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High-Risk Sexual Behavior and other Coping Mechanisms for Dealing with Negative Affect Associated with Social Stressors Among Gay and Bisexual Men Open Access

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Surveillance and epidemiological studies over the last number of years show that HIV incidence has remained relatively stable, and even increased in some populations. Ironically, some of the most substantial increases have been seen in the very populations that have been most heavily targeted for HIV prevention interventions. This suggests that current prevention models, which primarily emphasize rational thought process, may be neglecting some important mechanisms that influence or cause high-risk sexual behavior. This study examines how non-rational thought processes may relate to high-risk sexual behavior in the face of social stressors. Grounded in Carver’s & Scheier’s (1996, 1998) Self-Regulatory Failure Model, which suggests that under certain circumstances, individuals may shift from abstract goals to more immediate sensory oriented goals. I explored a model that includes gay-related discrimination, hate crimes, and social stressors as predictors of high-risk sexual behavior, mediated by negative affect. I also explore whether the putative link between negative affect and high-risk sexual behavior is moderated by sensation seeking and avoidant coping personality styles. Lastly, I conducted exploratory analyses on the role alcohol may play in this model. The study employed a two stage purposive sampling procedure: First, 20 different U.S. media markets were selected at random; and next, individuals were recruited from within those media markets to participate in an online survey about these topics. Because the outcome data were counts of sexual behavior with a large proportion of zero responses, I employed Zero Inflated Poisson regression modeling. This modeling procedure allows one to examine if different variables predict initiation of behavior versus frequency of behavior. The results show partial support for the hypothesized model. Interpersonal stressors and discrimination appear to be consistent predictors of high-risk sexual behavior in this sample; however, the relationship to the outcomes differ for initiation of behavior as opposed to frequency of behavior, and further by type of sexual behavior. Hate crime rates showed little ability to predict high-risk sexual behavior outcomes. There is tentative evidence for distancing forms of coping as moderators of the relationship between negative affect and high-risk sexual behavior. Negative affect did not emerge as a mediator in the primary model examined in this study; although, negative affect was independently related to some sexual behavior outcomes. When alcohol use during sex was added as part of the exploratory analyses, negative affect emerged as a mediator for some high-risk sexual behavior outcomes. Exploratory analyses also revealed relationships between alcohol with sex, discrimination, and social stressors that suggest a strong interplay between all four variables and the sexual behavior outcomes. Hate crimes, however, were still mostly unrelated to high-risk sexual behavior in the exploratory analyses. Overall, these results point to a dynamic, complex, and non-linear set of relationships between interpersonal stressors, affect, sexual behavior, and alcohol use. Larger sample sizes, longitudinal study designs, and more granular measures of affect may help to clarify the causal relationships between these constructs. These results have implications for prevention interventions that emphasize emotional self-regulation at the individual level and address discrimination and stigma at a structural level.

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