Interpersonal and intrapersonal conflict and their association with substance use

描述（由申请人提供）：在美国，艾滋病毒阳性的男性与男性发生性关系的人数持续上升，特别是在纽约市等大城市中心。因此，评估艾滋病毒阳性男同性恋和双性恋男子的社会心理和性健康及福祉的独特方法，对于制定针对减少这一人群的性风险和药物使用的干预措施至关重要。由于污名化，艾滋病毒阳性患者仍然难以披露其艾滋病毒状况，这种困难在性行为中尤为明显。在先前的研究中，身份披露和药物使用都被作为增加艾滋病毒阳性男同性恋和双性恋男性性风险（即无安全套性行为）的变量进行了调查。在与非主要（即新的或偶然的）性伴侣发生性接触时，由于害怕人际拒绝和内心羞耻而产生的认知冲突可能会影响信息披露、物质使用和避孕套使用之间的协同关系。基于认知失调的社会心理学理论，本研究基于一个假设，即认知失调（即冲突）是一种消极的唤醒状态，它激励人们从事减少消极唤醒的行为。我们假设人际冲突（例如，害怕因披露艾滋病毒阳性状况和使用避孕套而被拒绝）和人际冲突（例如，更高程度的性羞耻感）会导致这种情况

DESCRIPTION (provided by applicant): The numbers of men who have sex with men who are HIV-positive in the United States continues to rise, particularly in large urban centers such as New York City. As such, unique approaches to assessing psychosocial and sexual health and well-being of HIV-positive gay and bisexual men are crucial to developing interventions tailored to reducing sexual risk and substance use in this population. Disclosure of HIV status remains difficult for HIV-positive people due to stigma, and this difficulty is especially apparent within sexual situations. Both status disclosure and substance use have been investigated in prior research as variables that increase sexual risk (i.e. sex without condoms) among HIV-positive gay and bisexual men. During sexual encounters with non-main (i.e. new or casual) sexual partners, cognitive conflicts that result from fear of interpersonal rejection and intrapersonal shame are likely to influence the synergistic relationship between disclosure, substance use, and condom use. Building on the social psychological theory of cognitive dissonance, this investigation is based on a hypothesis that dissonance (i.e. conflict) is a negative state of arousal that motivates people to engage in behaviors to reduce that negative arousal. We hypothesize that interpersonal conflict (i.e., fear of being rejected for disclosing HIV-positive status and for using condoms) and intrapersonal conflict (i.e., higher levels of sexual shame) will interact to increase substance use and decrease both condom use and disclosure within sexual encounters. The primary goal of this study is to provide useful measurements of these constructs and examine these hypotheses to inform public health interventions aimed at reducing sexual risk and substance use. As such, the project focuses on two aims: (1) to establish reliability, validity, factor structure, and psychometric properties of three measures of intrapersonal and interpersonal conflict; and (2) to elaborate and test the relationship of interpersonal and intrapersonal conflict with HIV status disclosure, sexual risk, and substance use during sex with casual partners. The proposed project will be embedded into a larger study (R01MH87714, Parsons PI; referred to herein as the parent project), which is a longitudinal study that follows highly sexually active gay and bisexual men utilizing multiple methods to investigate their sexual risk behavior. The proposed project will add two internet-based assessments to the parent project that include both new and existing measures. We will combine these new measures with existing data to examine the psychometrics of the newly created measures and test the significance of the proposed hypotheses. The research and training plans proposed for this project are also designed to foster my development as a research scientist with a strong foundation in sexual risk, substance use, and research with HIV-positive gay and bisexual men.