Selection of Film Clips and Development of a Video for the Investigation of Sexual Decision Making among Men Who Have Sex with Men

Article excerpt

From the outset of the HIV epidemic in the United States, men who have sex with men (MSM) have been disproportionately affected by HIV and AIDS. MSM represent approximately 50% of those living with HIV in the United States and over 70% of HIV+ men (Centers for Disease Control [CDC], 2007; Hall et al., 2008). The MSM community made remarkable strides to reduce rates of risky sexual behavior during the first decade of the HIV and AIDS epidemic (Martin, 1987; Ostrow, 1999). However, recent data reveal an estimated 8.6% annual increase in the number of HIV and AIDS diagnoses among MSM from 2001 to 2006 (CDC, 2008). To stem the tide of new infections among MSM and to reduce transmission of sexually transmitted diseases (STDs) and drug-resistant HIV strains among MSM already living with HIV, research involving MSM remains a critical public health priority.

Despite the considerable advances in the last 10 years in the effectiveness and accessibility of medications in slowing the progression of AIDS, there remains no medical cure for it. Therefore, behavioral interventions aimed at decreasing the incidence of HIV through promotion of safer sexual practices remain the best approach to ameliorating the HIV epidemic (Kalichman & Weinhardt, 2001). Accordingly, there has been a major emphasis among researchers on identifying biological, psychological, and social or situational factors that may be associated with the occurrence of unsafe sex and the mechanisms of their action. One factor routinely identified as a risk modifier is alcohol use, especially with respect to how alcohol intoxication may impair sexual decision making.

Alcohol use has been associated with the occurrence of unsafe sexual behavior in multiple populations, including MSM. A recent review of 45 studies that investigated the association of alcohol use and sexual risk behavior among MSM found ample evidence of a relationship between the two variables, but also revealed that the relationship is complex and in need of ongoing attention (Woolf & Maisto, 2008). Specifically, it was concluded that a causal relationship between the two variables cannot be assumed until theory-based experimental research confirms the results from correlational research (Woolf & Maisto, 2008). Other reviews of research on the alcohol-sexual risk relationship with heterosexual populations have made similar observations (e.g., Cook & Clark, 2005; Cooper, 2002; Leigh & Stall, 1993; Weinhardt & Carey, 2000).

To address this gap in the literature, we developed a methodology for use in an experimental study to investigate the effects of alcohol intoxication and sexual arousal on the sexual behavior of MSM. A series of pilot studies was conducted to (a) select and establish face validity for the use of erotic film clips for the experimental manipulation of arousal in an analog risky sex situation and (b) produce and establish face validity for two interactive risk-exposure and role-play videos to be used for measuring risk perception and communication skills in an analog risky sex situation. To provide a context for this pilot research, we first briefly describe the experimental study for which these procedures and materials will be used.

Alcohol Intoxication, Sexual Arousal, and Sexual Decision Making

The pilot studies described here were designed to create materials for use in an experiment that tests the effects of sexual arousal and alcohol intoxication on risk perception. behavioral intentions, risk taking, and behavioral skills in MSM. To test the causal relationships among these variables, we plan a double-blind, randomized-dose alcohol administration study. For this study, single MSM (aged 21-50 years) will consume a beverage (alcohol, placebo control, or water) and then randomly assigned to either an "arousal" or a "neutral" condition. In the arousal condition, men will view film clips depicting sexually explicit material between two men: and in the neutral condition, participants will view a "scenes of nature" film clip. …