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Article Excerpt
Sexual compulsivity is associated with high rates of sexual behavior and may increase risks for sexually transmitted infections (STIs), including HIV infection. Individuals who are preoccupied with sex and lack control of their sexual impulses may engage in high-risk sexual acts despite the threat of HIV infection and other potential adverse outcomes (Gold & Heffner, 1998). Sexual compulsivity is a heterogeneous psychological construct that can encompass a preoccupation with sexual desires and behaviors to the degree that a person experiences disruptions in social relationships, occupational difficulties, and problems in daily living (Barth & Kinder, 1987; Black, Kehrberg, Flumerfelt, & Schlosser, 1997; Gold & Heffner, 1998). Sexual compulsivity is not a formal psychiatric diagnosis, and it is likely that sexual compulsivity has multiple forms and multiple etiologies. Our conceptualization of sexual compulsivity is not synonymous with sexual addiction, hypersexuality, or other clinically defined categories (Carnes, 1990; Schneider, 1994). Rather, we define sexual compulsivity as a propensity to experience sexual disinhibition and under-controlled sexual impulses and behaviors as self-identified by individuals. In the current research, we investigated the association between indicators of sexual preoccupation and poor sexual impulse control (sexual compulsivity) and risks for sexually transmitted infections in a sexually transmitted infections clinic sample.
In studies of people who are already infected and living with HIV-AIDS, indicators of sexual compulsivity correlate with continued sexual risk practices, including behaviors that transmit HIV to uninfected sex partners. Kalichman, Greenberg, and Abel (1997), for example, found that HIV-positive men who had recently engaged in unprotected sexual activities with multiple sex partners scored higher on a sexual compulsivity scale than did individuals who engaged in high-risk activities with only one sex partner. Benotsch, Kalichman, and Kelly (1999) also found that HIV positive men scoring higher in sexual compulsivity engaged in more frequent unprotected sex acts with more partners, reported greater use of cocaine in conjunction with sexual activity, and rated high-risk sex acts as more pleasurable. Finally, Benotsch, Kalichman, and Pinkerton (2001) investigated indicators of sexual compulsivity as a factor contributing to high-risk sexual behavior in a sample of HIV-positive men and women. Individuals who scored higher in sexual compulsivity engaged in unprotected anal and vaginal intercourse with more HIV-negative partners or partners of unknown HIV status compared to persons with lower sexual compulsivity scores. In this study, mathematical modeling of sexual risk behavior indicated that four times as many new HIV infections could be expected among the HIV-negative sex partners of people who report more indicators of sexual compulsivity compared to partners of people who report fewer indicators of sexual compulsivity. HIV-positive individuals scoring higher in sexual compulsivity were more likely to report cocaine use and scored higher on measures of psychopathology than individuals lower in sexual compulsivity. Taken together, these studies suggest that sexual compulsivity may be a factor in sexual risk behavior for some people living with HIV-AIDS and may therefore be important in predicting risk behaviors in people at risk but not yet infected.
The current study examined indicators of sexual compulsivity in a sample of persons at high risk for STIs by conducting three sets of analyses. First, we examined the prevalence of indicators of sexual compulsivity and the dimensional composition of sexual compulsivity among STI clinic patients. Next, we conducted descriptive analyses by comparing STI clinic patients who were characterized as either relatively higher or lower in sexual compulsivity on measures of substance use and substance use outcome expectancies (Leigh & Stall, 1993). For these analyses, we operationally defined higher sexual compulsivity as the within-gender 80th-percentile scores on a sexual compulsivity scale. Finally, we conducted regression analyses to test the independent effects of sexual compulsivity as a predictor of sexual risks after controlling for known correlates of sexual risk behavior. We hypothesized that (a) indicators of sexual compulsivity would be prevalent in an STI clinic sample, (b) individuals who scored higher in sexual compulsivity would be at higher risk for HIV and other STIs, and (c) indicators of sexual compulsivity would significantly predict sexual risk behaviors over and above established correlates of sexual risks for HIV and other STIs.
METHOD
Participants and Setting
Participants were 432 men and 193 women receiving services from the largest public health clinic in Milwaukee, WI. Although a city of moderate size (population 1.2 million), Milwaukee is characterized by ethnically diverse communities and an impoverished inner-city. Sexually transmitted infections surveillance has shown that Milwaukee has ranked highest among U.S. cities in chlamydia rates and 13th for gonorrhea (CDC, 1999). The majority of STIs (59%) and HIV (52%) in Wisconsin are diagnosed in Milwaukee. The clinic site for the study is the largest publicly funded STI clinic in Wisconsin and serves approximately 6,000 patients annually; the majority of clients are African American (83%), 11% are White, 5% are Latino, and less than 1% are of other ethnic backgrounds. The clinic provides free and confidential STI diagnostic and treatment services, including confidential HIV testing.
Measures
All assessment instruments were administered using audio computer-assisted structured interviews (ACASI). Participants viewed assessment items on a 15-inch color monitor, heard items read by machine voice using head-phones, and responded to items by clicking a mouse. Research has shown that ACASI procedures yield reliable responses in sexual behavior interviews (Metzger et al., 2000). The assessment included measures of demographic characteristics, sexual compulsivity, alcohol use outcome expectancies, substance use, and sexual behaviors.
Demographic characteristics....
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