Affective differences in Iowa Gambling Task performance associated with sexual risk taking and substance use among HIV-positive and HIV-negative men who have sex with men

ABSTRACT

We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.

KEYWORDS:

• Decision making
• Iowa Gambling Task
• Anxiety
• Sexual
• risk taking
• Substance use

Acknowledgements

The authors gratefully acknowledge the contributions of Jeffrey Parsons, Julia Tomassilli, H. Jonathon Rendina, Anthony Surace, Michael Adams, research staff at the Center for HIV Educational Studies and Training, and the participants who gave their time and energy to this research. We appreciate the insightful comments of three anonymous reviewers on an earlier version of the manuscript. We are grateful to Yu “Woody” Lin for his support of and interest in this project.

Additional information

Funding

Research reported in this paper was supported by the National Institute on Drug Abuse of the National Institutes of Health [award number R21A026792] (Golub, principal investigator, PI).