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1.  Anger as a Moderator of Safer Sex Motivation among Low Income Urban Women 
Journal of behavioral medicine  2005;28(5):493-506.
Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision-making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational-decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median-split). The theoretically expected “rational pattern” was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an “irrational pattern” emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge and risk-based decisions regarding safer sex may be limited to low-anger women.
doi:10.1007/s10865-005-9014-7
PMCID: PMC1383506  PMID: 16247592
HIV; knowledge; anger; safer sex; intention; risk perception
2.  How Do Social Norms Impact HIV Sexual Risk Behavior in HIV Positive Men Who Have Sex with Men: Multiple Mediator Effects 
Journal of health psychology  2009;14(6):761-770.
This study examines mediation of the association between social norms and unsafe sexual behavior. Self-report data were collected from 675 HIV-infected men enrolled in a study exploring interventions for HIV risk behavior. Unsafe sex included any unprotected anal sex with HIV-negative or HIV status unknown partners in the last three months. Norms for condom use indirectly influenced unsafe sex through condom self-efficacy and/or safer sex intentions. Additionally, sexual behavior discontrol influenced unsafe sex regardless of other individual or social factors. Our results suggest that interventions consider the combined effects of condom self-efficacy, safer sex intentions, and sexual behavior control.
doi:10.1177/1359105309338976
PMCID: PMC3433849  PMID: 19687113
Theory of Planned Behavior; unsafe sex; social norms; self-efficacy; intentions
3.  HIV Risk Profiles Among HIV-Positive, Methamphetamine-Using Men Who Have Sex with Both Men and Women 
Archives of Sexual Behavior  2011;40(4):793-801.
This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.
doi:10.1007/s10508-010-9713-1
PMCID: PMC3114110  PMID: 21203813
Men who have sex with men and women; Men who have sex with men; Bisexual; HIV; Methamphetamine; Injection drug use
4.  Effectiveness of a Behavioral Intervention for Increasing Safer Sex Behaviors in HIV-positive MSM Methamphetamine Users: Results from the EDGE Study 
Drug and alcohol dependence  2006;87(2-3):249-257.
Background
Methamphetamine use has been associated with rising STI/HIV transmission rates, particularly among men who have sex with men (MSM). Interventions which successfully reduce risk for HIV transmission among this population are a public health priority. This study examined the efficacy of a behavioral intervention for increasing safer sex behaviors in the context of ongoing methamphetamine use in a sample of HIV-positive, methamphetamine-using MSM.
Methods
Three-hundred forty one participants from San Diego, CA were randomly assigned to receive either a safer sex behavioral intervention (EDGE) or a time-equivalent diet-and-exercise attention-control condition. Random effects regression analyses were used to evaluate change in safer sex behaviors over a 12-month period.
Results
Participants in the EDGE intervention engaged in significantly more protected sex acts at the 8-month (p = .034) and 12-month assessment (p = 0.007). By 12-months post-baseline, a greater percentage of protected sex acts that was observed for EDGE (25.8%) vs. control participants (18.7%) (p = 0.038). There was a significant time-by-intervention interaction (p = .018) for self-efficacy for condom use, suggesting that EDGE participants’ self-efficacy demonstrated a greater increase over time compared to control participants.
Conclusions
These results suggest that it is possible to reduce high risk sexual behaviors in the context of ongoing methamphetamine use among HIV-infected MSM.
doi:10.1016/j.drugalcdep.2006.08.026
PMCID: PMC1904343  PMID: 17182196
HIV; AIDS; MSM; Safer Sex; Intervention; Methamphetamine
5.  Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. 
Western Journal of Medicine  1998;168(2):93-97.
Morbidity, mortality, and drug treatment data suggest that methamphetamine use is on the rise. Based on research findings of the sexual behaviors of methamphetamine-using injection drug users, we chose to examine the relationship between methamphetamine use during sex and risky sexual behaviors and human immunodeficiency virus (HIV) seropositivity among clients of publicly funded HIV testing sites in California who reported never injecting drugs. We found that among gay, bisexual, and heterosexual men and heterosexual women, users of methamphetamines reported more sexual partners than non-methamphetamine users. Among heterosexuals, a greater percentage of methamphetamine users than nonusers participated in anal intercourse. Methamphetamine use was independently related to decreased condom use during vaginal and anal intercourse, prostitution, and sex with known injection drug users. In addition, methamphetamine users were more likely to have had a sexually transmitted disease. When controlling for race or ethnicity; age; exposure to possibly infected blood or blood products; and the use of cocaine, alcohol, or marijuana during sex, methamphetamine-using bisexual men were more likely to test positive for HIV than those reporting no history of methamphetamine use. Our data suggest that noninjection methamphetamine use is related to increased, unprotected sexual activity and the risk of contracting sexually transmitted diseases, including HIV.
PMCID: PMC1304836  PMID: 9499742
6.  Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men 
Drug assertiveness skills have been demonstrated effective in reducing substance use behaviors among patients with alcohol- or heroin-use disorders. This study examined the association between drug assertiveness and methamphetamine use, psychological factors, and sexual risk behaviors in a sample of 250 HIV-positive men who have sex with men (MSM) enrolled in a safer sex intervention in San Diego, CA. Less assertiveness in turning down drugs was associated with greater frequency and larger amounts of methamphetamine use, lower self-esteem, higher scores on a measure of sexual sensation-seeking, and greater attendance at risky sexual venues. These data suggest that drug assertiveness training should be incorporated into drug abuse treatment programs and other risk reduction interventions for methamphetamine users.
doi:10.1016/j.jsat.2011.03.006
PMCID: PMC3154402  PMID: 21550758
drug assertiveness behavior; methamphetamine; sexual risk behavior; men who have sex with men; HIV-positive
7.  Knowing the Consequences of Unprotected Sex with Seroconcordant Partner Is Associated with Increased Safer Sex Intentions among HIV-positive Men in Kathmandu, Nepal 
Unprotected sexual intercourse among HIV-positive people can adversely affect their own health by increasing their exposure to multiple strains of HIV-1 or other sexually transmitted infections (STIs). The study explored the relationship between knowledge of Nepalese HIV-positive men about the consequences of having unprotected sex with seroconcordant partners and their intention to practise safer sex with such partners. In total, 166 participants recruited conveniently in the Kathmandu Valley, Nepal, were interviewed. Each participant reported intention to practise safer sex with seroconcordant partners, know-ledge about the consequences of having unprotected sex with seroconcordant partners, perceived partner-related barriers to condom-use, belief that condoms interfere with sex, and condom-use self-efficacy. Of the 166 participants, 50.6% intended to practise safer sex every time they have sex with seroconcordant partners. Results of multiple logistic regression analysis showed that the participants who were aware of the possibility of HIV superinfection [adjusted odds ratio (AOR)=2.93, 95% confidence interval (CI) 1.16-7.34, p=0.022)] or that the presence of STIs in HIV-positive persons increases progression of HIV disease (AOR=2.80, 95% CI 1.08-7.26, p=0.033) were more likely to intend to practise safer sex with seroconcordant partners. Similarly, the participants who were employed or who had lower levels of belief that condoms interfere with sex were more likely to intend to practise safer sex. The findings suggest that improving the knowledge of HIV-positive persons about the consequences of having unprotected sex with seroconcordant partners might improve their intention to practise safer sex with such partners.
PMCID: PMC3131119  PMID: 21766554
HIV infections; Intention; Knowledge; Knowledge, attitudes, practices; Perceptions; Safe sex; Sexual behaviour; Nepal
8.  Sexual Decision-Making in HIV-Positive Men Who Have Sex with Men: How Moral Concerns and Sexual Motives Guide Intended Condom Use with Steady and Casual Sex Partners 
Archives of Sexual Behavior  2007;36(3):437-449.
Determinants of intended condom use with steady and casual sex partners were examined among Dutch HIV-positive men who have sex with men (MSM) (N = 296). Given the proposition that safer sex behavior among HIV-positive people is a form of prosocial behavior, the present study extended the general framework of the Theory of Planned Behavior with Schwartz’s norm-activation theory and tested the assumption that personal norms would mediate the effects of other psychosocial factors on intended condom use for anal sex. In addition, it was hypothesized that, depending on the context in which sex occurs, specific motives for unprotected anal sex may have a negative influence on intended condom use and, as such, undermine a prosocial tendency to practice safer sex. Therefore, we also investigated the influence of sexual motives for unprotected anal sex on intended condom use with steady and casual sex partners. Results indicated that the Theory of Planned Behavior adequately predicted condom use intentions (for casual sex partners and steady sex partners, the explained variance was 52% and 53%, respectively). However, our proposed model of sexual decision-making significantly improved the prediction of behavioral intentions. For steady and casual sex partners, the assumption of the mediating role of personal norms on condom use intention was confirmed empirically. Additionally, sexual motives for unprotected anal sex exerted, as expected, a direct, negative effect on condom use intention with casual sex partners. The implications of the findings for future research and the development of HIV-prevention programs for HIV-positive MSM are discussed.
doi:10.1007/s10508-006-9125-4
PMCID: PMC1914258  PMID: 17333328
HIV-positive; Men who have Sex with Men; Sexual risk behavior; Personal norms; Sexual motives
9.  Pretest assessment as a component of safer sex intervention: A pilot study of brief one-session interventions for women partners of male injection druc users in New York city 
This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.
doi:10.1007/BF02386748
PMCID: PMC3456038  PMID: 10976612
Assessment; Evaluation; Heterosexual Partners of IDUs; HIV; Intervention; Women
10.  Applying Theory of Planned Behavior in Predicting of Patient Safety Behaviors of Nurses 
Materia Socio-Medica  2013;25(1):52-55.
Background:
Patient safety has become a major concern throughout the world. It is the absence of preventable harm to a patient during the process of health care, ensuring safer care is an enormous challenge, psychosocial variables influences behaviors of human. The theory of planned behavior (TPB) is a well-validated behavioral decision-making model that has been used to predict social and health behaviors. This study is aimed to investigate predictors of nurse’s patient safety intentions and behavior, using a TPB framework.
Methods:
Stratified sampling technique was used to choose 124 nurses who worked at the selected hospitals of Isfahan in 2011. Study tool was a questionnaire, designed by researchers team including 3 nurses a physician and a psychologist based on guideline of TPB model. Questionnaire Validity was confirmed by experts and its reliability was assessed by Cronbach’s alpha as 0.87. Binary logistic regression analysis was performed to evaluate how well each TPB variables predicted the variance in patient safety behavior. Analyzing was done by SPSS18.
Results:
Finding revealed that “normative beliefs” had the greatest influence on nurses intention to implement patient safety behaviors. Analyzing data by hospital types and workplace wards showed that both in public and private hospitals normative beliefs has affected safety behaviors of nurses more than other variables. Also in surgical wards, nurses behaviors have been affected by “control beliefs” and in medical wards by normative beliefs.
Conclusion:
Normative beliefs, and subjective norms were the most influential factor of safety behavior of nurses in this study. Considering the role of cultural context in these issues, it seemseducation of managers and top individuals about patient safety and its importance is a priority also control believes were another important predicting factor of behavior in surgical wards and intensive care units. Regarding the complexity of work in these spaces, applying medical guidelines and effective supervision must be seriously followed.
doi:10.5455/msm.2013.25.52-55
PMCID: PMC3655788  PMID: 23687461
nurses; patient safety; psychology; theory of planned behavior (TPB).
11.  The Prediction of Physical Activity Intention and Behavior in Elderly Male Residents of a Nursing Home: A Comparison of Two Behavioral Theories 
Background: Regular physical activity is ranked as a leading health indicator. Despite the extensive benefits of physical activity, elder people are much less active than desired. Using Theory of Planned Behavior (TPB) and the self-efficacy construct, this study examined the prediction of physical activity intention and behavior in a sample of elderly male resident of a nursing home.
Methods: In a cross-sectional study of the residents of Kahrizak Nursing Home in Tehran, Iran, elderly men who were 60 years or older, capable of independent living, mobility, and verbal communication were asked to complete measures of the TPB, self-efficacy and physical activity behavior.
Results: A hierarchical step-wise multiple regression analysis indicated that affective/instrumental attitude, subjective norm, and perceived behavioral control (PBC) explained 32.8% of the variance in physical activity intention, and self-efficacy provided an additional 2.7%. In a reverse step regression, the TPB variables explained an additional 12.2% of physical activity intention. In a multiple regression analysis on physical activity behavior, affective/instrumental attitude, subjective norm, perceived behavioral control (PBC) and intention explained 15.7% of the variance in physical activity behavior while self-efficacy contributed an additional 5.6%. In the reverse step regression, TPB predictors contributed an additional 3.0% in explaining the variance in physical activity behavior.
Conclusion: The results indicate that in addition to the TPB, self-efficacy may also play an important role in the prediction of behavior, and should be included in the design of physical activity programs for elderly men of nursing home residents.
PMCID: PMC3470291  PMID: 23115427
Attitude; intention; elderly; self-efficacy
12.  Correlates of Condom Use Intentions and Behaviors Among a Community-Based Sample of Latino Men in Los Angeles 
HIV/AIDS has disproportionately affected Latino communities. The majority of research addressing HIV risk behaviors within this population has focused on women. However, men who have sex with women (MSW) are a population increasingly becoming infected with HIV and heterosexual contact is the primary source of HIV transmission among Latinos diagnosed with AIDS. It has been assumed that because men are likely to control condom use, relationship factors are less likely to influence safer sex behavior among men. However, because condom use is an interdependent behavior, understanding factors that predict safer sex behavior among MSW is critical. This study examined the influence of multiple factors on condom use behavior in a community-based sample of young Latino men. Data from 191 Latino men who completed baseline interviews for an intervention were analyzed to examine the association of background, intrapersonal and relationship factors with intentions to use condoms and condom use in the past three months. Findings from multivariate analyses indicated that more positive attitudes toward condoms, stronger partner condom norms and greater participation in decision-making about condom use were significantly associated with both condom use and condom use intentions. Additionally, men reporting lower expectations of negative partner reactions to condom requests were more likely to use condoms, and condom use intentions were higher among men reporting more health protective communication in the relationship. Findings suggest that interventions to prevent HIV need to include men as well as women and address the role of relationship factors and dynamics in safer sex practices.
doi:10.1007/s11524-006-9064-3
PMCID: PMC2430480  PMID: 16845495
Condom use; Condom use intentions; HIV/STI prevention; Intrapersonal factors; Latino men; Relationships characteristics
13.  Correlates of Trading Sex for Methamphetamine in a Sample of HIV-Negative Heterosexual Methamphetamine Users 
Journal of psychoactive drugs  2011;43(2):79-88.
While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.
PMCID: PMC3506393  PMID: 21858954
sex trading; methamphetamine; heterosexual; sexual risk behavior
14.  Predictors of Intention to Change HIV Sexual and Injection Risk Behaviors among Heterosexual Methamphetamine-Using Offenders in Drug Treatment: A Test of the AIDS Risk Reduction Model 
This study tested components of the AIDS Risk Reduction Model (ARRM) for a sample of methamphetamine-using offenders in drug treatment. Analyses included the first two stages of the ARRM, problem recognition and intention to reduce risk (potential precursors to later possible behavior change), assessing predictors of intentions to increase condom use, reduce other sexual risk, and disinfect needles. Path analysis results showed potential applicability of the ARRM as a basis for intervention development for this population. There was a consistent effect of self-efficacy for risk reduction strategies, as well as direct or indirect effects of problem recognition factors (AIDS knowledge, peer norms), on the three intention indicators. Prior sex risk behavior (condom use) was directly negatively related to intention to use condoms; prior needle use was indirectly negatively related to intention to disinfect. Intention to use condoms was lower for females. Results can help identify areas for intervention development.
doi:10.1007/s11414-007-9106-y
PMCID: PMC3695827  PMID: 18214688
methamphetamine; HIV risk behaviors; AIDS Risk Reduction Model; heterosexual; offenders
15.  Factors associated with sex in the context of methamphetamine use in different sexual venues among HIV-positive men who have sex with men 
BMC Public Health  2010;10:178.
Background
Harm reduction has focused primarily on reduction of high-risk substance using behaviors rather than reductions in high-risk sexual behaviors. Furthermore, most studies focus on individual behavior change, with less attention paid to the social and environmental context. This paper promotes understanding of the interplay between the individual and the social context by examining the psychosocial and behavioral characteristics of 321 methamphetamine-using HIV-positive men who have sex with men (MSM) in San Diego, CA based on the locations or venues of their sexual activities when "high" on methamphetamine.
Methods
Participants in a safer-sex intervention study underwent a baseline assessment that queried demographic and psychosocial characteristics as well as drug use and sexual risk behaviors. For purposes of analysis, respondents were classified according to their preference of sexual venue: private (e.g., home), commercial (e.g., bathhouse), or public (e.g., public park or restroom).
Results
The commercial venue group was younger, better educated, more likely to identify as gay, and significantly more likely to have used "club drugs" as compared to the other two groups. Men in the commercial- and public-venue groups reported more high-risk sex compared to the private-venue group. The public-venue group reported heavier drug and alcohol use, had significantly higher Beck depression scores, reported more experiences of stigma, and scored higher on a measure of sexual compulsivity than did the other two groups.
Conclusion
In an effort to reduce HIV/STI risk-behaviors, future studies should investigate the feasibility of modifying personal, psychosocial and structural factors associated with the use of risky sexual venues where HIV-positive methamphetamine users engage in sexual activity when "high" on methamphetamine.
Trial registration
ClinicalTrials.gov NCT00432926
doi:10.1186/1471-2458-10-178
PMCID: PMC2858118  PMID: 20359362
16.  Social and Behavioral Characteristics of HIV-positive MSM Who Trade Sex for Methamphetamine 
Background
Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common.
Objectives
This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not.
Results
Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than $20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine.
Conclusions and Scientific Significance
These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.
doi:10.3109/00952990.2010.505273
PMCID: PMC3383823  PMID: 20955106
methamphetamine; trading sex; men who have sex with men; sexual risk behavior
17.  A Model of Sexual Risk Behaviors Among Young Gay and Bisexual Men: Longitudinal Associations of Mental Health, Substance Abuse, Sexual Abuse, and the Coming-Out Process 
Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population-specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Further, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.
doi:10.1521/aeap.2006.18.5.444
PMCID: PMC3222951  PMID: 17067255
Sexual Risk Behaviors; Anal Sex; Child Sexual Abuse; Substance Abuse; Anxiety; Condom Use Intentions; Internalized Homophobia; Self-Disclosure
18.  Interactive Voice Response Self-Monitoring to Assess Risk Behaviors in Rural Substance Users Living with HIV/AIDS 
AIDS and Behavior  2012;16(2):432-440.
Community-dwelling HIV/AIDS patients in rural Alabama self-monitored (SM) daily HIV risk behaviors using an Interactive Voice Response (IVR) system, which may enhance reporting, reduce monitored behaviors, and extend the reach of care. Sexually active substance users (35 men, 19 women) engaged in IVR SM of sex, substance use, and surrounding contexts for 4–10 weeks. Baseline predictors of IVR utilization were assessed, and longitudinal IVR SM effects on risk behaviors were examined. Frequent (n = 22), infrequent (n = 22), and non-caller (n = 10) groups were analyzed. Non-callers had shorter durations of HIV medical care and lower safer sex self-efficacy and tended to be older heterosexuals. Among callers, frequent callers had lost less social support. Longitudinal logistic regression models indicated reductions in risky sex and drug use with IVR SM over time. IVR systems appear to have utility for risk assessment and reduction for rural populations living with HIV disease.
doi:10.1007/s10461-011-9889-y
PMCID: PMC3264810  PMID: 21311964
HIV/AIDS; IVR self-monitoring; Alcohol and drug use; Risky sex
19.  When do condom use intentions lead to actions? Examining the role of sexual communication on safer sexual behavior among people living with HIV 
Journal of health psychology  2012;18(4):507-517.
This study investigated the moderating role of sexual communication in the association between intentions to use condoms and unprotected sex in a sample of 358 individuals living with HIV (233 men, 125 women, M age = 43). Longitudinal analyses revealed a significant interaction between condom intentions and sexual communication: individuals who were high in both condom intentions and safer sex communication engaged in less unprotected sex with all partners and with partners of HIV negative or unknown serostatus over 6 months of follow-up. Among individuals low in communication, intentions were not associated with unprotected sex. Implications for interventions are discussed.
doi:10.1177/1359105312446769
PMCID: PMC3612384  PMID: 22689591
Safer sex; HIV/AIDS; condom intentions; sexual communication
20.  Predicting active school travel: The role of planned behavior and habit strength 
Background
Despite strong support for predictive validity of the theory of planned behavior (TPB) substantial variance in both intention and behavior is unaccounted for by the model’s predictors. The present study tested the extent to which habit strength augments the predictive validity of the TPB in relation to a currently under-researched behavior that has important health implications, namely children’s active school travel.
Method
Participants (N = 126 children aged 8–9 years; 59 % males) were sampled from five elementary schools in the west of Scotland and completed questionnaire measures of all TPB constructs in relation to walking to school and both walking and car/bus use habit. Over the subsequent week, commuting steps on school journeys were measured objectively using an accelerometer. Hierarchical multiple regressions were used to test the predictive utility of the TPB and habit strength in relation to both intention and subsequent behavior.
Results
The TPB accounted for 41 % and 10 % of the variance in intention and objectively measured behavior, respectively. Together, walking habit and car/bus habit significantly increased the proportion of explained variance in both intention and behavior by 6 %. Perceived behavioral control and both walking and car/bus habit independently predicted intention. Intention and car/bus habit independently predicted behavior.
Conclusions
The TPB significantly predicts children’s active school travel. However, habit strength augments the predictive validity of the model. The results indicate that school travel is controlled by both intentional and habitual processes. In practice, interventions could usefully decrease the habitual use of motorized transport for travel to school and increase children’s intention to walk (via increases in perceived behavioral control and walking habit, and decreases in car/bus habit). Further research is needed to identify effective strategies for changing these antecedents of children’s active school travel.
doi:10.1186/1479-5868-9-65
PMCID: PMC3419676  PMID: 22647194
Theory of planned behavior; Habit; Active school travel; Walking; Children
21.  Methamphetamine Use, Transmission Risk Behavior and Internet Use Among HIV-Infected Patients in Medical Care, San Francisco, 2008 
AIDS and Behavior  2010;16(2):396-403.
Methamphetamine use is associated with adverse health outcomes and HIV incidence. Few studies have assessed methamphetamine use, sexual behavior and Internet use among HIV-infected patients. Surveys were administered to a sample of HIV-infected patients seeking medical care in a San Francisco county hospital and university-based clinic. In 2008, 35% of homosexual participants, 26% of heterosexual participants and 11% of female participants reported methamphetamine use in the past year. Of participants, 29% reported using the Internet to find sex partners; Internet-users versus non-Internet-users reported a higher median number of sex partners in 6 months (4 vs. 1), were more likely to report unprotected sex (32 vs. 10%), and higher rates of methamphetamine use in the past 12 months (48 vs. 24%). Given the association among methamphetamine use, increased sex partners and Internet use, the Internet may present a new and effective medium for interventions to reduce methamphetamine-associated sexual risk behavior.
doi:10.1007/s10461-010-9869-7
PMCID: PMC3274665  PMID: 21190073
Methamphetamine; HIV; MSM; Internet
22.  Correlates of Unprotected Sex Among Adult Heterosexual Men Living with HIV 
The correlates of unprotected sex among a sample of heterosexual men living with HIV (n = 121) were examined to determine whether patient characteristics can be used as a basis for tailoring safer sex counseling in the clinic setting. Potential correlates of self-reported unprotected oral sex (fellatio) and vaginal sex included participant demographics (e.g., age, ethnicity), disease status (CD4 counts, viral load, years since diagnosis), safer sex beliefs (e.g., condom attitudes), substance use, psychological characteristics (depressive symptoms, dispositional optimism and pessimism), and sex partner characteristics (main/casual partner, HIV status of partner, and duration of relationship). A series of logistic regression analyses were used to determine significant relationships. Correlates of reported levels of prior 3-month unprotected fellatio (24%) and vaginal (21%) sex were not associated with the type of relationship (main or casual) or perceived HIV serostatus of the partner (positive, negative, or unknown). Unprotected fellatio was positively associated with age and CD4 count and inversely associated with optimism and positive condom attitudes (all p's < 0.05). Unprotected vaginal sex was positively associated with duration of relationship and inversely associated with positive condom attitudes. Prevention efforts among sexually active adult heterosexual men living with HIV may benefit from focusing on improving attitudes towards condom use regardless of partner relationship status.
doi:10.1007/s11524-006-9068-z
PMCID: PMC2430484  PMID: 16736114
Condom attitudes; Heterosexual; HIV; Optimism; Unsafe sex
23.  Methamphetamine Use, Attitudes About Condoms, and Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men 
Archives of Sexual Behavior  2009;40(2):267-272.
This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM’s attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.
doi:10.1007/s10508-009-9566-7
PMCID: PMC2891784  PMID: 19856091
Methamphetamine; Attitudes; Condoms; Sexual risk; Men who have sex with men
24.  Methamphetamine Use, Attitudes About Condoms, and Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men 
Archives of sexual behavior  2009;40(2):267-272.
This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM's attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.
doi:10.1007/s10508-009-9566-7
PMCID: PMC2891784  PMID: 19856091
Methamphetamine; Attitudes; Condoms; Sexual risk; Men who have sex with men
25.  HIV-Positive Men Sexually Active with Women: Sexual Behaviors and Sexual Risks 
This study examines patterns of sexual behavior, sexual relating, and sexual risk among HIV-positive men sexually active with women. A total of 278 HIV-positive men were interviewed every 6–12 months between 1994 and 2002 and reported considerable variability in sexual behaviors over time. Many were not sexually active at all for months at a time; many continued to have multiple female and at times male partners. Over one-third of the cohort had one or more periods when they had engaged in unprotected sex with a female partner who was HIV-negative or status unknown (unsafe sex). Periods of unsafe sex alternated with periods of safer sex. Contextual factors such as partner relations, housing status, active drug use, and recently exchanging sex showed the strongest association with increased odds of unsafe sex. A number of predictors of unsafe sex among African American men were not significant among the Latino sub-population, suggesting race/ethnic differences in factors contributing to heterosexual transmission. Implications for prevention interventions are discussed.
doi:10.1007/s11524-006-9074-1
PMCID: PMC2430477  PMID: 16770702
Contextual factors; Heterosexual men; Persons living with HIV/AIDS; Prevention planning; Sexual behavior; Sexual risk

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