Assessing sexual risk behaviour of young gay men in primary relationships: the incorporation of negotiated safety and negotiated safety compliance.

OBJECTIVES: To establish the actual rate of risky unprotected anal intercourse (UAI) among young gay men in steady relationships by correcting for negotiated safety (NS) and NS compliance. In addition, to examine whether the rate of UAI with steady partners, after correction for NS and NS compliance, is higher than the rate of UAI during sexual contacts with casual partners. METHODS: A total of 435 young gay men completed questionnaires regarding relationship status, HIV status, NS agreements, and sexual behaviour with steady and casual partners in the preceding 6 months. RESULTS: Twelve per cent of the participants in a relationship practised NS. The non-compliance rate with NS agreements reached 10%. The rate of UAI with steady partners stood at 54%. After correction for NS and NS compliance, the actual risky UAI rate with steady partners dropped to 39%. Chi square tests showed that even after correction for NS and NS compliance, the rates of UAI with steady partners remained significantly higher than the rates of UAI with casual partners. CONCLUSION: It is imperative to correct the rates of UAI with steady partners for NS and NS compliance in order to estimate accurately the rates of risky UAI. The higher rates of risky UAI found with steady partners, even after correcting for NS, support the assumption that steady relationships provide a context that facilitates sexual risk-taking behaviour. We should therefore specifically target primary relationships as a source of risk for HIV transmission, and take into consideration non-compliance with NS agreements.

Increase in the share of steady partners as a source of HIV infection: a 17-year study of seroconversion among gay men.

OBJECTIVES: To examine the share of steady versus casual partners as the source of HIV infection in gay male seroconversions between 1984 and 2000 and the effect of age at seroconversion on the source of HIV transmission. METHODS: The sample consisted of 144 seroconverstors from the Amsterdam Cohort Study among Homosexual Men. Questionnaires and post-seroconversion interviews were used to determine the source of HIV transmission. RESULTS: Analysis revealed an interaction effect between calendar year and age at seroconversion (P < 0.05). Younger seroconverters had higher odds ratios [odds ratio, 11.33; 95% confidence interval, 1.77--72.13] to be infected by their steady partner late in the AIDS epidemic: 15% (three of 20) between 1984 and 1987 versus 67% (six of nine) between 1994 and 2000. No such time effect was present for older seroconverters who were consistently more likely to be infected by a casual partner: 79% (37 of 47) between 1984 and 1987, and 83% (15 of 18) between 1994 and 2000. CONCLUSIONS: Young gay seroconverters today are more likely to have contracted HIV from a steady partner than from a casual partner, compared with early in the AIDS epidemic and compared also with older gay seroconverters. There is a pressing need for preventive measures addressing sexual risk behaviour within steady relationships among younger gay men.

On the classification and diagnosis of pathological grief.

It has been suggested that pathological grief should become either a separate category of mental disorder or be integrated within existing, extended classifications in systems such as the Diagnostic and Statistical Manual of Mental Disorders. Despite strong arguments for inclusion, and advancements by scientists toward development of diagnostic classification, there has been a lack of critical evaluation. Several issues need further scrutiny and clarification. These concern the definition of pathological grief, the distinction of pathological from normal grief, its relationship with other disorders, and the lack of agreement among scientists about criteria for pathological grief. Further research needs to focus on delineation of syndromes that comprise "pathological grief," and on derivation of acceptable, valid, diagnostic criteria. Evaluation of the ramifications--both positive and potentially negative--associated with the revision of the diagnostic status of pathological grief needs also to be undertaken.

Does "grief work" work?

This article challenges the long-standing belief in the necessity of "grief work" for adjustment to bereavement. Evidence is offered from a prospective study of 30 widows and 30 widowers that indicates that grief work is not always as essential for adjustment to bereavement as theorists and clinicians have claimed. Widows who avoided confronting their loss did not differ in their depression scores from widows who worked through their grief. However, for widowers, performance of grief work was associated with better adjustment over an 18-month period. The implications of these findings for the grief work hypothesis are considered.

The role of loneliness and social support in adjustment to loss: a test of attachment versus stress theory.

A longitudinal study of a matched sample of 60 recently widowed and 60 married men and women tested predictions from stress and attachment theory regarding the role of social support in adjustment to bereavement. Stress theory predicts a buffering effect, attributing the impact of bereavement on well-being to stressful deficits caused by the loss and assuming that these deficits can be compensated through social support. In contrast, attachment theory denies that supportive friends can compensate the loss of an attachment figure and predicts main effects of marital status and social support. Attachment theory further suggests that marital status and social support influence well-being by different pathways, with the impact of marital status mediated by emotional loneliness and the impact of social support mediated by social loneliness. Results clearly supported attachment theory.

Broken hearts or broken bonds. Love and death in historical perspective.

Psychological theories and practices frequently neglect the extent to which their subject matter is historically and culturally defined. This issue is explored in the context of theories and therapies related to bereavement. Contemporary orientations emphasize the importance of breaking bonds with the deceased and the return of survivors to autonomous lifestyles. Placing the orientation in cultural and historical context reveals that it is largely a product of a modernist worldview. Within the romanticist ethos of the preceding century, such breaking of bonds would destroy one's identity and the meaning of life. In light of contemporary variations in subcultural meanings and values, a postmodern view is suggested in which reflexive responsibility is focal.

Delinquency, health behaviour and health.

OBJECTIVES: This study investigated the association between delinquency and health in a sample of adolescents and young adults (aged 13-24) and examined whether the association could have been due to delinquency-related differences in demographic, socio-economic and life-style factors. METHOD: The study is based on cross-sectional data from a sample of 3677 adolescents and young adults interviewed as part of a survey of Dutch households. Health, health behaviour, and delinquency were assessed through self-report measures. RESULTS: Delinquency was significantly related to three of the four measures of health behaviour (smoking, alcohol consumption, and drug use), even after control for demographic and socio-economic factors. Delinquency was also significantly associated with all three measures of health assessed in this study (somatic symptoms, general health, and chronic conditions). However, only minimal support was found for the hypothesis that the association between delinquency and health was mediated by differences in health behaviour or demographic/socio-economic differences. CONCLUSIONS: Adolescent delinquents are less healthy than non-delinquents. Potential causes for this relationship are proposed. Possibly, personality factors, such as hostility, or psychosocial stress might explain why delinquency correlates with health.

Educational Status and Risk of HIV in Young Gay Men.

Lower socioeconomic status (SES) has been associated with higher rates of HIV infection as well as higher rates of unsafe sex. The behavioral determinants that might mediate the effect of SES on risky sex have not been studied thus far. We investigated the involvement of social cognitions in the link between educational status and unprotected anal sex in 292 participants of the Amsterdam Young Gay Men Study. We found that poorly educated men had poorer knowledge about HIV and preventive behavior, perceived social norms to be less favorable towards condom usage with casual partners, and had lower perceived control over that behavior than the better educated men. Poorly educated men were also more likely to have engaged in unprotected anal sex with casual partners in the six-month period that followed the assessment of the social cognitions. However, the education-related behavioral difference could not be explained by social cognitions. We concluded that cognitive models of behavior might not explain all of the risk behavior in gay men with lower SES. These men's risk-taking behavior might result from specific psychological characteristics of men with lower SES that interfere with traditional cognition-behavior correlations as posited in prevailing models of behavior.