Compulsive Behaviors, Mental Health, and HIV Risk

描述（由申请人提供）：性幻想（SC）的特点是性幻想和行为的频率和强度增加，以干扰个人，人际关系或职业追求。研究人员一直在各种人群中发现SC和危险性行为之间的密切联系，特别是在男男性行为者（MSM）中。性行为不是SC的唯一定义特征;性强迫男性报告了一系列与其性行为相关的心理症状（药物和酒精滥用，心理健康和情感共病障碍）。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SC MSM的研究并没有区分行为与心理因素在SC MSM中HIV风险中的作用。大多数研究比较SC MSM与其他MSM，而不控制性行为的一般比率。我们的研究表明，有相当数量的男男性接触者在行为上与SC男男性接触者相似（即他们有相同数量的性伴侣，并以相同的频率进行性行为），但在心理上与SC MSM非常不同（即他们没有报告对他们的性行为的痛苦，失去控制，他们的性行为干扰了他们的个人和职业生活，或者他们经常在毒品和酒精的影响下从事性活动）。这些男性-性活跃，但非SC男男性接触者-将提供一个关键的窗口机制，SC与更大的艾滋病毒风险和性行为的影响下，药物和酒精。确定区分高度性活跃的SC-MSM和高度性活跃的非SC MSM的因素将使我们能够确定使SC男性更容易受到高风险性行为影响的心理因素，并为两种人群的艾滋病毒预防干预措施的制定提供信息。“这项研究将比较两个高度性活跃的MSM样本，一个队列表现出SC症状，另一个没有。通过比较性活跃的SC和非SC MSM，我们可以更好地了解SC和艾滋病毒传播之间的联系，以及使某些男性容易受到SC及其负面后果的心理，环境，物质使用和背景因素。我们将使用响应者驱动的抽样方法招募400名（n=200 SC，n=200 non-SC）高度性活跃的MSM（> 9个伴侣，< 90天）参与者将被纵向随访13个月，并参加各种评估，捕获先前条件（神经认知缺陷，经历的耻辱和滥用）和事件水平触发因素（药物和酒精使用，影响）。本研究将探讨这些因素在SC与HIV危险行为之间的中介和调节作用。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，这项研究将作为形成性干预发展的基础，以减少高性活跃的男男性行为者中的艾滋病毒相关风险。 公共卫生相关性：这项研究的结果将有助于更细致地了解与男性发生性关系的男性（MSM）之间的性强迫（SC）和艾滋病毒相关的风险行为之间的关联。最终，这项研究将作为基础，告知干预措施的发展，以减少艾滋病毒相关的风险之间的高度性活跃的男男性行为者，SC和非SC一样。

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.