Compulsive Behaviors, Mental Health, and HIV Risk

描述(由申请人提供)：性强迫症(SC)的特征是性幻想和行为增加，频率和强度增加，从而干扰个人、人际或职业追求。研究人员一直在各种人群中发现性功能障碍和危险的性行为之间的强烈联系，特别是在男男性行为者(MSM)中。性行为并不是性欲障碍的唯一特征；性强迫症男性报告了与他们的性行为相关的一系列心理症状(药物和酒精滥用、心理健康和情感共病)。研究表明，这些心理因素可能会加剧SC MSM感染艾滋病毒的风险。然而，过去对性接触者的研究并没有区分行为因素和心理因素在性接触者HIV风险中的作用。大多数研究将SC MSM与其他MSM进行比较，而没有控制一般的性行为比率。我们的研究表明，有相当数量的MSM在行为上与SC MSM相似(即他们有相同数量的性伴侣，进行相同频率的性行为)，但在心理上与SC MSM非常不同(即他们不报告自己的性行为痛苦、失控、他们的性行为干扰他们的个人和职业生活，或者他们在药物和酒精的影响下频繁地进行性行为)。这些男性--高度性生活活跃，但不是性功能障碍男男性接触者--将为了解性功能障碍与更大的艾滋病毒风险和在药物和酒精影响下的性行为的机制提供一个关键窗口。识别高性活跃性活动MSM与高性活跃性非性活跃MSM的因素将使我们能够确定使SC男性更容易受到高危性行为影响的心理因素，并为针对这两个人群的HIV预防干预措施的发展提供信息以解决这些限制并与PA-07-409“不同人群的健康研究”相一致，本研究将比较两个高性活跃性MSM样本，一个队列显示有SC症状，另一个没有。通过比较性行为高度活跃的性活跃性行为者和非性活跃性行为者，我们可以更好地了解性活动性行为与HIV传播之间的联系，以及使某些男性容易感染性活动性行为及其负面后果的心理、环境、物质使用和背景因素。我们将使用受访者驱动的抽样来招募400名(n=200 SC，n=200非SC)性行为高度活跃的MSM(&gt；9个伴侣，&lt；90天)参与者将被纵向跟踪13个月，并参与各种评估，既包括先前的情况(神经认知缺陷和经历过的耻辱和虐待)，也包括事件层面的触发因素(药物和酒精使用，以及影响)。这项研究将确定这些因素在调节和调节SC和HIV危险行为之间的关系中所起的作用。我们的纵向方法将允许跟踪跨群体的轨迹和分析个人内部的行为。最终，这项研究将作为形成性干预发展的基础，以降低高度性行为活跃的MSM中与艾滋病毒相关的风险。 公共卫生相关性：这项研究的结果将有助于更细微地理解性强迫症(SC)和男男性行为者(MSM)中艾滋病毒相关危险行为之间的联系。最终，这项研究将作为信息干预发展的基础，以降低高度性行为活跃的MSM、性功能障碍者和非性功能障碍者的艾滋病毒相关风险。

DESCRIPTION (provided by applicant): Sexual Compulsivity (SC) is characterized by sexual fantasies and behaviors that increase in frequency and intensity so as to interfere with personal, interpersonal, or vocational pursuits. Researchers have consistently identified strong links between SC and risky sexual behavior in a variety of populations, but particularly among men who have sex with men (MSM). Sexual behavior is not the only defining feature of SC; sexually compulsive men report a series of psychological symptoms (drug and alcohol abuse, mental health and affective comorbid disorders) associated with their sexual behavior. Research suggests that these psychological factors may exacerbate HIV risk for SC MSM. However, past research on SC MSM has not distinguished between the role of behavioral versus psychological factors in HIV risk among SC MSM. Most studies compare SC MSM with other MSM without controlling for general rates of sexual behavior. Our research suggests that there are significant numbers of MSM who are behaviorally similar to SC MSM (i.e. they have equivalent numbers of sexual partners and engage in sexual behaviors with equivalent frequency), but are psychologically very different from SC MSM (i.e. they do not report distress about their sexual behavior, loss of control, that their sexual behavior interferes with their personal and professional lives, or that they engage in sexual activity under the influence of drugs and alcohol as frequently). These men - highly sexually active, but non-SC MSM - will provide a critical window into the mechanisms by which SC is associated with greater HIV risk and sex under the influence of drugs and alcohol. Identifying factors that distinguish highly sexually active SC-MSM from highly sexually active non-SC MSM will allow us to identify psychological factors that make SC men more vulnerable to high-risk sexual behavior and inform the development of HIV prevention interventions for both populations Addressing these limitations and consistent with PA-07-409 "Health Research with Diverse Populations," this study will compare two samples of highly sexually active MSM, one cohort which exhibits SC symptoms and one which does not. By comparing highly sexually active SC and non-SC MSM, we can better understand both the connections between SC and HIV transmission, and the psychological, environmental, substance use, and contextual factors that make certain men vulnerable to SC and its negative consequences. We will use respondent-driven sampling to recruit 400 (n=200 SC, n=200 non-SC) highly sexually active MSM (> 9 partners, < 90 days) Participants will be followed longitudinally for 13 months and take part in a variety of assessments, capturing both antecedent conditions (neurocognitive deficits, and experienced stigma and abuse) and event-level triggers (drug and alcohol use, and affect). This study will determine the role of these factors in mediating and moderating the relationship between SC and HIV risk behavior. Our longitudinal approach will allow tracking of trajectories across groups and analysis of behaviors within individuals. Ultimately, this study will serve as the foundation for formative intervention development to reduce HIV associated risks among highly-sexually-active MSM. PUBLIC HEALTH RELEVANCE: The findings of this study will facilitate a more nuanced understanding of the association between sexual compulsivity (SC) and HIV-associated risk behaviors among men who have sex with men (MSM). Ultimately, this study will serve as the foundation to inform intervention development to reduce HIV associated risks among highly-sexually-active MSM, SC and non-SC alike.