Hendershot, Stoner, George, and Norris (2007) explored dispositional influences on sexual risk taking among 611 heterosexual young adult drinkers of alcohol, a sample that was 49% female and 76% white, with an average age of 25 years. The investigators found that
sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. This finding suggests that alcohol expectancies and drinking before sex represent proximal pathways through which dispositional factors such as sexual sensation seeking influence sexual risk behavior. Gender differences in the relationships among the variables were not supported, demonstrating that sexual sensation seeking, alcohol expectancies, and drinking before sex function similarly in predicting sexual risk behavior among heterosexual men and women in the present study. (pp. 368-369)
On the basis of these findings, Hendershot and colleagues suggest that "[i]nterventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking" (p. 365). Even though
personality factors may pose intransigent targets for interventions ..., understanding the role of relevant personality constructs could nonetheless help to identify high-risk individuals and/or anticipate intervention effectiveness, perhaps enhancing the efficacy of individualized interventions ... . In addition, the availability of efficacious cognitive-behavioral strategies for reducing substance use behavior ... as well as preliminary evidence that drinking patterns can be altered via manipulation of expectancies ... suggest[s] that drinking and expectancies could serve as viable intervention targets for individuals with a dispositional proclivity for risk taking. (p. 371)
On the subject of efficacious intervention strategies, Margolin et al. (2007) have built upon their previous work "by assessing the efficacy of 3-S [spiritual self-schema] therapy1 in a different patient population – drug users living with HIV/AIDS – using a new 12-session version of the therapy (3-S+)" (p. 984). In brief, 3-S+ therapy is "a manual-guided, spirituality-focused, psychotherapy that integrates modern cognitive-behavioral psychotherapeutic techniques with Buddhist psychological principles" (p. 981). It is designed "to decrease impulsivity, and its associated maladaptive behaviors – substance abuse, HIV risk behavior, and lack of motivation for recovery – by increasing spiritual practices, such as meditation and mindfulness, and other practices consistent with each patient's faith" (p. 994). Of 38 methadone maintenance recipients living with HIV, 21 consented to participate in this 12-week course of adjunctive treatment; the remaining 17 study participants received methadone maintenance only (i.e., standard care). "Relative to a standard care comparison condition, patients completing 3-S+ therapy reported greater decreases in impulsivity and intoxicant use, and greater increases in spiritual practices and motivation for abstinence, HIV prevention, and medication adherence" (p. 980). Although these results are encouraging, Margolin and colleagues recognize that preliminary findings such as these need to be corroborated through a randomized clinical trial.
Jaffe, Shoptaw, Stein, Reback, and Rotheram-Fuller (2007)
assessed relationships among dynamic changes tracked over time in methamphetamine [meth] use, depression symptoms, and ... unprotected anal intercourse [UAI] ... in a sample of 145 [meth]-dependent gay and bisexual males enrolled in a 16-week outpatient drug treatment research program. Participants were randomly assigned into 1 of 4 conditions: contingency management (CM), cognitive behavioral therapy (CBT; the control condition), combined CM and CBT, and a tailored gay-specific version of the CBT condition. (p. 301)
Although all participants in this study demonstrated improvement over the 16-week period, the investigators found that "[p]articipants with the greatest downward trajectory in [meth] use (urine verified) reported the greatest and quickest decreases in ... depressive symptoms and sexual risk behaviors. The control group reported the most [meth] use over the 16 weeks; the tailored gay-specific group reported a more rapidly decreasing slope in [meth] use than the other participants" (p. 301).
One implication of these results, according to Jaffe and colleagues, is that
[meth]-abusing individuals seeking care should initially be provided interventions to reduce [meth] use, in order for the caregiver to observe the extent to which co-morbid disorders are reduced before starting treatment regimens that address depression or that target risk behavior reductions. The minority of individuals who continue to have problems with depression and sexual risk behaviors in the absence of [meth] use may be the ideal group who benefits maximally from additional intensive interventions. Findings from this modeling investigation suggest using this type of evidence-based approach in selecting appropriate and tailored interventions with [meth]-dependent men who have sex with men [MSM]. (p. 306)
Good news comes from Latka et al. (2007) who, with the assistance of audio computer-assisted self-interviewing technology, studied a convenience sample of 1,114 injecting drug users (IDUs) who had been living with HIV for 9 years (on average) in four U.S. cities and found that
75% of this sample felt responsible for protecting their sexual partners from HIV. In cross-sectional multivariate analysis, HIV-positive IDUs who felt responsible were those with greater HIV knowledge ..., perceived social support ..., self-efficacy for safely injecting ..., and self-efficacy for using condoms ... . Feeling responsible was associated with having relatively fewer sex partners ... and … lower odds of unprotected sex ... but was not associated with safer injection practices. Feelings of responsibility did not vary by demographic characteristics, suggesting that prevention messages that encourage HIV-positive people to play a role in curbing HIV transmission may be acceptable to many HIV-positive IDUs. (p. S88)
Latka and colleagues suggest that
[i]ncreasing correct HIV knowledge, social support, and self-confidence in using condoms and injecting safely may represent alternative ways of increasing feelings of responsibility. Implications are that counseling for HIV-positive IDUs should be multidimensional and focus on supporting condom use when it occurs, improving skills to initiate and use condoms to boost or maintain self-confidence for safer sex, addressing gaps in knowledge about how HIV is transmitted and how HIV-positive people can care for themselves, and making social service referrals to enhance support networks as needed. (pp. S91, S93)
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Winter 2008 Newsletter / Volume 9, Issue 2
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