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Tensions Between the Epidemiology and Psychology of HIV Risk: Implications for Pre-exposure Prophylaxis

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Abstract

This study focuses on psychological differences in risk-taking patterns and their association with risk compensation motivations in the context of pre-exposure prophylaxis (PrEP). Participants were 257 HIV-negative MSM and transgender women recruited in New York City. The majority of participants (89.5 %, n = 230), could be classified as either: Intimates (40 %), who report unprotected anal intercourse (UAI) only with a main partner believed to be HIV-negative; Trusters (34 %), who engaged in UAI only with casual partners believed to be HIV-negative; and Gamblers (26 %) who report UAI with partners of unknown serostatus. Partner-based classifications were better predictors of HIV risk perception and other traditional correlates of risk-taking (e.g. impulsivity, sexual compulsivity) than rates of UAI. The three groups differed significantly in PrEP-related risk compensation motivations: sexual pleasure (Gamblers), intimacy (Trusters) and partner pressure (Intimates). These data underscore the importance of focusing the psychological dynamics of risk perception and sexual decision-making.

Resumen

Este estudio se enfocó en las diferencias psicológicas en los patrones de toma de riesgos y su asociación con las motivaciones de compensación de riesgo en el contexto de la profilaxis pre -exposición (PrEP). Los participantes fueron 257 hombres que tienen sexo con hombres y mujeres transgénero VIH- Negativo reclutados en la ciudad de Nueva York. La mayoría de los participantes (89.5 %, n = 230), se pueden clasificar como: Intimos (40 %), que reportan penetracion anal sin condón (PASC) solo con una pareja principal la cual creen es VIH -negativo; Los que confían (34 %), que reportan PASC sólo con parejas casuales que creen son VIH negativo, y Los que apuestan (26 %) que reportan PASC con parejas de estado serológico desconocido. Las clasificaciones basadas en parejas fueron mejores predictores de la percepción de riesgo de VIH y otras correlaciones tradicionales de toma de riesgos (por ejemplo, impulsividad, compulsividad sexual) que las tasas del UAI. Los tres grupos fueron diferentes significativamente en las motivaciones de compensación de riesgo relacionados con la profilaxis pre-exposición: el placer sexual (Los que Apuestan), la intimidad (Los que confían) y la presión de la pareja (Intimos). Esta data subraya la importancia de enfocarse en la dinámica psicológica de la percepción del riesgo y la toma de decisiones sexuales.

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Acknowledgments

This project was funded by Grant R01MH095565 from the National Institute of Mental Health (S.A. Golub, PI). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. Many thanks to Kristi Gamarel and Dr. David Greenberg for their contributions and suggestions. The author also gratefully acknowledges the hard work of Anthony Surace, Kailip Boonrai, Inna Saboshchuk, and Dr. Corina Lelutiu-Weinberger, as well as the participants who gave their time and energy to this project.

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Authors and Affiliations

  1. Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA

    Sarit A. Golub

  2. Doctoral Program in Psychology, The Graduate Center of the City University of New York (CUNY), New York, NY, USA

    Sarit A. Golub

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Correspondence to Sarit A. Golub.

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Golub, S.A. Tensions Between the Epidemiology and Psychology of HIV Risk: Implications for Pre-exposure Prophylaxis. AIDS Behav 18, 1686–1693 (2014). https://doi.org/10.1007/s10461-014-0770-7

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