Compulsive Behaviors, Mental Health, and HIV Risk

描述（由申请人提供）：性强迫症（SC）的特征是性幻想和性行为的频率和强度增加，从而干扰个人、人际关系或职业追求。研究人员一致认为，在各种人群中，尤其是男男性行为者（MSM）中，SC与危险的性行为之间存在密切联系。性行为并不是SC的唯一特征；性强迫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、精神健康和情感共病障碍）。研究表明，这些心理因素可能会加剧男同性恋者感染艾滋病毒的风险。然而，过去对男同性恋者的研究并没有区分行为因素和心理因素在男同性恋者中HIV风险中的作用。大多数研究比较男同性恋者和其他男同性恋者，而没有控制一般的性行为率。我们的研究表明，有相当数量的男男性接触者在行为上与男男性接触者相似（即他们有相同数量的性伴侣，并以相同的频率从事性行为），但在心理上与男男性接触者非常不同(即他们不会对自己的性行为感到痛苦，失去控制，他们的性行为干扰了他们的个人和职业生活，或者他们在毒品和酒精的影响下经常进行性行为)。这些男性——性行为高度活跃，但非SC男男性行为者——将提供一个关键窗口，让我们了解在药物和酒精的影响下，SC与更大的艾滋病毒风险和性行为之间存在关联的机制。识别区分性活跃度高的SC-MSM和性活跃度高的非SC-MSM的因素，将使我们能够识别使SC男性更容易遭受高风险性行为的心理因素，并为这两种人群的艾滋病毒预防干预措施的发展提供信息。本研究将比较两个性行为高度活跃的男男性行为者样本，其中一组表现出SC症状，另一组没有。通过比较性活跃的男男性接触者和非男男性接触者，我们可以更好地了解男男性接触者和艾滋病毒传播之间的联系，以及心理、环境、物质使用和背景因素，这些因素使某些男性容易受到性接触者及其负面后果的影响。我们将采用受访者驱动的抽样方法，招募400名（n=200名男同性恋者，n=200名非男同性恋者）高度性活跃的男同性恋者（bb90名伴侣，< 90天），参与者将被纵向跟踪13个月，并参加各种评估，包括前情（神经认知缺陷，经历过的耻辱和虐待）和事件层面的触发因素（药物和酒精使用，以及影响）。本研究将确定这些因素在介导和调节SC与HIV风险行为之间的关系中的作用。我们的纵向方法将允许跟踪跨群体的轨迹和分析个人的行为。最终，这项研究将成为形成性干预发展的基础，以降低高性活跃的男男性行为者与艾滋病毒相关的风险。

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.