Explaining gay men's unrealistic optimism about becoming infected with HIV

Using the COM-B model to characterize the barriers and facilitators of pre-exposure prophylaxis (PrEP) uptake in men who have sex with men

OBJECTIVES

Using the COM-B model, this study aimed to characterize barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake amongst men who have sex with men (MSM).

DESIGN AND METHOD

Semistructured interviews with 13 MSM who were non-PrEP users were conducted with a specific focus on barriers and facilitators to PrEP uptake. A 15-item interview schedule was created informed by the COM-B model. Transcripts were transcribed verbatim and inductively analysed using thematic analysis. To illustrate pathways for intervention design, inductive themes were then deductively mapped onto COM-B constructs.

RESULTS

Results demonstrated that barriers to PrEP uptake were closely aligned with five (of six) COM-B components: psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. These COM-B subcomponents reflected seven thematized barriers: (1) limited information about PrEP, (2) restricted access to PrEP, (3) gay identity and sexual stigmatization, (4) social and cultural stigmatization, (5) capabilities in treatment adherence, (6) optimistic bias about sexual behaviours and (7) calculating risk. No facilitators or physical capability concerns were demonstrated.

CONCLUSION

This study adopted a novel behaviour change-informed approach to understanding barriers and facilitators to PrEP uptake amongst MSM. Unrealistic optimism about self-protective individual behaviours, the physical accessibility of PrEP and (mis)information together interacted closely with perceptions of personal and social stigmatization to dynamically impact PrEP uptake decisions. Barriers to PrEP uptake mapped clearly to the COM-B; therefore, these results provide the foundation for Behaviour Change Wheel intervention development to improve rates of PrEP uptake and its acceptability for MSM.

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 pandemic: Two longitudinal studies

Objective

Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS.

Method

In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later.

Results

In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself.

Conclusions

Exaggeration of one’s personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample.

Practitioner points

Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty.

The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder.

This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism.

Spontaneous comparisons with others in gay men's judgements of HIV risk

In studies on ‘unrealistic optimism’ (UO), when people are asked questions designed to make them compare their risk of experiencing an undesirable event with that of the average person, they tend to respond that their risk is lower. This study investigated whether comparisons of own and others’ risk also occur spontaneously, unprovoked by such questions. Gay men uninfected with HIV (n = 50) were asked to think aloud about their risk of becoming infected; their comments were audiotaped and analysed. Over half the men added comments relating to others’ risk. The phrasing of these comments and the reported basis for them are described. The men represented others’ risk as relatively high, own risk as relatively low. In the case of one-third of the men, it seemed possible to be confident that a comparison was being made. The findings suggest that comparisons of own and others’ risk do occur spontaneously and that, while the judgements made in UO studies do not capture all the characteristics of those made spontaneously, they resemble them in important ways.

Invincibility fable: tool development to measure invincibility

Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement.

OBJECTIVE

To determine psychometric properties of the Adolescent Invincibility Tool (AIT).

METHODS

Reliability was assessed and validity was examined using principal components analysis.

RESULTS

Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility.

DISCUSSION

Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.

Tóth T, Mocsonaki L, Amirkhanian Y. Effects of Stigmatization on Gay Men Living with HIV/AIDS in a Central-Eastern European Context: A Qualitative Analysis from Hungary

This qualitative study highlights the social dynamics affecting people living with HIV (PLH) in Hungary and in the Central-Eastern European region. The study focused on the special needs and concerns of men living with HIV/AIDS as well as changes in their social relationships and institutional support provision, coping strategies and patterns of social functioning, especially in the context of social stigmatization. Consistent with international qualitative research findings in the field of HIV/AIDS prevention, the present study contributes to a fuller understanding of relationship between sexual behavior, HIV/AIDS related risks and risk perceptions as well as homosexuality-and HIV/AIDS stigma-related social exclusion in a previously under-researched socio-cultural setting. The findings of our study point to several barriers to effective HIV prevention, which should be overcome to improve the present situation by lessening the adverse effects of HIV/AIDS-and homosexuality-related stigma within the gay community, the general population and especially among service providers. One of the main barriers is the lack of public health programs specifically targeting MSM in Hungary, where the predominant mode of HIV transmission remains sex between men.

Influencing factors of healthcare-seeking behaviors in Taiwanese patients with hepatitis C

The purpose of this study was to determine factors that influence the frequency of hospital clinic visits for hepatitis C patients in Taiwan and identify data related to healthcare-seeking behaviors of patients by using a developed questionnaire based on the Health Belief Model. Consistent clinic visits for follow-up and treatment are required of the hepatitis C patient to be compliant with therapy guidelines. Recent studies targeted only Western communities in which hepatitis C is nonepidemic, unlike hepatitis C virus-endemic regions of Taiwan where patients may exhibit 10-20 times higher seroprevalence. Influences on hospital clinic visit attendance were identified as educational level, income, and aspartate aminotransferase level at diagnosis. Perceived benefits from and barriers to action were similar among the 390 evaluable subjects at various frequencies of hospital clinic visits (both p > .05); however, subjects who visited the hospital clinic between 1 and 6 months exhibited significantly higher scores of perceived susceptibility to disease and severity of disease than those who visited the hospital clinic at 7-9 months or less often (all p ≤ .001). Findings lay the foundation for future studies to address strategies to increase compliance with treatment regimens for Taiwanese patients with hepatitis C.

Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City

OBJECTIVE

This study examined how disengagement coping with HIV risk mediated the association between internalized homophobia and unprotected anal intercourse (UAI) and how sexual encounters in public venues (public sex) and drug use moderated the association between disengagement coping and UAI among HIV-negative gay men. Disengagement coping included fatalistic beliefs about maintaining HIV-negative seronegative serostatus (fatalism), optimistic attitudes toward medical seriousness of HIV infection and reduced concern about HIV risk due to highly active anti-retroviral therapies (optimism), and negative affective states associated with sexual risk (anxiety).

DESIGN

A survey was conducted among 285 HIV-negative gay men at an HIV prevention counseling program in New York City.

MAIN OUTCOME MEASURES

Sexual risk was defined as having had UAI with nonprimary partners in the past 6 months.

RESULTS

In addition to the positive association between internalized homophobia, disengagement coping, and UAI, fatalism mediated the association between internalized homophobia and UAI; and optimism mediated the association between anxiety and UAI. A significant moderation effect of public sex was found between fatalism and UAI.

CONCLUSIONS

The findings highlight the importance of understanding disengagement coping as it affects sexual risk practices among HIV-negative gay men in the continuing epidemic.

HIV knowledge and attitudes toward HIV testing of South Side Chicago Housing Authority residents

High HIV infection rates in the United States are increasingly due to heterosexual risk behaviors, with increased rates in blacks and women. A survey of HIV knowledge and attitudes about HIV testing was conducted in an inner-city public housing population that included a convenience sample of residents of South Side Chicago Housing Authority facilities. The questionnaire addressed knowledge about HIV transmission and disease, health care options, condom use, prior HIV testing, and preferred places for HIV testing and education. Five hundred residents, ages 13-50 years completed the survey, during the period from November 2002 until April 2003. Eighty-three percent of the respondents were female and 50% of those surveyed were from 18-30 years of age. Race/ethnicity was not questioned in order to improve response rate. A comparable sample conducted earlier showed that population was 99% black race. Most respondents were knowledgeable about HIV transmission risk factors, although misinformation about transmission, treatment and prevention existed. Knowledge that HIV therapy is available was high (71%), while 25% thought an HIV vaccine was available and 13% thought there was a cure for HIV. Two thirds of sexually active respondents reported condom use in the past year. Three quarters reported previous testing for HIV and 90% of those tested returned for results. Most respondents wanted to learn more about HIV risk factors, testing and treatment but preferred primary care clinics to specialized places for HIV testing. Targeted HIV education interventions in the public housing facilities or primary care clinics are warranted.