in the past 10-15 years.
The most common source of exposure was sexual contact with high risk behavior individuals or with known HIV infected/AIDS persons. The 5 most frequent clinical signs of infection were: weight loss; chronic diarrhea, fever; fatigue; night sweats. Kaposi's sarcoma was diagnosed only in homosexual and bisexual men. Median survival time after diagnosis was less than 1 month with the mean equal to 4 months.
Publication No. 1356402
Nicodemo RA (1990). The AIDS epidemic and the minority groups. M.P.H. Thesis, New York Medical College, MAI vol. 29-01, p. 0107, 116 pages.
Abstract by author: The AIDS crisis is a function of the unexpected response that the health care system had to face to prevent the HIV infection in the very diverse groups (homosexual/bisexual, heterosexual, minority groups, etc.). The bioepidemiological characteristics of HIV also makes it difficult to undertake the proper preventive measures. While AIDS is decreasing among homosexual/bisexual groups, it is increasing in the poor, inner city neighborhoods minority groups, very related with IVDU, and drug use associated with hypersexuality. Sociocultural normative behaviors, and the not so well understood ethnic determinants for risk behaviors are also contributor factors for HIV infection. The scenario of slow but steady increase in heterosexual cases makes it necessary to examine the sexual mixing preferences related with the spread of AIDS in society as well as the role played for the minority groups. Preventive measures will depend in our epidemiological understanding of these diverse groups as well as the acting identified barriers.
Neisen JH (1992). Family history, high risk behaviors and human-immunodeficiency virus (HIV) infection status in adult gay men with chemical dependency problems. PH.D. Thesis, University of Minnesota, DAI Vol. 53-07A, p. 2560, 162 pages.
Abstract by author: As the AIDS (Acquired Immune Deficiency Syndrome) epidemic has moved into its second decade there are still few studies that have identified the role of familial antecedents in the development and progression of AIDS. This study examined familial antecedents of high risk sexual and intravenous (IV) drug using behaviors associated with HIV infection. Whereas most previous AIDS epidemiological studies focused on either sexual behavioral risk factors or IV drug using risk factors, this study examined both in a population of 100 gay men in one alcohol and drug treatment program. Data from this study indicates: (1) family variables are predictors of both sexual and IV drug using risk behaviors known to transmit HIV and (2) high risk sexual behaviors and IV drug use are predictors of HIV seropositivity. A series of multiple logistic regression analyses were used to identify predictors for (1) IV drug use, (2) high risk sexual behaviors and (3) HIV status. Parental psychoactive substance abuse increased the odds of IV drug use by 13% and high risk sexual behaviors by 12%. Parental divorce or separation increased the odds of engaging in IV drug use by 27% and high risk sexual behaviors by 73%. Subjects from families with a history of both parental psychoactive substance abuse and parental divorce or separation increased the odds of a history of IV drug use by 44% and high risk sexual behaviors by 95%. Concomitantly, IV drug use increased the odds of self-reporting HIV seropositive by 35%. High risk sexual behaviors increased the odds of self-reporting HIV seropositive by 92%. Lastly, exposure to HIV by both IV drug use and high risk sexual behaviors increased the odds of self-reporting HIV seropositive by 160% indicating that exposure via more than one mode of transmission greatly increases the likelihood of HIV seropositivity. These results indicate the need to target high risk families and youth to prevent IV drug use, high risk sexual behaviors and ultimately HIV infection.
O'Brien JM (1996). Men in grief: death of a partner. PH.D. Thesis, Michigan State University, DAI, Vol. 57-09A, p. 3829, 240 pages.
Abstract by author: The literature is replete with articles about the grieving process that occurs when one loses a partner (Bowling, 1988; Feinson, 1986; Folken, 1991; Gass & Chang, 1989; Schuchter & Zisook, 1986; Zisook & Schuchter, 1991). However, men are seldom the sole focus of partner loss research (Lister, 1991) and the literature on gay grief is even more sparse (Doka, 1987; Siegel & Hoefer, 1981). The purpose of this qualitative study was to examine the experiences of both heterosexual and gay men grieving the death of a partner due to chronic illness. Although there were unique aspects of heterosexual and gay men’s grief, results demonstrated that many issues relevant to grieving the death of a partner transcend the issue of sexual orientation. Key findings focused on recognizing the diversity of men and exploring the relationship between gender socialization outcomes and men’s grief. Recommendations for practitioners working with grieving men and researchers focusing on men’s grief are offered.
Paraskevopouios A (1995). Clients' perceptions of significant psychological issues across the HIV/AIDS continuum. M.A. Thesis, McGill University, MAI Vol. 34-05, p. 1741, 124 pages, ISBN: 0-612-07951-1.
Abstract by author: The objective of the proposed research study was to answer the following research questions: Do clients in their respectful stages of diagnosis place more emphasis on certain psychological issues than others? And if so, can we identify the specific psychological issues that were considered to be most significant and unique across the stages of the HIV/AIDS continuum? To test these research questions, 37 homosexual men falling in three specific stages of the infection were surveyed. These three stages included: (1) HIV+ asymptomatic, (2) HIV+ chronic symptomatic, and (3) AIDS diagnosis. The HIV/AIDS Client Concern (HACC) questionnaire was developed to assess the significance clients placed on certain psychological issues and, was administered to all the subjects. The statistical analyses revealed that clients' level of diagnosis influenced how much emphasis they placed on what they considered to be significant psychological issues. More specifically, clients in the asymptotic group reported a higher concern with issues surrounding confidentiality of their HIV/AIDS status than the AIDS diagnosis group.
The chronic symptomatic group, on the other hand, was significantly more concerned with issues regarding feelings of guilt/shame, shock, depression, fear, loneliness, and anxiety of infecting other people through casual contact than the other groups. In addition, the AIDS diagnosis group was most concerned with issues surrounding the planning of their future care in comparison with the asymptomatic group. A more detailed analysis of each questions' content and its significance as well as the implications such results have for both researchers and practitioners alike will be discussed.
Parrott RT (1996). Art, longevity, and HIV disease: a study of seropositive gay men with non-progressing HIV disease. PH.D. Thesis, The Union Institute, DAI, Vol. 57-08A, p. 3683, 186 pages.
Abstract by author: The significance of this study lies in its implication for expanding the perception of HIV disease. The findings presented were derived from structured interviews with a sample of ten seropositive gay men identified as non-progressors. This qualitative study examined an account of the participants' personal histories, investigated four adaptive challenges in surviving HIV disease, and explored the artwork of each participant.
A heuristic methodology was employed in search of these archetypes, symbols, and colors which appeared to be related to longevity in the adult gay male with non-progressive HIV disease. One significant finding was the history of sexual violation. Major coping methods that promoted health were exercise and psychotherapy. Homophobia and its internalizations were also explored disclosing the participants' attitudes about revealing their gay identity. Archetypal themes identified were centralization, life, nature, and the tree. Geometric figures used most were the single lines, and circles. The predominant color was blue.
This investigation asserted that HIV disease and its progression is indeed a multifaceted area consisting of important variables such as: sexual abuse, homophobic internalizations, character, lifestyle, and the support of significant others. Psychosocial stages of the disease have been expanded to include the existential dimension, and the significance of spirituality. The various motifs and colors identified appeared to be an indication of the inner state of mind of non-progressors. As a benefit for partaking in this study, the following participants were given co-authorship provided that a signed release form was received: Marlon Bourque, Richard Carter, Josh Crane, Patrick Dean, Ismael Hernandez, James Mc Clendon, Jay Slemmer, and David Varela.
Perry SM (1994). Prediction of risky sexual behavior among lesbians: a theoretical comparison. PH.D. Thesis, University of Houston, DAI Vol. 55-09B, p. 4171, 123 pages.
Abstract by author: The overall objective of this study was to explore lesbian health and risky sexual behaviors. This study compared three theoretical models (Health Belief Model, theory of reasoned action, and theory of planned behavior) in terms of prediction of risky behaviors. Subjects were 152 lesbian and bisexual women, primarily Caucasian. Subjects completed a 45-minute health risk behavior survey. Seven hypotheses were tested.
The first used multiple regression to compare the theoretical models. The results indicated that both the reasoned action and planned behavior models were able to predict a significant amount of variance. The next three hypotheses examined the correlation between age, knowing people with HIV, risk behaviors and substance use. However, these results are difficult to interpret due to possible cohort effects. Hypothesis 5 tested the predictive ability of the HBM variables and yielded inconsistent results. The sixth hypothesis examined the correlation between subjective norms and risky behaviors and found several significant relationships. These results demonstrate the importance of perceived norms.
The final hypothesis examined the relationship between drug use and risky behaviors. Alcohol use was related to three risky behaviors and marijuana use was related to one risky behavior. Additionally, exploratory analyses revealed relationships between demographic and sexual history variables and health or risk behaviors. Limitations of this study and suggestions for future research were discussed.
Pober PM (1996). Still angry after all these years: performing the language of HIV and the marked body in "The Normal Heart" and "The Destiny of Me." PH.D. Thesis, The University of Texas at Austin, DAI Vol. 57-06A, p. 2273, 177 pages.
Abstract by author: He is the "angriest gay man in America": Larry Kramer. Through his polemical dramatic texts, this study contends that he used the language of HIV (the human immunodeficiency virus) and the performed representations of the HIV+ marked body to draw attention to the AIDS crisis. Analyzing the rhetoric and imagery that prompted the conflation of HIV with homosexuality, this dissertation: first, constructs a methodological approach to address behavioral, emotive, and comparative communication cues within the autobiographical plays of Larry Kramer; and second, uses that methodology to analyze the performance of the HIV+ marked body in those same dramas. Behavioral cues focus on: (1) the perception of HIV as God's punishment; (2) justifying homophobia; (3) coming out of the HIV and homosexual closets; (4) media representations of HIV; (5) heterosexuality as perceived cure; and (6) the perceptions of HIV as contagious. Emotive Communication cues focus on the use of fear, anger, and panic to induce action amongst audience members. Comparative Communication cues address the use of: (1) generalized metaphors (including "plague"); (2) specific imagistic comparisons (including "Holocaust"); and (3) social binaries designed to segment population elements (including "HIV+ versus HIV-").
The uniqueness of this study rests in its attention to the performed body as "marked," to the signification of said marking(s) as evidence of "cultural disavowal," and to the interplay between HIV and performance constructed by presentness and everyday life. Using Larry Kramer and his two acclaimed autobiographical dramatic texts as a template for these methodological tenets, this study strives to illuminate the performing language of HIV and the performativity of the marked body through theatre and extratextual life. The study contends that the performance of stigmatized bodies serves to illuminate those issues of stigma attached to the target population. Furthermore, performance addresses the element of contagion/infection and examines the fear associated as a product of social construction. Additionally, this study proffers the belief that social drama, here framed by Larry Kramer and the AIDS crisis, can force issues into public discussion which might otherwise remain silent.
Porche DJ (1995). Relationship of cognitive health behavior model and emotional state of anal and oral sexual practices of homosexual males in New Orleans. D.N.S. Thesis, Louisiana State University, DAI Vol. 56-08B, p. 4244, 234 pages.
Abstract by author: The research question for this study was "What is the relationship of psychosocial variables from the Cognitive Health Behavior Model and emotional state to the practice of anal and oral intercourse in homosexual males in New Orleans?" The purpose of this comparative cross-sectional study was to describe the relationship of psychosocial variables and emotional state to the practice of anal and oral intercourse in homosexual males to facilitate prevention planning. A purposive sample of 138 homosexual males was collected at the NO/AIDS Task Force, Lesbian and Gay Community Center, and referrals.
Subjects completed the questionnaires: (1) Psychosocial Sexual Behavior Questionnaire and (2) Beck Depression Inventory. Consent forms were not cross-referenced to questionnaires. Data analysis was conducted utilizing a SAS package. Data analysis consisted of Spearman's rho and ANOVA. Data were reported as an aggregate with no individuals reported by name. The sample was composed of men from: colleague referrals, personal contacts, gay social groups/organizations, NO/AIDS Task Force, NO/AIDS Awareness seminar, and Lesbian and Gay Community Center. The sample was mostly white educated males with a religious affiliation who had a propensity to earn a living. The majority of the subjects had incomes exceeding the poverty level.
More than three-fourths of the sample had been HIV antibody tested. Of those tested for HIV antibodies, 82 were not infected, 34 were infected. The length of time HIV infection status was known by subjects ranged from 3 days to 10 years. The mean period of time that HIV infection was known was 4 months and 21 days. All 34 HIV infected subjects did believe in their HIV infection state. Homosexual males in New Orleans area had varying degrees of risk as measured by the Psychosocial Sexual Behavior Questionnaire when engaging in anal intercourse behaviors. Receptive anal intercourse with a condom was not significantly different from the expected responses based on chi-square test. There was little difference between the observed and expected frequencies in the practice of receptive anal intercourse with a condom. All oral intercourse behaviors were significantly different from expected responses based on the chi- square test for goodness-of-fit.
Subjects with a high perceived risk of sexual behaviors, behavior efficacy, social norms, self-efficacy and depression scores practiced less insertive anal intercourse without a condom. High perceived risk of sexual behaviors and self-efficacy was correlated with less receptive anal intercourse without a condom and withdrawal prior to ejaculation. Perceived susceptibility to HIV infection, perceived seriousness to HIV infection, perceived risk of sexual behaviors, social norms, and emotional state were not correlated with oral intercourse practices of homosexual males in New Orleans.
Based on results of stepwise multiple regression analysis, unsafe sexual practices was predicted by self- efficacy. When self-efficacy was removed as a variable from stepwise multiple regression analysis, unsafe sexual practices was predicted by social norms. High self-efficacy was correlated and predictive of safer sexual practices......
Powell-Cope GM (1992). Becoming a couple affected by HIV infection. PH.D. Thesis, University of Washington, DAI Vol. 53-08B, p. 4035, 264 pages.
Abstract by author: The purposes of this study were: (1) to describe the experiences of gay couples when at least one was diagnosed with symptomatic HIV infection or AIDS, and (2) to explain couples' experiences in the context of heterosexism. To address the first study purpose, grounded theory provided the methodological basis for data gathering and data analysis. The second study purpose was achieved through a structural analysis that explained the relationship between couples' actions, their acknowledgment, or lack thereof, of heterosexism as an important dimension of their social environment, and the intended and unintended consequences of their actions on heterosexism.
The sample consisted of 9 gay couples. Becoming a Couple Affected by HIV Infection was perceived as a major life transition as each individual was challenged with confronting multiple losses including possible death of the PWA, the pre-AIDS lifestyle, relationships with friends and family members, the future, finances, and health. The beginning of this transitional began with "hitting home," or the awareness and subsequent emotional shock that life as the couple knew it before HIV was gone. "Mutual protection" is the mechanism by which individuals in the couple governed their activities toward one another. The major motivation for actions taken by study participants was the protection of the self and the other by forestalling losses such as threats to the relationship, health, and privacy, and preserving important relational characteristics such as independence, social boundaries, and intimacy. "Moving on" marked the end of the transition and included acceptance of a world in which loss and uncertainty were expected, if not commonplace, and moving on with one's life within the relationship, having renegotiated its meaning. Study participants settled on one of two different perspectives for the future: succumbing to AIDS or surviving HIV infection.
Structural analysis revealed that although study participants defined their experiences using the term homophobia, their experiences could also be understood in the context of heterosexism, or the socially constructed belief that heterosexuality is superior to homosexuality. Heterosexism asks heterosexuals to consider their privileged position which serves to perpetuate the constraints placed upon gay couples coping with HIV infection. Employing this term helps us to understand the institutionalized and systematic constraints placed upon gay couples, as compared to the concept of homophobia, which tends to focus on the individual personality traits of gays and those who harbor negative feelings toward them.
Rebchook GM (1996). Sociocultural influences on the unprotected sexual behavior of self-identified gay and bisexual men. PH.D. Thesis, University of Colorado at Boulder, DAI, Vol. 57-10B, p.6656, 239 pages.
Abstract by author: The HIV/AIDS epidemic continues to affect the gay community to a significant degree. In Boulder County, Colorado, 81% of AIDS cases and 71% of HIV cases are among men who have sex with men. Nationwide, gay men have adopted high rates of condom use, but still report rates of unprotected anal sex ranging from 10-77%. HIV prevention efforts during the first decade of the epidemic have not sufficiently influenced the sexual risk behavior of gay men, perhaps in part because they have not fully considered the social context in which gay men live and how the world of gay men has been influenced by HIV. This study explored the relationship between attitudes about one's own sexual orientation (internalized homophobia, degree of outness, proportion of gay friends), survivor guilt, attitudes about sex (favoring unprotected sex, using sex as a coping mechanism or crutch), attitudes about AIDS (AIDS fatigue, idealizing HIV, and exposure to the HIV culture) to reported rates of unprotected sex (level of unprotected sex since 1978, number of unprotected sex partners in past six months, frequency of unsafe sex, time since last unprotected sex).
Results showed that gay and bisexual men with more positive attitudes about their sexual orientation had unprotected sex more recently. There is evidence suggesting that survivor guilt may have some positive relationship with levels of unprotected sex.
There was no evidence to support the other hypotheses. The study describes the sample's sexual behavior, and concludes that even the men who report unprotected sex may not possess unhealthy traits or characteristics that HIV prevention programs need to target. Having unprotected sex may be a factor of how likely one is to interact sexually with other members of a culture. Additionally, findings that: (1) men in long term relationships and (2) younger men, both have more unprotected and protected sex support this conclusion. Second generation HIV prevention programs need to address the complexity of gay men's sexual decision making. Effective programs are likely to be community interventions that address the cultural parameters of gay men's existence including: members, world, language, social practices, choice principles, and statuses.
Rockfeller K (1994). The context of meaning and psychosocial adaptations to HIV/AIDS by HIV-negative gay. PH.D. Thesis, Saybrook Institute, DAI, Vol. 55-06A, p. 1509, 381 pages.
Abstract by author: Well into the second decade of the HIV/AIDS epidemic psychosocial research has overlooked the experience of being HIV-negative in a community devastated by HIV/AIDS. Semi-structured interviews and open-ended dialogues were used to investigate the context of life meaning and psychosocial adaptations to HIV/AIDS by HIV-negative gay men (n = 32). The research utilized human subjects as co-participants exploring multiple loss, bereavement, reoccurring grief and how those who are HIV-negative shift their life meaning, purpose and values as a result of living in the age of AIDS.
The investigation replicated Schaefer's (1991) study on psychological adaptations to the epidemic by HIV-positive gay men and diagnosed AIDS patients (n = 20) on life meaning, value and purpose. Data from the study on HIV-negative men were compared with Schaefer's (1991) findings.
The research used a combination of methods to study: experiences with HIV antibody testing, interactions with HIV-positive loved ones and friends, demographics, and sexuality in the age of AIDS. The open-ended dialogues probed life meaning and purpose as a result of being HIV-negative incorporating multiple sources of data (dreams, film and cultural imagery, participant observation). Interviews were tape recorded, transcribed, and analyzed using Textbase Alpha, a software program designed for qualitative data management and thematic content analysis.
Qualitative content analysis identified as reoccurring psychosocial stressors for HIV-negative gay men: watching partners, friends and acquaintances fall ill and die, isolation and immobilization resulting from unprocessed grief and bereavement, the complex uncertainty of one's ability to maintain a seronegative status and fear of seroconversion, the lack of personal and communal support systems for HIV-negative men within the gay community, sexuality and sexual expression in the age of AIDS. Content analysis revealed psychosocial adaptations to include: HIV as a catalyst for self-discovery and self-growth, the importance of intimate and interpersonal relationships, creating community and social support systems, volunteerism and social activism while contributing to one's community and/or society and aesthetic appreciation and involvement.
Personal and communal rituals of grieving were instrumental in assisting bereaved individuals in expressive grief work adapting to multiple loss and bereavement, incorporating the wounded healer archetype, transforming survivor guilt to survivor mission with renewed personal/communal identity and social activism.
Russell G (1995). Risk factors, social stress, and social supports as predictors of psychiatric morbidity in gay/bisexual African American men impacted by HIV/AIDS. PH.D. Thesis, DAI Vol. 56-11B, p. 6405, 109 pages.
Abstract by author: Data from the AAHP, a 3-year, multi-site, cross- sectional investigation (Myers et al. 1995), were used to examine the relative contributions of risk factors (i.e., age, income, education, psychiatric history, serostatus, drug use, and alcohol use) related to stress vulnerability, social stress and four sources of social stress, and the perceived quality of social supports received in predicting any current psychiatric disorders, any current mood disorders, and any current anxiety disorders in 242 gay/bisexual, African-American men, approximately half of whom were HIV+. All risk factors were expected to contribute to outcome with psychiatric history predicted to be the strongest predictor of current psychiatric disorder, mood history the strongest predictor of current mood disorders, and anxiety history the strongest predictor of current anxiety disorders.
Overall social stress and two social status stresses (i.e., economic status stresses and marginal group status stress) were expected to predict outcome while two social role stresses (i.e., work/unemployment stresses and relationship stresses) were not. Social supports were expected to serve as either a protector or moderator of stress. Hierarchical logistic regressions (p < .05) revealed low education predicted any psychiatric disorder and anxiety disorders, low income and mood disorders, and mood history predicted current anxiety disorders. Social stress findings were consistent with hypotheses in that overall social stress and social status stresses predicted some outcomes. Social support findings were inconsistent with hypotheses. Implications, limitations and suggestions for further study are also discussed.
Saragossi CR (1996). You are HIV-positive: whom do you tell? M.S.W. Thesis, California State University, Long Beach, MAI, Vol. 35-03, p. 0713, 122 pages.
Abstract by author: HIV/AIDS is not only a medical problem, but also a social problem. The diagnosis carries a stigma that has profound psychological, social, and emotional ramifications. For this reason, when a person is HIV infected, the diagnosis is often a closely guarded secret, even within the family.
In the early years of the disease, gay males and intravenous drug users were those primarily infected. Historically, women are relatively new to the cast of those who are infected with HIV/AIDS. The most highly represented populations of infected women are IV drug users and minority women. The majority of these women are single heads of households with young children. How these women respond to their positive diagnosis can have tremendous repercussions to the individual as well as the family. People with HIV/AIDS must decide to whom and when to disclose this information. This study explored whether patterns of disclosure exist.
Sexton SK (1997). Sense of belonging and risk-taking behavior in persons at risk for HIV infection. M.S. Thesis, California State University, Long Beach, MAI, Vol. 36-02, p. 0516, 37 pages.
Abstract by author: The spread of HIV infection among gay men has been cause for concern. Factors associated with sexual risk-taking behavior, including lack of social support, have been studied in this population. Sense of belonging, a newly developed gauge of community fit and sense of value, has not been previously studied in relation to sexual risk taking.
This study sought to determine whether increased sense of belonging was associated with decreased risk-taking behavior in a group of gay men. Fifty-seven gay men visiting The Center, a community center for the gay and lesbian community in Long Beach, California, were asked to complete questionnaires on sense of belonging and risk taking. No correlation was found between risk taking and sense of belonging scores in this group.
Sherburne SP (1995). Affective reactions, social support and willingness to self-disclose to HIV seropositive individuals; impact of sexual orientation and responsibility for the infection. M.S. Thesis, Old Dominion University, MAI Vol. 34-03, p. 1304, 110 pages.
Abstract by author: An attributional model of controllability suggests that perceptions of someone's controllability of an event lead to anger and rejection, whereas perceptions of uncontrollability lead to pity and helping. This study examined the impact of an HIV victim's sexual orientation and "responsibility" for infection on subjects' affective responses, self-disclosure to the person, social support, and liking and trust for the person. Subjects received messages from their "partner" (a confederate) stating that he had just learned he was HIV positive. The message either stated that he was heterosexual or homosexual, and that he had either only one partner or many partners.
Subjects responded to this message, and were also given the opportunity to self-disclose. Subjects were then measured on their affective responses, liking and trust for their partner, and other measures. Overall, subjects reported more negative affect and less trust for a homosexual versus heterosexual HIV positive individual. Subjects also responded more intimately to a heterosexual HIV positive person than to a homosexual HIV positive individual. Subjects reported feeling more negative with a homosexual/irresponsible HIV positive person than anyone else, and dismissed (ignored or attempted to explain away) the problem less with someone who was homosexual/irresponsible than anyone else. Subjects also responded with more factually intimate statements and self-disclosed with more non-intimate statements with a homosexual/irresponsible person than anyone else. These results indicate a negative bias toward homosexuals, and that the negative bias is compounded when paired with a perception of irresponsibility.
Silva RT (1992). Correlates of risk behavior for HIV infection among gay and bisexual males. PH.D. Thesis, State International University, DAI Vol. 53-02B, p. 1055, 128 pages.
Abstract by author: The problem. The current study examined the relationships between the AIDS-risk sexual practice level of gay or bisexual men and a number of psychological, social, and behavioral variables. On the basis of findings from other areas of health behavior promotion research, several psychosocial dimensions were expected to predict risk behavior patterns. In relation to persons who have modified risky aspects of their sexual behavior, those who still engage in high-risk practices were hypothesized to be less knowledgeable about AIDS, to evidence lower self-esteem, to be more apt to attribute personal likelihood of HIV infection to external factors, to report less satisfaction in relationships, and to perceive less social support from family.
Method. One-way analyses of variance was used to evaluate these hypotheses, with level of risk serving as the independent variable and the psychosocial measures serving as dependent variables. Also, between-groups differences for demographics were assessed. As such, this study explored correlates of risk behavior that would have implications for long-term survival as well as for prevention campaigns and treatment programs.
Results. The results of the present
study did not support previous research findings and instead revealed that
all five null hypotheses established at the outset of the study were retained.
While ANOVAs and Pearson correlations of the variables failed to yield
significant findings, significant correlations were found between the following
demographic characteristics and risk level: age, counseling history, and
religious affiliation. Subjects more likely to practice low risk behaviors
were found to be older, identify with a religious belief system, and have
experienced more counseling. Furthermore, age, education, occupation, amount
of counseling, and the number of months since diagnosis were significantly
related to risk behavior sub-variables (such as the number of various high
risk and moderate
Silvestre AJ (1992). HIV rates and differences in behavior among men entering an HIV disease cohort study. PH.D. Thesis, University of Pittsburgh, DAI Vol. 53-06A, p. 2111, 148 pages.
Abstract by author: The number of newly-diagnosed AIDS cases among homosexual men continues to increase. While substantial amounts of data have been gathered about HIV-related behaviors and infection rates early in the epidemic, less is known about current rates and practices especially among homosexual teenagers and young adults. Data were collected through self-administered questionnaires and blood donations from 1614 homosexual and bisexual men in 1984-1985 and between 1988 and 1992 in Pittsburgh. Data indicate that while men recently entering the study practice fewer risky behaviors, significant numbers continue to engage in unsafe sex. 35% of men entering the study since 1988 report engaging in unprotected anal receptive intercourse with at least one partner during the six months before their study visit and 16% with more than one partner. The rates were significantly higher for men less than 22 years old. Approximately 7% of the younger men and 18% of the men over 22 years of age in the 1988-1992 cohort were already infected with HIV on joining the study. These rates are the same as the rates in Pittsburgh in1984. Alarming numbers of young gay men are being infected. Aggressive HIV/AIDS risk reduction programs are needed in high schools and existing networks in the gay community.
Simon PM (1990). Barriers to prevention of HIV infection among male prostitutes. PH.D. Thesis, Tulane University, DAI Vol. 52-03A, p. 1099, 148 pages.
Abstract by author: A sample of 211 male street prostitutes were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Based on the constructs of the Health Belief Model, subjects' perceptions of susceptibility to HIV infection, severity of HIV infection, benefit to engagement in preventive health behavior to avoid infection, and barriers to the reduction of HIV-related risk behaviors were examined. Serological data from the study confirms an HIV point prevalence rate of (175 per 1,000) among the sample. Sexual behaviors associated with increased risk of HIV infection were, engagement in anal sex and oral-genital sex, history of syphilis, and a self-defined sexual orientation of homosexual. Based on previous research and the theoretical framework suggested by the Health Belief Model, it was expected that increased HIV-related risk behavior among the male street prostitutes would be inversely related to perceived severity of HIV infection, perceived susceptibility to HIV infection and perceived benefit to prevention of HIV infection and positively related to an increased perception of barriers to preventive health behavior. The findings partially support this model.
Increases in perceived susceptibility and benefit to HIV prevention were significantly related to reduced risk. However, prostitutes' level of perceived severity of HIV infection was not significantly associated with risk behavior. Three lifestyle factors were found to function as barriers to engaging in risk reduction behavior. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter and reported increased pleasure from sexual activity with their customers were more likely to engage in HIV-related risk behaviors.
The data suggest that male prostitutes engage in numerous unprotected sexual acts placing them at high risk for not only the acquisition of HIV infection but the transmission of HIV to other partners. Further research focusing on HIV- related risk behaviors of both male prostitutes and their customers is recommended. Utilization of the findings from this study in the design and implementation of future HIV-related preventive health education programs is discussed.
Slavin SF (1995). Acquired Immunodeficiency Syndrome: graduate social work students' knowledge and attitudes. M.S.W. Thesis, California State University, Long Beach, DAI Vol. 33-06, p. 1738, 80 pages.
Abstract by author: This study examines the knowledge about and attitudes toward HIV/AIDS of students in the Master of Social Work program at California State University, Long Beach. It is a partial replication of a 1993 study done by David Goh, which examined the attitudes and knowledge about HIV/AIDS of undergraduate and graduate students. Overall, the study found the students to have good knowledge and accepting attitudes. However, gaps were found.
Homosexual students had higher knowledge levels and more accepting attitudes. This was also found to be true of students who indicated having had some experience with HIV/AIDS through paid work, field work, volunteer work or personal. The researcher believes that the gaps can be closed through the educational process. Recommendations for curriculum and field practicum were made as well as recommendations for further research.
Smith RB (1996).The impact of gay identity development on AIDS-risk behavior among younger gay men. PH.D. Thesis, University of Maryland, College Park, DAI, Vol. 58-01B, p. 442, 251 pages.
Abstract by author: Previous research has found high occurrences of AIDS-risk behavior among younger gay men. The process of gay identity development is posited as a special developmental challenge that may affect these individuals' sexual behavior.
Earlier studies have examined general explanatory models for as well as specific correlates of high-risk sexual behavior. Various theoretical models have also been proposed as descriptors of the process of gay identity development. These models suggest that there are four underlying dimensions of gay identity development: gay awareness/self-acceptance, attitudes about homosexuality, gay community involvement, and disclosure of same-sex attractions to significant others.
A model is advanced in which AIDS-risk behavior is predicted by these four dimensions of gay identity development - both directly and, indirectly, through these four variables' impact on the mediating variables of self-esteem, disavowal of AIDS risk, and perceptions that safer sex is the norm. The role of emotional distress in these processes was also examined.
Anonymous, self-report questionnaires were distributed to 640 self-identified gay or bisexual males aged 18 to 25. A total of 312 questionnaires were returned, and 305 were included in the final sample. Structural equation modeling techniques were employed in data analysis. The hypothesized model was not supported by the data. But the data did support a model in which AIDS-risk behavior was indirectly predicted by self-acceptance and attitudes toward homosexuality, through the impact of these variables on the mediating variables of self-esteem, disavowal of AIDS risk, and perceptions that safer sex is the norm. Gay community involvement and self-disclosure were found to have little influence in the model. Emotional distress was found to have influence, either as an independent variable or, with self-esteem, as a mediating variable. Self-esteem and emotional distress may be general outcomes of gay identity development that in turn influence variables more directly related to AIDS-risk behavior.
Various limitations of the current study are discussed. Implications for interventions with younger gay males and for future research are reviewed.
Sorenson EA (1994). Stigma and identity: a multiple case history of people with AIDS. PH.D. Thesis, The University of Michigan, DAI, Vol. 55-08B, p. 3602, 157 pages.
Abstract by author: The existing literature on stigma describes stigma in terms of groups' actions and attitudes, with little attention to the experience of stigmatized individuals.
This study adopts the multideterministic view of Erikson, who asserts that people's experiences are influenced by cultural, interpersonal, intrapsychic and developmental factors. The reader is encouraged in particular to attend carefully to the narrative histories of study participants. These tell how the current experience of social rejection becomes personally relevant within a context of cultural factors, interpersonal relationships and life historical experiences of abandonment and ostracism.
The stigma experience is likened to an identity crisis, through which the individual appropriates aspects of the social attitude toward him in personally specific ways. Unlike developmental and normative crises like adolescence, the identity crises provoked by stigma are seen as traumatically imposed on participants.
Participants' narratives describe their reactions to stigma in experiences of disequilibration which bring to bear aspects of their personal histories. One section of the dissertation presents ways social definitions and labels such as "Black", "gay", and "individualist" are selectively utilized by participants to highlight aspects of their conflicts about self-definition. Another section illustrates ways participants' expectations of dependency, separateness, and autonomy in relationships are patterned historically and stimulated in the stigma experience.
A final section discusses participants' conflicts about self integrity as it is threatened by the social imposition of stigma. These findings support the view that the group attributions promoted by stigmatization are internalized by people with AIDS, but with personal specificity. Attending to their stories permits a richer understanding of the complex social psychology of stigma, occurring in a shared social context which attempts to detrimentally divide the HIV-infected population from the non-infected. We may then come to a finer, more tolerant appreciation of the common humanity of stigmatized people insofar as reading their narratives stimulates an awareness of comparable experiences in our own lives.
Stately AL (1997). The psychological adjustment of HIV-negative gay men in a sero-different couple: the impact of HIV-illness factors, AIDS-related loss, intimacy and social support and anticipatory grief and psychological distress. PH.D. Thesis, California School of Professional Psychology, Los Angeles, DAI, Vol. 58-09B, p. 5142, 206 pages.
Abstract by author: The purpose of the study was to address gaps in the literature on HIV sero-different gay male couples, and to test the impact of key variables on anticipatory grief and psychological adjustment among HIV-negative partners in sero-different couples. The independent variables included HIV-related illness factors, AIDS-related bereavement characteristics (number and impact of previous losses to AIDS), and social-interpersonal characteristics (intimacy and perceived satisfaction with social support). The dependent variables were the level of anticipatory grief and psychological disturbance as reported by the HIV-negative partner. The sample consisted of 93 HIV-negative gay men in sero-different couples who had been together six months or longer. Participants were primarily white, educated, middle-income, young gay men living in the United States, who completed either an on-line or paper version of the survey. Results of the study generally support the hypotheses. For this sample, CD4 count, number of illnesses (for HIV-positive partner) in the past year, and subjective impact of AIDS-related losses within the past year account for a significant amount of variance in anticipatory grief. Number of illnesses within the past year emerged consistently as the most significant predictor in explaining the variance in psychological disturbance and distress. Explanations for these results are offered which take into consideration the impact of various psychological and social processes discussed in previous research on gay men and the impact of chronic illness on the functioning of individuals and couples. The study also explored the impact of key intimacy variables. HIV-related self-disclosure and survivor guilt and the other independent variables on psychological symptoms. Cohesion, compatibility, identity and affection had significant impact on the experience of psychological distress for these men, while HIV-related self-disclosure had no predictive value. Further, there is strong evidence that survivor guilt, as well as the number of illnesses experienced by the HIV-positive partner, has a tremendous impact on symptomatic distress. Recommendations for future research and the development of treatment interventions are offered in light of these findings.
Tao G (1995). Modifying high risk sexual behaviors among gay and bisexual adolescents; evaluation of an intervention program. PH.D. Thesis, University of Minnesota, DAI Vol. 56-08B, p. 4273, 202 pages.
Abstract by author: This study tries to identify historical trends and predictors of high-risk behaviors in gay and bisexual youth, using Social Learning Theory as a conceptual framework, and to evaluate the Youth and AIDS Project, using cost benefit/effectiveness analysis.
Five-hundred and one male volunteers, 13-21 years of age, self-identified as gay/bisexual or having sex with men, were recruited into the initial interview in Minnesota during June 1, 1989-May 31, 1994. Three- hundred and seventy-six of them participated in the 3- month follow-up interview. The written instruments used in the interviews include measures of sexual behaviors, motivation, self-efficacy, knowledge about HIV/AIDS transmission, and psychosocial and demographical information. Loglinear regression in trends study, covariance structure models in HIV risk reduction study, and a model of HIV transmission in the evaluation of the Youth and AIDS Project are mainly used in this study.
The findings indicate that with the increase of social supports, participants have an increase in their AIDS knowledge, but that good AIDS knowledge does not guarantee that participants change their high-risk sexual behaviors. High-risk sexual behaviors are correlated with participants' motivation, drug and alcohol use, parental relationship, AIDS knowledge, suicide attempts, and peer support. HIV risk reduction is predicted by past sexual experience, drug and alcohol use, and parental relationship.
The intervention program could limit HIV prevalence to under 8% at year 2000 if all risky gay and bisexual adolescents were recruited to program participation and educated to modify their sexual behaviors. Without the intervention, HIV prevalence is predicted to be approximately 22% at year 2000. The cost-benefit ratio of the intervention program is approximately 1:18.7. The federal government should increase expenditures for AIDS prevention programs such as the Youth and AIDS Projects since the return to society from investment in these programs clearly exceeds their costs.
Effective HIV prevention should be carried out at group or individual levels for gay and bisexual adolescents. Targeting of programmatic efforts at those who practice high-risk sex, those who have been involved in drug and alcohol use, or those whose parents have divorced would yield the greatest benefits.
Tattle SG (1995).Factors influencing condom use in 16 to 25 year old gay and bisexual males: a study using the theory of planned behaviour. M.SC. Thesis, University of Toronto, MAI, VOL. 34-05, p. 1924, 143 pages, ISBN: 0-612-07621-0.
Abstract by author: This descriptive correlational study examined the relationships between intention, attitudes, subjective norms and perceived behavioural control, related to the use of condoms for anal intercourse, among a group of gay and bisexual men aged 16 to 25. The study was conducted in two phases and was based on the Theory of Planned Behaviour (Ajzen, 1988, 1991).
Results indicated that intention to wear condoms when in the insertive role during anal intercourse was weakly associated with subjective norms and perceived behavioural control. Intention to insist on condom use when in the receptive role during anal intercourse was weakly related to attitudes. Intention to use condoms in either role during the next six months was extremely high, despite moderate levels of condom use in the previous six months. This study highlights many of the beliefs which underlie attitudes, subjective norms and perceived behavioural control in this population. Recommendations are made for nursing practice, education and further research.
Thomson JD (1997). Barriers to consistent condom use: a major HIV risk factor among homeless adolescents. PH.D. Thesis, California Schools of Professional Psychology, Berkeley, CA. DAI, Vol. 58-05B, p. 2662, 163 pages.
Abstract by author: This study examined risk factors for HIV infection among a sample of 68 young men and 36 young women ages 15-20 at a drop-in shelter in San Francisco, the majority of whom had been living on the street for 6 to 24 months or longer prior to sampling. Consistency of condom use was examined, as was the utility of questions derived from the AIDS Risk Reduction Model and six psychosocial variables (e.g., age, time on the street, substance use, trauma, abuse or sexual risk behaviors) in prediction of use. Sampling was conducted at Central City Hospitality House Youth Program in the Tenderloin area of San Francisco. Participants were selected Monday through Friday using random sampling. They were interviewed regarding their current lifestyle, HIV risk behaviors and family history. The Trauma Symptom Checklist Child was administered in written form. Two primary groups emerged, that of older, white males (ages 18-20) who engaged in intravenous drug use and young men and women who self-identified as sexual minorities, (i.e., gay, lesbian, bisexual, transgender or undecided about sexual orientation).
When all variables were entered simultaneously, only one of three stages of the AIDS Risk Reduction Model predicted condom use. The variable most highly related to use was intention to employ condoms. None of the six psychosocial variables emerged as barriers to condom use. Contrary to the expectation that condom use would be compromised in this sample, 60% of those engaging in sex reported the use of a condom the last time they had vaginal or anal sex. Among a few members of the sample engaging in survival sex (i.e., prostitution), condom use was even higher (73%). The highest risk for HIV infection appeared to be intravenous drug use (58% lifetime), 57% reported use in the past 60 days, of whom 42% shared needles.
The results indicated that (a) for this group, substance use is a pervasive risk factor for both HIV infection and an impairment to normal development into adulthood, (b) many homeless youths are at very high risk for HIV infection, (c) researchers must "fine-tune" instruments to account for highly diverse elements among the universe of homeless youths and (d) protective factors may represent a means of decreasing risk for HIV infection.
Tillotson DC (1997). Self-esteem and mood as predictors of sexual compulsivity in gay men. PSY.D. Thesis, California School of Professional Psychology, DAI, Vol. 58-05B, p. 2703, 135 pages.
Abstract by author: While sexual compulsivity in the gay male population has been studied (Baum & Fishman, 1994; Pincu, 1989; Quadland, 1983, 1985; Quadland & Shattls, 1987), little is known about the etiological determinants for this behavior. Therefore, a large sample of gay-identified men (N = 261) completed questionnaires concerning sexual behavior, self-concept, and mood. Multiple regression analyses revealed that low self-esteem and dysphoric mood were predictive of compulsive sexual behavior in gay men. Specifically, anxiety was highly predictive of sexually compulsivity and depression was associated with sexual behavior motivated by anger, avoiding or loneliness. Subjects who felt doubtful of their moral worth, undesirable, lacking in confidence, dissatisfied with their religion, and dissatisfied with their relationship to family reported more sexually compulsive behavior. Adjunctively, six gay men who perceived their sexual behaviors as problematic were interviewed. Interviewees spoke a history of low self-esteem, depression, anxiety, obsessive-compulsive behaviors, or difficulties with mood swings. Difficult family relationships were reported, as well as problems with polysubstance abuse and dependence and high-risk sexual behavior. This study’s findings suggest that gay men struggle with low self-esteem, mood problems, polysubstance abuse and dependence, and risky sexual behaviors. A strong relationship was demonstrated between self-esteem, mood and compulsively sexual behaviors. These findings, as well as future research, may enhance the development and implementation of HIV prevention strategies, more socioculturally sensitive instrumentation, and gay-affirmative psychotherapies.
Turner DC (1994). For the sake of male pleasure: gay identity, HIV, grief and risky sex. PH.D. Thesis, University of California, Los Angeles, DAI, Vol. 55-12A, p. 3900, 244 pages.
Abstract by author: This project uses an ethnographic and life history approach in providing a descriptive study of gay Identity development and the impact of HIV and AIDS on the mental, social, and physical wellbeing of HIV negative gay men who reside in West Hollywood, California. Theories and models of gay identity acquisition, notions of a cohesive self, and gay culture are discussed and modified based upon the data collected. The impact of HIV/AIDS on study participants includes styles of coping with the deaths of friends and lovers as well as sexual behaviors which put individuals at risk for HIV infection. Most gay men report occasional behaviors that put them at risk for HIV infection and are labeled as "relapsers" in the literature. In this study, comparisons of safer and unsafe sexual encounters suggest that unsafe events may occur because of the perceived extraordinary sexual abilities and physical attributes of sexual partners, heavy foreplay, and/or the use of alcohol and drugs. Moreover, all of these reasons have an impact on the brain which may impair the individual's ability to calculate risk. In light of these results, health education theories and psychological constructs such as self-esteem are discussed and suggestions for health interventions are given.
Vanable PA (1997). Alcohol use, self-regulatory failure, and increased behavioral risk for HIV. PH.D. Thesis, University of Illinois at Chicago, DAI, Vol. 58-11B, p. 6248, 113 pages.
Abstract by author: Although numerous reports suggest that alcohol use is related to sexual behavior that is high-risk for HIV infection, inconsistent findings and methodological shortcomings have impeded efforts to derive clear prevention implications from these studies. Drawing from theory and research on alcohol use and health behavior regulation, the goal of the present study was to identify individual and situational factors that condition or moderate the link between drinking and risky sexual behavior. Data are drawn from event specific assessments of alcohol use and HIV risk behavior for two occasions of sexual activity. Respondents were 1183 gay and bisexual men recruited as part of a vaccine preparedness study. Based on research indicating that alcohol impairs attentional capacity and monitoring of abstract behavioral standards, it was hypothesized that drinking would be most strongly associated with HIV risk in settings where risky behavior is, under sober conditions, most strongly inhibited or constrained. Drawing from social learning models, it was also predicted that people with strong alcohol expectancies would be more likely to drink in sexual settings and, in turn, would be more vulnerable to lapses toward increased risk after consuming alcohol. Providing partial support for these hypotheses, results indicated that alcohol use was most consistently related to sexual risk taking in settings where concern about avoiding risky behavior is presumed to be highest (sex with non-steady or "casual" partners) and among individuals who in general are very concerned about avoiding sexual risk. In addition, expectations that alcohol enhances sexual responding and reduces tension were related to the use of alcohol in sexual settings, and interacted with a measure of safer sex "burnout" to predict total amount of alcohol consumed across two recent sexual encounters. No support was found for the hypothesis that alcohol expectancies would moderate the alcohol/risky sex link. Results are discussed in terms of their implications for understanding the variable effects of alcohol on sexual responding and for designing targeted interventions to reduce substance-related risk behavior.
Vieille RC Jr (1997). The use of hypnosis, self-hypnosis, mental imagery, and naturalistic trance to enhance immunity and health in gay men with HIV. PH.D. Thesis, California School of Professional Psychology, Fresno, DAI, Vol. 58-10B, p. 5692, 310 pages.
Abstract by author: This paper elaborated a contextualist metatheoretical foundation for psychoneuroimmunological investigation. While it subjected its hypotheses to empirical confrontation through traditional mechanistic methodology, it adhered to its contextualist perspective to interpret its results.
The study examined whether hypnosis and mental imagery administered in six 1-hour individual sessions, with daily, at-home practice of self-hypnosis and naturalistic trance would enhance immunity and health in 14 HIV-positive gay men. Dependent variables were number of CD4 cells per mm$sp3,$ CD4 to CD8 ratio, hardiness as tested by the Personal Views Survey, HIV-related symptoms as determined by the HIV Distress Inventory, and tension-anxiety and depression-dejection as tested by the Profile of Mood States (POMS). It hypothesized that practice-frequency of self-hypnosis would correlate with positive results. Finally, it hypothesized that hypnotic susceptibility as measured by the Stanford Hypnotic Susceptibility Scale: Form C would correlate with successful outcome.
A quasi-experimental, untreated control group (n=9) with pretest and posttest design was employed. Results were subjected to a mixed-design ANOVA and revealed a significant difference between groups for tension-anxiety only. As pretest CD4/CD8 ratio measures between groups were significantly different, outcome measures were adjusted through an ANCOVA, and a significant main effect was found between groups at posttest. Frequency of combined self-hypnosis and naturalistic trance correlated significantly and strongly with improvement in tension-anxiety. Frequency of self-hypnosis alone was correlated strongly and significantly with improvement in CD4/CD8 ratio, HIV-related symptom distress, and tension-anxiety. Hypnotizability was unrelated to positive outcome. Post hoc analysis determined reliable, clinically significant improvement for 3 of the 6 participants falling in the dysfunctional range for tension-anxiety at pretest and for all 6 participants falling in the dysfunctional range for depression-dejection, The biopsychosocial view of contextualism posits a level of complexity necessitating an idiographic focus on the unique individual. This view indicated that several participants found improvement in targeted symptoms, experienced insights into the nature of their interpersonal relationships, engaged in new behaviors to improve those relationships, obtained increased self-awareness and self-confidence, and experienced increased vitality.
Weinberger MC (1995). The comparative efficacy of stress inoculation training and supportive therapy in the treatment of psychological distress in males with AIDS- related complex. PH.D. Thesis, California School of Professional Psychology, San Diego, DAI, VOL. 50-03B, p. 1127, 233 pages.
Abstract by author: Recent research has suggested that stress-induced levels of depression and anxiety may lead to immune suppression. This further compromise of their already precarious immune systems may be fatal to those with AID's Related Complex (ARC). While researchers in AIDS/ARC have called for interventions to reduce the levels of depression and anxiety in persons with ARC, to date little research is available to delineate the most effective method to accomplish this. The purpose of the present study was to assess the comparative effectiveness of Stress Inoculation Training (SIT), and supportive therapy in reducing stress in men with ARC. Thirty gay/bisexual men who were diagnosed with ARC were randomly assigned to one of three conditions: an SIT intervention group, a supportive therapy intervention group, or a wait-list control group.
Pre-treatment measures of symptoms of depression and anxiety were obtained from all subjects, as was demographic information. These measures were: The Symptom Checklist 90-R (SCL 90-R), The Profile of Mood States (POMS), The Beck Depression Inventory (BDI), and The State-Trait Anxiety Inventory (STAI).
The subjects met once weekly for 1.5 hours at the San Diego AID's Project for four consecutive weeks. Immediately after the interventions and one month later subjects again filled out the measures.
The SIT intervention group utilized the transactional model of stress derived from Lazarus, and incorporated behavioral (relaxation training), as well as cognitive techniques. It explored the cognitive appraisals which occur when one is confronted with a situation which may tax the person's resources. It was predicted that the SIT group would show significantly lower levels of stress than the other two groups.
Results indicated that all three groups improved in their levels of stress, with no group doing significantly better than the other. It was also found that intervention subjects diagnosed over 15 months did not evidence lower levels of stress than the other subjects. The need for increased psychosocial support services, as well as suggestions for further research with this population are discussed in the context of the results obtained and their implications.
Wheeler DP (1992). Marginalization, locus-of-control, and gender identification: mediating variables in the risk for sexual exposure to HIV among young urban Black males. PH.D. Thesis, University of Pittsburgh, DAI Vol. 53-05A, p. 1671, 173 pages.
Abstract by author: In the field of HIV and AIDS research a substantial literature has emerged detailing intervention campaigns with homosexual populations. Much less empirical research has been conducted to investigate the social factors contributing to HIV/AIDS in minority communities. The present study seeks to identify the existence of relationships between three variables (marginalization, locus of control and gender identification) and the risk for sexual exposure to HIV among young (13-21 year old) urban Black males. A survey instrument measuring six distinct categorical areas was administered through the county health department's sexually transmitted disease clinic. The six areas of the survey instrument were: social class, race/ethnicity, marginalization, locus of control, gender identification, and risk factors for sexual exposure to HIV. Five-hundred and fifty-two responses were obtained. In the study population significant relationships were found to exist between race, marginalization, social class, and risk for sexual exposure to HIV on key components. Discriminant function analyses were applied to determine the models ability to predict inclusion on the criterion variables. The model was found to significantly predict inclusion on several components of the composite dependent variable. Black males were significantly more likely to have unplanned fathering events (p =.000) than their White counterparts and to have past and present histories of sexually transmitted diseases (p=.024 & p =.000 respectively). These factors are suggested as proxies for risk of exposure to HIV/AIDS. Less significant findings were obtained for differences between Black and White males on locus of control or gender identification. Further exploration of psychosocial and environmental determinants of risk for HIV exposure through sexual practices appears warranted.
Yost JEE (1996). AIDS talk. DR.P.H. Thesis, The University of Texas H.S.C. at Houston School of Public Health, DAI, Vol. 58-06B, p. 2988, 537 pages.
Abstract by author: The observations of Michel Foucault, noted Twentieth Century French philosopher, regarding modern power relations and orders of discourse, form the framework utilized to analyze and interpret the power struggles of AIDS activists and their opponents—the religious and radical right, and the administrative agencies of the ‘Liberal’ welfare State. Supported by the tools of sociolinguistic inquiry, the analysis highlights the success of a safer sex campaign in Houston, Texas to illustrate the dynamics of cultural and political change by means of discursive transformations initiated by the gay micro-culture. The KS/AIDS Foundation, allied with both the biomedical community and gay entertainment spheres, was successful in conveying biomedical cautions that resulted in altered personal behavior and modified public attitudes by using linguistic conventions consonant with the discourse of the Houston gay micro-culture. The transformation of discursive practices transgressed not only the Houston gay micro-culture’s boundaries, but the city boundaries of Houston as well. In addition to cultural and political change, moderate and confrontational gay activists also sought to change the cognitive boundaries surrounding ‘the gold standard’ for clinical research trials.
From a Foucauldian perspective, the same-sex community evolved from the subordinated Other to a position of power in a period of five years. Transformations in discursive practices and power relations are exemplified by the changing definitions employed by AIDS policy-makers, the public validation of community-based research and the establishment of parallel track drug studies. Finally, transformations in discursive practices surrounding the issues of HIV antibody testing are interpreted using Foucault’s six points of power relations. The Montrose Clinic provides the case study for this investigation. The clinic turned the technical rationalities of the State against itself to achieve its own ends and those of the gay micro-culture—anonymous testing with pre and post test counseling. AIDS Talk portrays a dramatic transformation in discursive practices and power relations that transcends the historical moment to provide a model for future activists. Volume 2 contains copies of fugitive primary source materials largely unavailable elsewhere. Original documents are archived in the Harris County Medical Archives in the Houston Academy of Medicine located in the Texas Medical Center Library, Houston, Texas.
Publication No. 9736148
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