Psychological and Cognitive Mechanisms of Sexual Compulsivity and HIV Risk

描述（由申请人提供）：项目概述性行为（SC），或高水平的性行为与缺乏控制的感觉相结合，与无保护的性行为和其他艾滋病毒性风险行为密切相关。这种关联在不同人群中都很明显，但在男男性行为者（MSM）中尤为明显。这项建议建立在我们以前的研究基础上，该研究发现，即使在控制了其他已知的相关因素（例如，使用安全套的自我效能、进行安全性行为的意图等）。然而，虽然SC与不安全性行为之间的联系得到了相当多的专家支持，但SC增加风险的方式，以及如何最好地影响此类过程以降低风险，目前尚不清楚。SC已被概念化为成瘾性障碍、冲动性障碍和强迫性障碍。其他人质疑SC作为一种可定义的疾病的存在，并将增加的性行为归因于高性欲。所有概念化的共同点是四个因素：消极情感、性唤起、行为抑制和认知控制。这些因素通过干扰控制一个人的性冲动的能力（这将导致多次性接触）和通过考虑多种强化冲突的能力受损以及考虑干扰避孕套使用的愉悦行为的长期后果的能力受损来影响HIV风险。本研究将提供必要的实证数据，以阐明SC的特点，以及它是如何导致艾滋病性风险行为水平的增加。具体而言，本研究采用病例对照设计，比较两组男男性接触者，125男男性接触者与SC和125男男性接触者没有SC。我们将招募参与者从社区使用克雷格的列表，报纸，目标是GLBT社区，并张贴传单在社区GLBT居民的高浓度。我们还将从一个为GLBT个体提供药物滥用和性强迫服务的治疗项目中招募人员。我们的研究探讨性唤起和消极情绪之间的关系，通过测量性唤起的色情刺激诱导后的两种类型的消极情绪（抑郁和焦虑）。我们通过使用四种标准化的心理测量方法来探索行为激活、性兴奋、行为抑制和性抑制的影响，并通过使用三种认知任务来探索认知控制的影响：测量冲突监控的Stroop任务，测量抑制控制的Reynolds学习任务，延迟折扣任务测量倾向于较小的即时奖励或较大的延迟奖励。这种多方法的策略将使我们能够描述SC，并提供所需的经验数据，以确定，从而帮助解决，影响不安全的性行为的潜在机制。这项研究的结果将进一步采取细致入微的方法来制定干预措施，并允许将资源最密集的预防工作针对那些最有可能传播艾滋病毒的人。N：\SPA Research\赠款\Miner RO 1重新提交Jan_2011\Final Documents\Project Summary 12-30-2010.docx

DESCRIPTION (provided by applicant): Project Summary Sexual Compulsivity (SC), or high levels of sexual behavior combined with a perceived lack of control, is strongly associated with unprotected sex and other HIV sexual risk behaviors. This association has been ro- bust across populations, but particularly strong in men who have sex with men (MSM). This proposal builds on our previous research which found that SC is associated with sero-discordant unprotected anal intercourse in HIV-positive MSM even after controlling for other known correlates (e.g., condom use self-efficacy, intentions to practice safer sex, etc.). However, while the association between SC and unsafe sex has considerable em- pirical support, the manner in which SC confers this increased risk, and therefore how to best influence such processes in order to reduce risk, is as yet, unknown. SC has been conceptualized as an addictive disorder, an impulsive disorder, and as a compulsive disorder. Others have questioned the existence of SC as a defin-able disorder and attribute the increased sexual behavior to high sex drive. Common across all conceptualiza-tions are four factors: negative affect, sexual arousal, behavioral inhibition, and cognitive control. These fac- tors influence HIV risk by interfering with the ability to manage one's sexual impulses, which would lead to multiple sexual encounters, and through impairments in the ability to consider multiple reinforcement contin- gencies and to consider the long-term consequences of pleasurable behavior which interferes with condom use. This study will provide needed empirical data to clarify the characteristics of SC and how it leads to in- creased levels of HIV sexual risk behavior. Specifically, this study uses a case-control design to compare two groups of MSM, 125 MSM with SC and 125 MSM without SC. We will recruit participants from the community using Craig's list, a newspaper that targets the GLBT community, and posting flyers in neighborhoods with high concentrations of GLBT residents. We will also recruit from a treatment program that provides services for substance abuse and sexual compulsivity in GLBT individuals. Our study explores the relationship between sexual arousal and negative mood by measuring sexual arousal to erotic stimuli following the induction of two types of negative mood (depression and anxiety). We explore the influence of behavioral activation, sexual excitation, behavioral inhibition, and sexual inhibition by the use of four standardized psychometric measures, and we explore the influence of cognitive control through the use of three cognitive tasks: the Stroop task that measures conflict monitoring, the Reversal learning task that measures inhibitory control, and the Delayed dis- counting task that measures the tendency to favor either smaller immediate or larger delayed rewards. This multi-method strategy will allow us to characterize SC and to provide needed empirical data to identify, and therefore help address, the underlying mechanisms that influence unsafe sexual behavior. The findings of this study will further a nuanced approach to the development of interventions and allow for targeting the most re- source-intensive prevention efforts at those individuals most likely to spread HIV. N:\SPA Research\Grants\Miner RO1 resubmssion Jan_2011\Final Documents\Project Summary 12-30-2010.docx