Interpersonal and intrapersonal conflict and their association with substance use

描述（由申请人提供）：在美国，与艾滋病毒阳性男性发生性关系的男性人数继续上升，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者和双性恋者的心理社会和性健康和福祉的独特方法对于制定针对性的干预措施以减少这一人群的性风险和药物使用至关重要。由于耻辱感，艾滋病毒抗体阳性者仍然很难披露艾滋病毒状况，这一困难在性行为方面尤其明显。在先前的研究中，身份披露和物质使用都被认为是增加艾滋病毒阳性男同性恋和双性恋男性性风险（即不使用避孕套的性行为）的变量。在与非主要（即新的或偶然的）性伴侣的性接触中，由于害怕人际拒绝和自我羞辱而产生的认知冲突可能会影响披露，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，这项调查基于一个假设，即失调（即冲突）是一种消极的唤醒状态，激励人们参与行为以减少消极的唤醒。我们假设人际冲突（即，害怕因披露艾滋病毒阳性状况和使用避孕套而被拒绝）和个人内部冲突（即，性羞耻感） 相互作用，增加药物使用，减少安全套的使用和性接触中的披露。本研究的主要目标是提供有用的测量这些结构，并检查这些假设，以告知公共卫生干预措施，旨在减少性风险和物质使用。因此，本研究的主要目的有二：（1）建立三个测量指标的信度、效度、因素结构和心理测量学特性。 自我冲突和人际冲突;（2）阐述和测试人际冲突和自我冲突与艾滋病毒状态披露，性风险，以及与临时伴侣发生性行为时使用药物的关系。拟议的项目将嵌入到一项更大的研究（R 01 MH 87714，Parsons PI;在此称为父项目）中，该研究是一项纵向研究，跟踪性活跃的同性恋和双性恋男性，利用多种方法调查他们的性风险行为。拟议的项目将在母项目的基础上增加两项基于互联网的评估，其中包括新的和现有的措施。我们将联合收割机这些新的措施与现有的数据，检查新创建的措施的心理测量和测试的重要性，提出的假设。为该项目提出的研究和培训计划也旨在促进我作为一名研究科学家的发展，在性风险，物质使用和艾滋病毒阳性同性恋和双性恋男性研究方面有着坚实的基础。 公共卫生相关性：该项目旨在调查物质使用，状态披露和安全套使用之间的协同关系，因为它们影响HIV阳性男同性恋和双性恋男性的HIV传播风险。利用一个框架的基础上验证理论的认知失调，本研究将提高我们的理解，人际和自我冲突如何相互作用，以增加或抑制传播风险行为。更好地理解认知冲突在影响风险行为中的作用，对于未来艾滋病毒阳性男同性恋和双性恋男性的艾滋病毒预防工作的发展至关重要。

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. PUBLIC HEALTH RELEVANCE: This project was designed to investigate the synergistic relationship between substance use, status disclosure, and condom use as they influence HIV transmission risk among HIV-positive gay and bisexual men. Utilizing a framework based in the validated theory of cognitive dissonance, this study will enhance our understanding of how interpersonal and intrapersonal conflicts may interact to increase or inhibit transmission risk behaviors. A better understanding of the role of cognitive conflicts in influencing risk behavior will be essential to the development of future HIV prevention efforts with HIV-positive gay and bisexual men.