Guiding psychologists through inner and outer worlds: reflections from an academic Levinsonian psychobiography of Joe Slovo.

Psychobiography has become valuable within the context of professional psychology training. A recent psychobiography purposively sampled Joe Slovo to uncover, reconstruct and illustrate significant trajectories of his development. Slovo's (1926-1995) lifelong dedication to the struggle against Apartheid has been widely acknowledged, and he held longstanding leadership positions in various South African liberation movements. Levinson's theory of lifespan development served as the study's psychological lens. Alexander's approaches to data identification and extraction were used, followed by a psycho-historical matrix for data categorisation based on the life cycle theory and significant historical periods throughout Slovo's life. To fully embrace the Levinsonian understanding that an individual cannot be separated from their social world, consideration was given to significant historical and sociocultural forces and events during the data analysis. Therefore, this study's findings extend beyond Slovo's individual development to illuminate the complex ways external forces, such as family dynamics, historical events, political movements, community concerns and cultural and language considerations, influence developmental trajectories, life structures and tasks. The authors reflect on the value of sociocultural and contextual sensitivity in psychobiography to help trainee psychologists venture beyond the subject's inner psychological life, including understanding their outer worlds.

Holistic wellness in the life of Angela Merkel: a call to revise the wheel of wellness in the light of new positive psychology movements and socio-cultural changes.

Holistic wellness theories conceptualise wellness as a multidimensional and synergistic construct. The term wellness refers to a way of life oriented towards optimal health and wellbeing in which body, mind, and spirit are integrated by the individual to live life fully within the human and natural community. The proposed Wheel of Wellness Model incorporate five life tasks that are influenced by seven life forces that are, in turn, influenced by global events. In this study, the model is employed to explore the life of Angela Merkel from a psychobiographical and holistic wellness perspective. Merkel was purposively selected as an extraordinary leader who demonstrated exceptional coping abilities and wellness. Findings show that Merkel's wellness is particularly strong in terms of spirituality and self-direction. Suggestions are proposed how to expand the WoW in the context of latest positive psychology developments and with regard to socio-cultural changes within contemporary societies.

Kneeling and standing up from a chair as performance-based tests to evaluate knee function in the high-flexion range: a randomized controlled trial comparing a conventional and a high-flexion TKA design.

BACKGROUND: We compared the functional outcome between conventional and high-flexion total knee arthroplasty (TKA) using kneeling and sit-to-stand tests at 1 year post-operative. In addition, the patient's daily functioning, pain and satisfaction were quantified using questionnaires. METHODS: We randomly assigned 56 patients to receive either a conventional or a high-flexion TKA. Primary outcomes were maximum flexion angle and maximum thigh-calf contact measured during kneeling at 1 year post operatively. Secondary outcomes were the angular knee velocity and ground reaction force ratio measured during sit-to-stand performance tests, and questionnaires. RESULTS: At one year post-operative, maximum knee flexion during kneeling was higher for the high-flexion TKA group (median 128.02° (range 108-146)) compared to the conventional TKA group (119.13° (range 72-135)) (p = 0.03). Maximum thigh-calf contact force was higher for the high flexion TKA group (median 17.82 N (range 2.98-114.64)) compared to the conventional TKA group (median 9.37 N (range 0.33-46.58))(p = 0.04). The sit-to-stand tests showed a significantly higher angular knee velocity in the conventional TKA group (12.12 rad/s (95%CI 0.34-23.91); p = 0.04). There were no significant differences between groups in ground reaction force ratios and patient-reported outcome scores. CONCLUSION: Although no differences were found in patient-reported outcome scores, differences in performance-based tests were clearly apparent. Standing up from a chair at 90° of knee flexion appeared to be easier for the conventional group. The kneeling test revealed significantly higher weight-bearing knee flexion for the high-flex group. Hence, if kneeling is an important activity for a patient a high-flex design may be recommendable. TRIAL REGISTRATION: The study was retrospectively registered in ClinicalTrials.gov under identifier NCT00899041 (date of registration: May 11, 2009).

Creating a Meaningful Life: Psychobiographical Investigations.

This article serves as the editorial to the Special Issue of Europe's Journal of Psychology that focusses on "Creating a meaningful life: Psychobiographical investigations." The introduction provides a brief overview of the articles that offer original and innovative approaches to the growing research area of psychobiography, meaning and identity from different theoretical, methodological, disciplinary and socio-cultural background.

The Meaning of Life and Death in the Eyes of Frankl: Archetypal and Terror Management Perspectives.

This article aims to uncover the meaning of life and death across the lifespan of the extraordinary person, Viktor E. Frankl (1905-1997). Frankl was purposively sampled due to his international acclaim as an Austrian neurologist and psychiatrist, who later became famous as a holocaust survivor and the founder of logotherapy. Through his approach of "healing through meaning," he became the founder of the meaning-centred school of psychotherapy and published many books on existential and humanistic psychology. The study describes the meaning of life and death through two theoretical approaches: the archetypal analysis based on C.G. Jung's and C.S. Pearson's work and a terror management approach based on the melancholic existentialist work of Ernest Becker. The methodology of psychobiography is used to conduct the psycho-historical analysis of the interplay of archetypes and death annihilation anxiety throughout Frankl's lifespan. The article evaluates how archetypes and death anxiety interacts and how they built meaning in different stages of Frankl's lifespan. The theories are discussed and illustrated in the light of Viktor E. Frankl's life.

Meaning and Wellness: A Comparative Psychobiography on Helen Suzman and Beyers Naudé.

This comparative psychobiographical study provides an in-depth exploration of meaning in the lives of two extraordinary individuals, Helen Suzman and Beyers Naudé. A comparison of the construction of meaning, as an important aspect of wellness within the holistic wellness model, is given for these South African anti-apartheid activists. Suzman (1917-2009) dedicated her career to opposing apartheid policy as a parliamentary politician. Naudé (1915-2004) was a renowned public figure dedicated to social justice in his role as a theologian. The holistic wellness model views the Neo-Adlerian life task of spirituality as crucial to ascribing meaning to life events, acknowledging multiple potential sources of meaning. The differences and similarities pertaining to the domains of meaning-making of these two subjects are explored. The subjects, who differed regarding biographical variables, were found to share a common sense of purpose within the same socio-political milieu. The study findings confirm that commitment to diverse sources of meaning and generativity are central to meaningfulness. This comparative psychobiographical study contributes to the eugraphic exploration of the meaning-making processes of these exemplary individuals.

The Spiritual Wellness of an Intellectual, Novelist, Journalist and Politician: The Meaningful Life of Sol Plaatje.

The study investigates Sol Plaatje's (1876-1932) spiritual wellness across his lifespan. He was purposively sampled due to his impact upon South African society. As an intellectual, novelist, journalist, and politician, Plaatje was also a founder member of the South African Native National Congress, which later became the African National Congress. His life history reflected a significant degree of spiritual wellness, which was uncovered through the systematic analysis of publicly available life-history materials, including primary and secondary sources. The Wheel of Wellness (WoW) model by Sweeney and Witmer was applied to interpret the biographical evidence of spirituality and meaning in his life. Spirituality, as the central life task of the WoW, and regarded as the most influential domain of a healthy individual, incorporates religious beliefs and other individualised aspects of meaning-making. Findings indicate that spirituality characterised Plaatje's childhood years and continued to play a role throughout his adult years. His sense of meaning and purpose was personified in the promotion and preservation of human rights and dignity, which embraced inter-racial respect, compassion, and service to others.

Meaning-Making Narratives Within a Puzzle of Parts: A Psychobiographical Sketch of Sylvia Plath.

This study aimed to unveil Sylvia Plath's (1932-1963) meaning-making narratives, within her life's puzzle of parts, by utilising the Internal Family System (IFS) model of Schwartz. Plath was purposively selected as subject since she has been proclaimed as one of the most renowned and influential voices in 20th century Anglo-American culture and literature. Although she only published one collection of poems, "The Collosus", and one novel, "The Bell Jar", in her lifetime, the plethora of short stories, poems, journal entries and letters which were published after her suicide secured her status as a powerful and creative voice. Methodological strategies utilised to sort and integrate the wealth of publically-available socio-historical data on Plath included the analysis of psychobiographical indicators of salience according to the model of Irving Alexander and the data analysis matrix procedure of Robert Yin. Findings suggest that each stage of Plath's life was characterised by "parts-led" functioning as a result of transferred burdens, imperfect care-taking, existential anxiety and traumatic emotional experiences. This resulted in polarisation of her different parts, which blocked the healing energy of her Self and aggravated feelings of worthlessness, in spite of her creative meaning-making narratives. Since Sylvia used her creative genius to address socio-historical issues and injustices, her life lends itself to meaning-making narratives, especially those that empower and inspire future generations of previously disempowered groups.

Delirium scales: A review of current evidence.

OBJECTIVES: Delirium is a common neuropsychiatric condition with many adverse outcomes in elderly populations including death. Despite this, it is often misdiagnosed and mistreated. A number of scales can be used to detect delirium. We review scales that have been used in delirium studies and report their psychometric properties. METHOD: An extensive MEDLINE database search and subsequent examination of reference lists was conducted to identify the various delirium scales that have been designed, primarily for use in the elderly. RESULTS: Twenty-four scales were identified. Delirium instruments differed according to the classification system they were based on, length of time to administer, the rater and whether they were screening scales or measured symptom severity. The psychometric properties of each scale is reported. CONCLUSION: A large number of scales exist, but not all are properly evaluated in terms of psychometric properties, and there is not unanimity about which scale is the best. However, a small number of scales may be considered already to be robust and useable: the CAM, the DRS, the MDAS and the NEECHAM.

The agriburb: recalling the suburban side of Ontario, California's agricultural colonization.

This essay spotlights the development of Ontario, California, in the last decades of the nineteenth century. It demonstrates that many agricultural communities in California, particularly so-called agricultural colonies, represent a unique rural suburban type labeled here as "agriburbs." Agriburbs, such as Ontario, were communities consciously planned, developed, and promoted based on the drive for profit in emerging agricultural markets. Advertised as the perfect mix of rural and urban, they promised a superior middle-class lifestyle. On the one hand, agriburbs evoked the myths of agrarian security and virtue, a life on a farm in an environment that was good for both soil and soul. On the other hand, agriburbs were ideally urbane but not urban because of their many amenities that represented cultural symbols of modernity, refinement, and progress. An understanding of California's agriburbs deepens an appreciation for both the growth and development of California at the turn of the twentieth century and the diversity of suburban types across the American landscape.

Allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis: a previously unrecognized cause of morbidity.

BACKGROUND: A retrospective study of the clinical, epidemiologic, and virologic features of norovirus gastroenteritis in 12 adult allogeneic hematopoietic stem cell transplant (HSCT) recipients. METHODS: Norovirus infection was diagnosed by reverse-transcriptase polymerase chain reaction. Strains were genotyped by nucleic acid sequence of the most highly conserved region of the norovirus gene encoding the capsid S (shell) domain. RESULTS: Ten of 12 patients presented with vomiting of short duration, but diarrhea was present in all. The median time from onset to norovirus diagnosis was 1 month (range, 0.25-6.0 months). Eleven patients were receiving immunosuppression when norovirus infection was diagnosed: 8 for graft-versus-host disease (GVHD) in an organ other than gut, 1 for previous gut GVHD, and 2 for presumed gut GVHD that proved to be norovirus gastroenteritis. Six patients required enteral or parenteral nutrition for severe weight loss. In 10 patients, diarrhea lasted a median of 3 months (range, 0.5-14 months) and virus was shed at a high level throughout. The remaining 2 patients died after 4 months of diarrhea (one died of unrelated complications, and the other died of malnutrition). The noroviruses found were GII (untyped), GII-3, GII-4, and GII-7 in 1, 1, 9, and 1 patients, respectively. Eleven of the 12 patients had acquired their infection in the community. Phylogenetic analysis of the GII-4 strains demonstrated that all differed. CONCLUSIONS: Noroviruses are a hitherto unsuspected cause of prolonged morbidity and mortality in adults after allogeneic HSCT. The use of reverse-transcriptase polymerase chain reaction to detect high viral load levels in feces distinguishes norovirus gastroenteritis from gut GVHD.

Prolonged anticoagulation therapy adjunctive to aspirin after successful fibrinolysis: from early reduction in reocclusion to improved long-term clinical outcome.

BACKGROUND: Long-term addition of antithrombotics (clopidogrel, anticoagulants) to aspirin has improved outcome after acute coronary syndromes. Data on the impact after fibrinolysis are scarce. In Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis-2 (APRICOT-2), adjunctive moderate-intensity coumarin (median international normalized ratio 2.6) conferred a marked reduction in 3-month reocclusion and ischemic events. Given the association between reocclusion and long-term outcome, we performed long-term clinical follow-up. METHODS: Patients with thrombolysis in myocardial infarction (TIMI) 3 flow <48 hours after fibrinolysis for ST-elevation myocardial infarction were randomized to aspirin plus coumarin, with prolonged heparinization until the target international normalized ratio (2-3) was reached, or aspirin with standard heparinization. Three-month follow-up angiography (reocclusion rates 15% vs 28%) and long-term clinical follow-up (median 7.3 years, interquartile range 5.9-8.6 years) were performed. RESULTS: Patients randomized to adjunctive anticoagulation (n = 123) received coumarin for a median of 280 days (113-387 days). Survival was 94% versus 88% in patients on aspirin alone (n = 128, P = .12). Infarct-free survival was 86% versus 71% (P = .01). Thrombolysis in myocardial infarction bleeding was 4% in both groups. Patients with reocclusion had impaired survival: 80% versus 94% (P < .01). In a multivariable model without reocclusion, combination therapy independently predicted survival (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.13-1.00) and infarct-free survival (HR 0.51, 95% CI 0.28-0.95). When adjusted for reocclusion, combination therapy did not predict outcome. Reocclusion independently predicted death (HR 2.56, 95% CI 1.02-6.43) and reinfarction. CONCLUSIONS: Moderate-intensity oral anticoagulation added to aspirin improved 8-year clinical outcome after successful fibrinolysis. The beneficial effect was largely attributed to a reduction in reocclusion, which independently predicted death and reinfarction. This study provides a mechanistic rationale for prolonged adjunctive anticoagulation after fibrinolysis.

The role of AA sponsors: a pilot study.

AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors. METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors' responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS). RESULTS: Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range 5-28); the median length of sobriety was 11 years (range 4.5-28); the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56). Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1) encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact, emotional support and practical support); and (3) carrying the message of AA (sharing sponsor's personal experience of recovery with sponsees). CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

[Visual recovery as the target for glaucoma]. / Visuelle Regeneration als Ziel für das Glaukom.

BACKGROUND: Visual recovery is an established but poorly studied phenomenon in glaucoma. OBJECTIVE: To provide insights into functional recovery of retinal ganglion cells (RGCs) with a view to providing information on the development of forms of treatment that improve RGC function after injury. METHOD: A model of recoverable RGC function in the mouse eye, induced by short-term elevation of intraocular pressure (IOP). RESULTS: The RGCs manifest near complete functional recovery after a prolonged period of dysfunction following acute IOP elevation. Increasing age and a high fat diet were subsequently found to impair recovery, whereas exercise substantially improved recovery such that older mice recovered in a similar way to young mice. CONCLUSION: Injured RGCs have the capacity to restore function after periods of functional impairment. Therapies that specifically target injured RGCs and enhance their capacity to recover function may provide a new approach for treating glaucoma.

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure.

BACKGROUND: Using the newer lower limit of normal criterion instead of the conventional cutoff values to define pulmonary function abnormalities may result in different predictors of pulmonary function impairment in patients with heart failure. Therefore, we assessed predictors of pulmonary function impairment in subjects with chronic heart failure according to the lower limit of normal in comparison with conventional cutoff values. METHODS: In this prospective cross-sectional study, 164 chronic heart failure subjects (age 68 ± 10 y, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction <40% underwent pulmonary function tests. Predictors of pulmonary function impairment were assessed using the lower limit of normal and conventional cutoff values (ie, 80% predicted value and the fixed ratio of FEV1/FVC <0.7). RESULTS: The lower limit of normal criterion identified an extra independent predictor of diffusion impairment compared with the 80% predicted value; in addition to body mass index, pack-years, and alveolar volume, female sex also turned out to be an independent predictor. A smoking history of ≥10 pack-years was a significant predictor of diffusion impairment and airway obstruction using the lower limit of normal criterion but not using the conventional cutoff values. However, lowering the cutoff points of conventional criteria to match the more stringent lower limit of normal and thus avoid overdiagnosis of diffusion impairment and airway obstruction in the elderly produced similar results as the lower limit of normal. CONCLUSIONS: The lower limit of normal identifies more predictors of diffusion impairment and airway obstruction compared with conventional cutoff values in subjects with chronic heart failure with left ventricular systolic dysfunction. However, lowering the conventional cutoff points yielded similar results as the lower limit of normal. (ClinicalTrials.gov registration NCT01429376.).

Aspirin plus coumarin versus aspirin alone in the prevention of reocclusion after fibrinolysis for acute myocardial infarction: results of the Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis (APRICOT)-2 Trial.

BACKGROUND: Despite the use of aspirin, reocclusion of the infarct-related artery occurs in approximately 30% of patients within the first year after successful fibrinolysis, with impaired clinical outcome. This study sought to assess the impact of a prolonged anticoagulation regimen as adjunctive to aspirin in the prevention of reocclusion and recurrent ischemic events after fibrinolysis for ST-elevation myocardial infarction. METHODS AND RESULTS: At coronary angiography <48 hours after fibrinolytic therapy, 308 patients receiving aspirin and intravenous heparin had a patent infarct-related artery (Thrombolysis In Myocardial Infarction [TIMI] grade 3 flow). They were randomly assigned to standard heparinization and continuation of aspirin alone or to a 3-month combination of aspirin with moderate-intensity coumarin, including continued heparinization until a target international normalized ratio (INR) of 2.0 to 3.0. Angiographic and clinical follow-up were assessed at 3 months. Median INR was 2.6 (25 to 75th percentiles 2.1 to 3.1). Reocclusion (< or =TIMI grade 2 flow) was observed in 15% of patients receiving aspirin and coumarin compared with 28% in those receiving aspirin alone (relative risk [RR], 0.55; 95% CI 0.33 to 0.90; P<0.02). TIMI grade 0 to 1 flow rates were 9% and 20%, respectively (RR, 0.46; 95% CI, 0.24 to 0.89; P<0.02). Survival rates free from reinfarction and revascularization were 86% and 66%, respectively (P<0.01). Bleeding (TIMI major and minor) was infrequent: 5% versus 3% (P=NS). CONCLUSIONS: As adjunctive to aspirin, a 3-month-regimen of moderate-intensity coumarin, including heparinization until the target INR is reached, markedly reduces reocclusion and recurrent events after successful fibrinolysis. This conceptual study provides a mechanistic rationale to further investigate the role of prolonged anticoagulation after fibrinolytic therapy.

Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status.

OBJECTIVE: To examine patterns and factors that correlate with unprotected anal intercourse (UAI) practices among San Francisco gay men, including UAI with partners of unknown or different HIV antibody status. DESIGN: A longitudinal cohort recruited for the San Francisco Young Men's Health Study in 1992; re-assessed annually. PARTICIPANTS AND METHODS: A sample of 510 unmarried gay men who were 18 to 29 years at baseline were originally recruited as part of a larger population and referral-based sample. Subjects participated in four consecutive waves of data collection. RESULTS: The prevalence of reported unprotected anal intercourse (UAI) increased from 37% to 50% between 1993-1994 and 1996-1997. Almost half of all men who reported UAI in 1996-1997 indicated that it occurred with a partner of unknown or discordant HIV antibody status. This high-risk practice correlated with greater numbers of male sex partners, use of nitrite inhalants, sex in commercial sex environments, perceived difficulty controlling sexual risk-taking, and negative emotional reactions following UAI. CONCLUSIONS: These data on increasing rates of sexual risk-taking further confirm trends in sexual behavior previously suggested by rising rates of rectal gonorrhea in this population. Additional and sustained prevention efforts are urgently needed in light of the very high background rates of HIV infection found among gay men in San Francisco.

Fractional efflux and net change in cellular cholesterol content mediated by sera from mice expressing both human apolipoprotein AI and human lecithin:cholesterol acyltransferase genes.

Human lecithin:cholesterol acyltransferase (LCAT) is a key enzyme in the metabolism of cholesterol and is postulated to participate in the physiological process called reverse cholesterol transport. We have used transgenic mice (Tgm) expressing either both human apolipoprotein AI (apo AI) and human LCAT genes or only the human apo AI gene (HuAILCAT or HuAI Tgm, respectively) to assess the consequences of LCAT overexpression on serum lipid and lipoprotein profiles and on the ability of each serum to promote bidirectional flux of cholesterol between serum and Fu5AH hepatoma cells. Mean serum LCAT activity of HuAILCAT Tgm was 2-fold increased compared to the HuAI group (48+/-9 vs. 24+/-5 nmol/ml per h, P<0.01 for HuAILCAT and HuAI Tgm, respectively) and the cholesterol esterification rates were not significantly different between the two groups of animals (66+/-11 vs. 74+/-18 nmol/ml per h for HuAILCAT and HuAI Tgm, respectively). HuAILCAT Tgm exhibited higher total cholesterol serum values (2.3-fold) due to an increase in both HDL-cholesterol (1. 9-fold) and non-HDL-cholesterol (3-fold). The HDL particles from HuAILCAT Tgm were relatively phospholipid depleted and cholesterol enriched compared to HuAI mice. When cells were incubated for six hours with the mouse serum, the fractional efflux of radiolabeled cholesterol was slightly increased with the HuAILCAT Tgm (1.2-fold) but the increase in intracellular cholesterol content was also 2-fold higher than with the HuAI Tgm. Fu5AH can be viewed as a model for the evaluation of bidirectional flux of cholesterol in SR-BI-rich cells. In this model LCAT overexpression in mice, by increasing both HDL and non-HDL-cholesterol, mostly enhances the uptake of cholesterol by the cells, which would be of benefit for the last step of reverse cholesterol transport in hepatocytes.

Biocompatibility assessment: application of fluorescent probe response (FPR) technique.

An in vitro test procedure capable of discriminating effectively between intact and membrane-damaged cells has been developed. This procedure utilizes fluorescein diacetate and ethidium bromide as fluorescent probes. The properties of the probes and the collapse in the selective cytoplasmic membrane permeability barrier of the damaged cells ensure the principal feature of the test procedure, that functional cells fluoresce bright green, but membrane-damaged cells fluoresce bright red. Investigations with natural rubber, silicone and acrylic polymers confirmed the suitability of the procedure to distinguish between materials on the basis of cytotoxicity.

Correlates of sexual risk-taking among gay male substance abusers.

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.