Delay Discounting and HIV Sexual Risk Behavior in Men who Have Sex with Men

 描述(由申请人提供)：艾滋病毒的流行继续导致全球每年约200万新感染，美国每年约有50,000例感染。在美国，大约63%的新艾滋病毒感染发生在男男性行为者(MSM)中。虽然行为干预在减少自我报告的性风险方面显示出一定的效果，但在减少艾滋病毒/性传播感染的发病率方面效果较差。需要改进行为艾滋病毒预防干预措施和更好的干预目标。本研究旨在探讨男男性接触者的延迟折扣(DD)与无套肛交(CAI)之间的关系。DD指的是个人倾向于喜欢较小的、直接的结果或奖励，而不是较大的、延迟的结果或奖励。关于性行为，在没有避孕套的情况下进行性行为的选择，可以被概念化为一种较小的、立即可用的奖励，而不是选择等到有避孕套时再进行性行为，后者可以被概念化为潜在的性传播疾病避免的更大、延迟的奖励。如果发现痴呆症与性传播疾病有关，那么这种关系可能成为开发旨在减少性风险和艾滋病毒/性传播感染发病率的新行为干预措施的基础。它也可能是识别男性身份的有价值的工具 最需要艾滋病预防干预的人群。在拟议的研究中，将以两种方式衡量DD。首先，货币贴现将使用货币选择问卷(McQ)进行衡量。McQ提供了一系列选择，要么是即刻可用的小额资金，要么是较大的延迟资金。受访者的偏好模式被用来确定他对延迟可用资金的折扣程度。其次，将使用性别折扣任务(SDT)来测量特定性别的DD。在这项任务中，受访者表示倾向于在不戴安全套的情况下立即发生性行为，以及在指定的延迟时间内使用避孕套进行性行为。回答模式被用来确定被调查者对性活动的轻视度(即，愿意等待)。这个项目有三个目标。对于前两个目标，将对MSM进行基于互联网的调查，以获得人口统计信息、最近的性行为史以及金钱和性折扣数据。目的1是评估金钱DD、性DD和脑梗塞之间的联系，并检验这种联系是否会随着年龄的变化而改变。目的二是利用结构方程模型检验货币和性别DD通过直接和间接途径与计算机辅助教学相关的假设。在目标3中，由NIDA资助的佐治亚州亚特兰大正在进行的HIV阴性年轻黑人/非裔美国男男性行为者队列研究的参与者将在基线水平上完成McQ和SDT。目标3是使用纵向数据分析来评估计算机辅助教学和认知发展之间的因果关系。在一定程度上，DD被发现与危险的性行为有关，它有可能成为MSM艾滋病毒预防干预的行为目标，并成为识别最有可能从事危险性行为的男性的工具。

 DESCRIPTION (provided by applicant): The HIV epidemic continues to result in approximately 2 million new infections globally each year, with approximately 50,000 infections in the United States annually. Within the United States, approximately 63% of new HIV infections occur among men who have sex with men (MSM). Although behavioral interventions have demonstrated modest efficacy in reducing self-­reported sexual risk-­taking, they have been less effective in reducing HIV/STI incidence. Improved behavioral HIV prevention interventions and better intervention targeting are needed. The proposed project is designed to examine the association between delay discounting (DD) and condomless anal intercourse (CAI) in MSM. DD refers to the tendency of individuals to prefer smaller, immediate consequences or rewards over larger, delayed consequences or rewards. With respect to sexual behavior, a choice to have sex without a condom when one is not available could be conceptualized as a smaller, immediately available reward compared to the choice to wait until a condom is available, which could be conceptualized as the larger, delayed reward of potential sexually transmitted disease avoidance. If DD is found to be associated with CAI, then that association could form the basis for development of new behavioral interventions designed to reduce sexual risk-­taking and HIV/STI incidence. It might also be a valuable tool to identify men most in need of HIV prevention intervention. DD will be measured in two ways in the proposed study. First, monetary discounting will be measured using the Monetary Choice Questionnaire (MCQ). The MCQ presents a series of choices between small, immediately available amounts of money and larger, delayed amounts of money. A respondent's pattern of preferences is used to determine the degree to which he discounts money available at a delay. Second, sex-­specific DD will be measured using the Sexual Discounting Task (SDT). In this task, respondents indicate a preference between immediate sex without a condom and sex at a specified delay with a condom. The pattern of responding is used to determine the degree to which the respondent discounts sexual activity (i.e., willingness to wait). This project has three aims. For the first two aims, an Internet-­based survey will be administered to MSM to obtain demographic information, recent sexual behavior history, and monetary and sexual discounting data. Aim 1 is to assess the association between monetary DD, sexual DD, and CAI and to examine if the association is modified by age. Aim 2 is to test the hypothesis that monetary and sexual DD are associated with CAI via direct and indirect pathways using structural equation modeling. In Aim 3, participants in an ongoing, NIDA-­funded cohort study of HIV-­negative, young, black/African-­American MSM in Atlanta, Georgia, will complete the MCQ and SDT at baseline. Aim 3 is to assess the causal association between CAI and DD using longitudinal data analysis. To the extent that DD is found to be associated with risky sexual behavior, it has the potential to be a behavioral target of HIV prevention interventions for MSM and a tool to identify men most at risk of engaging in risky sexual behavior.