Intercourse Occasions Research Articles

Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study.

ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance(p=.08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.

Daily associations between alcohol and sexual behavior in young adults.

We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record

Promoting Female Condom Use Among Female University Students in KwaZulu-Natal, South Africa: Results of a Randomized Behavioral Trial.

Relatively few interventions have tested the efficacy of female condom promotion either alone or in combination with other barrier methods. We evaluated the efficacy of a two-session (enhanced) cognitive-behavioral intervention (EI) (n = 147) against a one-session control (minimal) educational intervention (MI) (n = 149) to promote female condom (FC) use among female students aged 18-28 at a South African university. We assessed change from baseline to 2.5 and 5 months in number of vaginal intercourse occasions unprotected by male or female condoms in EI versus MI using generalized linear models with a log link function and GEE. Both groups reported significant reductions in number of unprotected vaginal intercourse occasions from baseline to each follow-up, with no significant difference between the two-session and single-session intervention. Introduction of a brief group-based MI FC promotion intervention with FC access holds promise for delivery in clinics and other community venues.

A Comparison of Demographic and Psychosexual Characteristics of Women With Primary Versus Secondary Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting approximately 12% of premenopausal women. It has been speculated that primary (ie, lifelong) and secondary (ie, acquired) PVD may represent 2 distinct conditions with different etiologies. There is also evidence that primary and secondary PVD subtypes may respond differently to conventional treatments. The goal of this study was to compare the demographic, clinical, and psychosexual characteristics of a large sample of premenopausal women with primary and secondary PVD. A total of 132 premenopausal women (n=42 primary; n=90 secondary) with PVD who sought treatment in a Multidisciplinary Vulvodynia Program completed demographic questions and a battery of validated self-report measures before treatment. Women with primary PVD had a longer duration of PVD as well as more time before diagnosis. Women with secondary PVD reported significantly more clitoral hood pain, higher overall vestibular pain levels, more overall sexual dysfunction and sex-related distress, and proportionately more intercourse occasions that were painful. Women with primary pain stated they had significantly more dysmenorrhea and were more likely to report that their partners were unaware of their PVD symptoms. There were no significant subtype differences on any psychological measure but a trend towards higher magnification of symptoms in women with secondary PVD. Overall the findings suggest some important differences in the characteristics of women with primary versus secondary PVD which may have management-related implications.

Prospective associations between perceived barriers to condom: use and "perfect use".

Identifying malleable predictors of condom use in a clinic-based population may benefit efforts to prevent sexually transmitted infections (STIs). To prospectively test associations between three measures (relational-trust factors, fit and feel, and dislike of condom use) and perfect condom use in patients attending clinics diagnosing STIs. A convenience sample was recruited from five clinics in three U.S. cities. Data were collected from December 2007 through April 2011. Daily electronic diaries were completed for up to 180 days. Occasions of penile-vaginal intercourse (PVI) involving condom use without any of four errors/problems were classified as "perfect use." Three subscales (relational-trust factors, fit and feel, and dislike of condom use) were developed from baseline data. Generalized estimating equations were used to account for non-independence of PVI events. Among 17,156 reported occasions of PVI, condoms were either not used or used with errors/problems in 8,857 (51.6%) instances. The remaining 8,829 occasions (48.4%) involved perfect use. Relational-trust (p=0.054) and fit and feel (p=0.13) issues were not significantly associated with perfect use. Dislike of condom use (p=0.005) was significantly associated with perfect use (estimated OR=0.93, 95% CI=0.89, 0.98). Significant interactions with race, age, or gender were not observed. Clinic attendees may be more likely to use condoms perfectly if three perceptions are reduced in magnitude: I won't use condoms, condoms spoil the mood, and I get turned off when my partner suggests we use condoms. Findings support a paradigm shift in the way clinics promote condom use to patients.

Australian Gay and Bisexual Men's Use of Erectile Dysfunction Medications During Recent Sexual Encounters

Use of erectile dysfunction medications (EDMs) is relatively common among gay and bisexual men and has been associated with human immunodeficiency virus sexual risk behavior. We aimed to determine what factors were related to EDM use on occasions when participants engaged in protected anal intercourse (PAIC) and when they engaged in unprotected anal intercourse (UAIC) with casual partners. An online cross-sectional survey was conducted, resulting in a sample of 1,376 Australian gay and bisexual men who reported an occasion of anal intercourse with casual male partners in the previous year. The main outcome measure was the use of EDM during most recent occasions of PAIC and UAIC. Men were as likely to use EDM on occasions when they were using condoms (11.6%) as they were on occasions when they did not use condoms (13.0%). There was no association between use of EDM and self-esteem, nor was there an association between sexual risk behavior and self-esteem. Men who used EDM were more sexually active overall and appeared to often use EDM to enhance and extend their sexual experiences. Men did not appear to use EDM specifically for the purposes of risk-taking and mainly used EDM to enhance sexual pleasure. Mental health issues were not indicated by use of EDM.

Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students

BackgroundAs reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience.MethodsA cross-sectional survey was carried out in 2010 among 1954 students at Mbarara University of Science and Technology, Uganda, using a self-administered questionnaire. Alcohol use was measured as consumption over the previous 12 months, during situations related to sexual activity and on the most recent occasion of sexual intercourse. Risky sexual behavior was defined as having two or more sexual partners in the previous 12 months or inconsistent condom use with new partners. Bivariate and multivariate logistic regression was performed to analyze the association between alcohol use and risky sexual behavior separately for males and females.ResultsEven after adjusting for confounders, the odds ratio (OR) of having two or more sexual partners in the past year indicated a statistically significant association with alcohol use on all levels (global, situational, and event) for both males and females. The ORs of inconsistent condom use with a new partner were significant for males who often consumed alcohol in relation to sexual activity—even after adjusting for potential confounders (OR, 1.75; confidence interval, 1.01–3.08). The risk of inconsistent condom use with a new partner was twice as high for females who often consumed alcohol in relation to sexual activity, although this association was not statistically significant.ConclusionsThe study supports previous research that alcohol consumption is associated with having multiple sexual partners. Inconsistent condom use was associated with the situational use of alcohol in relation to sexual activity and was similar for both genders. Interventions to reduce alcohol-related risky sexual behavior should target both male and female drinkers, particularly subgroups of students, who often consume alcohol in relation to sexual activity.

Is drinking alcohol associated with sexual coercion among Ugandan university students?: a cross-sectional study

BackgroundSexual coercion is prevalent in sub-Saharan Africa and is a risk factor for unintended pregnancies, sexually transmitted infections and mental health problems. Alcohol consumption patterns have been suggested to be an important factor behind the experience of sexual coercion among university students.ObjectiveTo study the association between alcohol consumption and the experience of sexual coercion among Ugandan university students.MethodIn 2010, 1954 Ugandan students participated in a cross sectional survey, conducted in Mbarara University of Science and Technology (72% response rate). A self-administered questionnaire assessed socio-demographic factors, alcohol consumption, mental health, and sexual behavior. Multivariable logistic regression analysis was used to examine the various predictors of recent experience of sexual coercion. The data were stratified by sex.ResultsOf the 1954 students, 27.6% reported having experienced sexual coercion and 16.4% stated that they had such an experience recently. Individuals who reported frequent consumption of alcohol, or having consumed alcohol often on the occasion of sexual intercourse, were found to have a higher probability of recent experiences of sexual coercion (OR adjusted 2.29, 95% CI 1.40–3.72, and OR adjusted 2.78, 95% CI 1.56–4.97, respectively). These associations were significant even after adjusting for potential confounders. A synergistic effect was found between poor mental health and frequent consumption of alcohol in conjunction with having sex with regard to its impact on recent experiences of sexual coercion.ConclusionWe found an association between alcohol consumption and experiences of sexual coercion among Ugandan university students. Therefore, universities may want to consider alcohol prevention under their policy framework, as it could reduce the potential risk of sexual coercion.

Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)

SummaryBackgroundSexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal).MethodsWe used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16–34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16–74 years were eligible) or the boost sample (in which only individuals aged 16–34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16–44 years from Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3.FindingsInterviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0–83·1%) of men and 77·7% (76·7–78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08–1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43–2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59–2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires—particularly in oral and anal sex—over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3.InterpretationSexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life—albeit reduced in range and frequency—emphasises that attention to sexual health and wellbeing is needed throughout the life course.FundingGrants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Hypersexual Behavior and HIV Sex Risk among Young Gay and Bisexual Men

Hypersexual behavior has been identified as a sexual risk correlate among gay and bisexual men (GBM). The Hypersexual Behavior Inventory (HBI) has been shown to be a reliable and valid measure of hypersexual behavior in clinical populations, yet it has not been used to assess hypersexual behavior in nonclinical samples. We examined the psychometric properties of the HBI with survey data recorded between December 2009 and March 2010 in a sample of young men (N = 366, M = 21.46 years old, SD = 1.95) who self-identified as gay (89%) or bisexual (11%) and assessed its association with unprotected receptive anal intercourse (URAI) partners and occasions. Using cross-sectional data of single, sexually active young GBM (YGBM), we used confirmatory factor analyses to test the HBI's three-factor structure. Using negative binomial regressions, we then tested the association between the HBI subscales and sexual risk. After accounting for covariates, we found that sexual control was a risk factor for URAI partners and occasions, and coping was found to be a protective factor for URAI occasions. In light of our findings, we discuss the importance of reexamining the theoretical assumptions of hypersexual behavior and propose HIV prevention strategies that may reduce young GBM's vulnerability to HIV infection.

HIV risk behaviour among public primary healthcare patients with tuberculosis in South Africa

Objective. To identify factors associated with HIV in tuberculosis (TB) patients in a public primary healthcare (PHC) setting in South Africa (SA). Method. Among 4 900 consecutively selected TB patients (54.5% men; women 45.5%) from 42 public PHC clinics in 3 districts in SA, a cross-sectional survey was performed to assess new TB and new TB retreatment patients within one month of anti-TB treatment. Results. The sample comprised 76.6% new TB patients and 23.4% TB retreatment patients. Of those who had tested for HIV, 59.9% were HIV-positive; 9.6% had never tested for HIV. In multivariate analysis, older age (odds ratio (OR) 5.86; confidence interval (CI) 4.07 - 8.44), female gender (OR 0.47; CI 0.37 - 0.59), residing in an informal settlement (OR 1.55; CI 1.13 - 2.12), being a TB retreatment patient (OR 0.55; CI 0.42 - 0.72), occasions of sexual intercourse with condom use (OR 1.07; CI 1.02 - 1.13) and having a sexual partner receiving antiretroviral treatment (ART) (OR 7.09, CI 4.35 - 11.57) were associated with an HIV-positive status in TB patients. Conclusion. This study revealed high HIV risk behaviour (e.g. unprotected last sexual intercourse and alcohol and drug use in the context of sexual intercourse) among TB patients in SA. Various factors were associated with HIV risk behaviour. Condom use and substance use risk reduction need to be considered as HIV-prevention measures when planning such strategies for TB patients.

HIV risk behaviour among public primary healthcare patients with tuberculosis in South Africa

Objective. To identify factors associated with HIV in tuberculosis (TB) patients in a public primary healthcare (PHC) setting in South Africa (SA).Method. Among 4 900 consecutively selected TB patients (54.5% men; women 45.5%) from 42 public PHC clinics in 3 districts in SA, a cross-sectional survey was performed to assess new TB and new TB retreatment patients within one month of anti-TB treatment.Results. The sample comprised 76.6% new TB patients and 23.4% TB retreatment patients. Of those who had tested for HIV, 59.9% were HIV-positive; 9.6% had never tested for HIV. In multivariate analysis, older age (odds ratio (OR) 5.86; confidence interval (CI) 4.07 - 8.44), female gender (OR 0.47; CI 0.37 - 0.59), residing in an informal settlement (OR 1.55; CI 1.13 - 2.12), being a TB retreatment patient (OR 0.55; CI 0.42 - 0.72), occasions of sexual intercourse with condom use (OR 1.07; CI 1.02 - 1.13) and having a sexual partner receiving antiretroviral treatment (ART) (OR 7.09, CI 4.35 - 11.57) were associated with an HIV-positive status in TB patients.Conclusion. This study revealed high HIV risk behaviour (e.g. unprotected last sexual intercourse and alcohol and drug use in the context of sexual intercourse) among TB patients in SA. Various factors were associated with HIV risk behaviour. Condom use and substance use risk reduction need to be considered as HIV-prevention measures when planning such strategies for TB patients.

Body Mass Index, Body Esteem, and Unprotected Receptive Anal Intercourse Among Young Men Who Have Sex with Men Who Seek Partners Online

Research examining the relationship between body mass index (BMI) and sexual risk outcomes among men who have sex with men (MSM) has yielded inconsistent results. Using a web-based survey, single-identified (e.g., not in a relationship) young MSM (N = 431) between the ages of 18 and 24 years who sought romantic partners online were asked to respond to items regarding their BMI, body image (e.g., attribution, dissatisfaction, and pride), and sexual risk behaviors. We used Poisson regressions to examine the relationships between BMI, body image, and the number of unprotected receptive anal intercourse (URAI) occasions and partners in the past 2 months. We found a curvilinear relationship between BMI and URAI occasions, and a linear relationship between BMI and URAI partners. These relationships persisted after accounting for body image. Further, we found that body attribution served as a protective factor whereas body pride served as a risk factor. We discuss the implications of our findings for sexual health education and HIV prevention.

Self-Efficacy Among Young Men Who have Sex with Men: An Exploratory Analysis of HIV/AIDS Risk Behaviors Across Partner Types

HIV infection continues to rise among young men who have sex with men (YMSM). We explored whether unprotected receptive anal intercourse (URAI) occasions and partners, respectively, were associated with YMSM's (N = 194; ages 18-24) self-efficacy for safe sex with regular and casual partners. We created four self-efficacy typologies: high self-efficacy with both partner types [HRHC; N = 73(41.7 %)], high self-efficacy with regular partners but low with casual partners [HRLC; N = 24(13.7 %)], low self-efficacy with regular partners but high with casual partners [LRHC; N = 21(12.0 %)], and low with both partner types [LRLC; N = 57(32.6 %)]. YMSM in the LRHC category reported fewer URAI occasions, whereas those in the HRLC group reported more URAI partner and occasions, respectively. YMSM having serodiscordant partners were more likely to report more URAI partners, and be represented in the LRLC category. These findings underscore the importance of addressing differential self-efficacy across partner types, and highlight an urgent need to enhance YMSM's self-efficacy with casual partners.

Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil

Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk. We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006-2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48-0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57-0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations. Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil. Interventions targeting food insecurity may have beneficial implications for HIV prevention in resource-limited settings.

Sexual force at sexual debut. Swedish adolescents with disabilities at higher risk than adolescents without disabilities

The aims of this study are first to compare the incidence of force on the first occasion of sexual intercourse reported by participants with disabilities to that of students without disabilities; second to determine whether there are significant differences in mental health, substance abuse, and school performance as reported by participants forced into their sexual debut as opposed to those who were not forced, analysed by gender; and finally to identify the significant variables that predict girls reporting force at sexual debut as opposed to girls not reporting force, as well as to identify similar variables within the male group. There were no data on sexual abuse prior to the first occasion of full sexual intercourse. MethodThis cross-sectional study is based on 2 surveys: Life and Health---Young People 2005 and 2007. All 17/18-year-old adolescents in upper-secondary schools in a county in Sweden were asked the same questions both years. A total of 2,254 students completed the survey in 2005 and 2,641 in 2007. ResultsThe main finding is that force at sexual debut (intercourse) is more common among adolescents with a disability (4.0%) than those not reporting any disability (1.6%), and is most common among those reporting multiple disabilities (10.4%). This was found both for girls and boys, even if the rates for girls were several times higher. Other findings are that girls and boys reporting force at sexual debut (disability and non-disability groups taken together) reported different profiles. For girls, their country of origin and who they live with are significant. This background data is not significant for boys. Boys report a strong psychosomatic reaction. ConclusionCulture-, functionality-, and gender-sensitive studies of adolescents’ reactions to sexual abuse are needed to help determine relevant and effective interventions

HIV Risk Reduction Intervention Among Medically Circumcised Young Men in South Africa: A Randomized Controlled Trial

Medical male circumcision (MMC) is now considered one of the best available evidence-based biomedical HIV prevention interventions. However, there is some concern about risks for behavioural disinhibition, or risk compensation, following MMC. The aim of this study was to test a brief one-session (180min) group culturally tailored HIV risk reduction counselling intervention among men undergoing medical circumcision in South Africa in order to limit behavioural disinhibition. A randomized controlled trial design was employed using a sample of 150 men, 75 in the experimental group and 75 in the control group. Comparisons between baseline and 3-month follow-up assessments on several key behavioural outcomes addressed by the intervention were done. Our study found that behavioural intentions and risk reduction skills significantly increased and sexual risk behaviour (reduction of the number of sexual partners and the number of unprotected vaginal sexual intercourse occasions) significantly decreased in the experimental compared to the control condition. However, male role norms did not change among the intervention conditions over time, while AIDS-related stigma beliefs significantly reduced in both conditions over time. Study findings show that a relatively brief (one session) and focused HIV risk reduction counselling can have at least short-term effects on reducing sexual risk behaviours in populations at high risk for behavioural disinhibition following medical male circumcision.

The Healthy Teen Girls Project: Comparison of Health Education and STD Risk Reduction Intervention for Incarcerated Adolescent Females

Adolescent girls incarcerated in a state reformatory (N = 246) were recruited and assigned to an 18-session health education program or a time-equivalent HIV prevention program. Cohorts were assigned to conditions using a randomized block design separated by a washout period to reduce contamination. Post intervention, girls in the HIV risk reduction program demonstrated the acquisition of risk-reduction behavioral skills and improved condom application skill. At a follow-up assessment approximately 9 months after release from the correctional facility, girls in both conditions reported fewer unprotected sexual intercourse occasions and less sex while under the influence of alcohol or other drugs.

Low Numeracy Predicts Reduced Accuracy of Retrospective Reports of Frequency of Sexual Behavior

Assessment of the frequency of sexual behavior relies on participants' ability to arithmetically aggregate information over time and across partners. This study examines the effect of numeracy (arithmetic skills) on the accuracy of retrospective reports of sexual behavior. For 91days, the participants completed daily reports about their sexual activity. Participants then completed a survey on sexual behavior over the same period. The discrepancies between the survey-based and the diary-based measures of frequency of vaginal and anal intercourse were evaluated. Multiple regression analysis showed that the discrepancy between retrospective and diary measurements of sexual intercourse increased with lower numeracy (P=0.026), lower education (P=0.001), aggregate question format compared to partner-by-partner format (P=0.031) and higher frequency of intercourse occasions (P<0.001). Lower numeracy led to a 1.5-fold increase (adjusted mean=14.1-20.9) in the discrepancy for those using the aggregate question format and a 2.0-fold increase (adjusted mean=3.7-7.6) for those using the partner-by-partner format.

Telephone-Administered Motivational Interviewing to Reduce Risky Sexual Behavior in HIV-Infected Rural Persons: A Pilot Randomized Clinical Trial

Although several studies have characterized patterns and predictors of continued risky sexual behavior in HIV-infected rural persons, far less research has evaluated interventions to reduce risky sex in this group. This pilot randomized clinical trial compared 2 brief telephone-administered interventions designed to reduce continued risky sexual behaviors in HIV-infected rural persons. Participants were 79 HIV-infected rural persons who reported 1 or more occasions of unprotected anal, vaginal, or oral sex in the past 2 months. Participants were recruited through AIDS service organizations in rural areas of 27 states and assigned randomly to either a 2-session, motivational interviewing plus skills-building intervention (i.e., integrated intervention; n = 48) or a 2-session, skills-building only comparison intervention (n = 31). Participants completed self-report measures of sexual behaviors and factors related to risky sex at preintervention and 2-month follow-up. Before enrolling into the intervention, 37% of participants had 2 or more sexual partners in the past 2 months, 29% had sex with 1 or more partners without knowing their partners' HIV serostatus, and almost one-third of participants located sex partners in high-risk environments (e.g., public parks, roadside rest areas). A 2 x 2 repeated measures multivariate analyses of variance found that integrated intervention participants reported greater increases in risk-reduction motivation and greater increases in condom-protected vaginal and oral intercourse occasions at follow-up compared to skills-building only participants. Brief telephone-administered interventions that integrate motivational interviewing with skills-building show potential to reduce risky sexual behaviors in HIV-infected rural persons. Additional and large-scale evaluations of this intervention approach appear warranted.