Assessing Maladaptive Responses to the Stress of Being at Risk of HIV Infection among HIV-Negative Gay Men in New York City

Abstract

The aim of this study was to examine the psychometric properties and preliminary validity of a newly developed 16-item measure to assess maladaptive responses to the stress of being at risk for HIV infection among HIV-negative gay men. The measure consisted of three factors: (a) fatalistic beliefs about maintaining an HIV-negative serostatus, (b) reduced perceived severity of HIV infection due to advances in medical treatment of HIV and AIDS, and (c) negative affective states associated with the risk of HIV infection. A total of 285 HIV-negative gay men at a counseling program in New York City participated in the study. Confirmatory factor analyses supported the three-factor model as an acceptable model fit: non-normed fit index = .91, comparative fit index = .92, goodness-of-fit index = .90, and root mean square error of approximation = .07. The measure and its subscales obtained in this sample achieved adequate internal consistency coefficients. Construct validity was supported by significant and positive associations with internalized homophobia, depression, self-justifications for the last unprotected anal intercourse (UAI), and actual UAI with casual sex partners. Understanding the dynamics of maladaptive responses to the epidemic and intense anxieties elicited by HIV risk among HIV-negative gay men living in a place of high seroprevalence provides useful information to guide psychosocial interventions in the population.

Acknowledgments

We thank the participants in this research for their time and express gratitude to talkSafe staff and peer counselors who worked, above all, for the well-being of gay men. talkSafe was supported by the Centers for Disease Control and Prevention grant funding, given through the New York City Department of Health to the Medical and Health Research Association of New York City, Inc. The contents of this study are solely the responsibility of talkSafe and do not necessarily represent the official views of the funders. This research was also supported by a training grant from the National Institutes of Mental Health (T32 MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator: Anke A. Ehrhardt, PhD) and a center grant from the National Institutes of Mental Health to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, PhD).

Notes

Note. ITCS = item-total correlation for subscale; ITCT = item-total correlation for total scale.

¹We initially developed another construct, mutuality in serodiscordant dyad, to assess relationship issues affected by the imbalance that HIV illness can cause (e.g., fear of the seropositive partner dying and lack of communication between the partners). However, the subscale was excluded from the analysis due to a small sample size in the study. Only 8% (n = 22 out of 285) of the participants reported that they were currently in a relationship with an HIV-positive partner.

^a UAI with casual sex partners.

^b Gay bathhouse, gay porn theaters or video stores, and sex parties.

^c Crystal amphetamine, 3.4-methylenedioxymethamphetamine, “ecstasy,” and ketamine.

Note. NNFI = non-normed fit index; CFI = comparative fit index; GFI = goodness-of-fit index; AGFI = adjusted goodness-of-fit index; RMSEA = root mean square error of approximation.

Note. UAI–AI = Unprotected Anal Intercourse–Attitudes Inventory; IH = internalized homophobia; BDI = Beck Depression Inventory (r = .38, p < .001 between IH and BDI); ASD = anger/self-destructiveness; PSE = pleasure seeking/escapism; IN = intimacy needs; RCM = rational choice making; EPR = erroneous perception of risk; CED = condom-related erectile dysfunction.

*p < .05. **p < .01. ***p < .001.

Note. Effect size was calculated by Cohen's d.

*p < .01. **p < .001.