Thursday, June 18, 2009

Rape and HIV in South Africa

The title links to a Globe & Mail overview of a very disturbing recent report about sexual assault in South Africa. The original report is here.

Some 27% of randomly sampled men report at least one rape lifetime, and almost 5% report a rape within the past year. Many - but certainly not all - rapes were within a relationship.

Some 3% of men reported an MSM rape, and 10% of respondents reported that they themselves had been victim of an MSM rape.

The authors describe this phenomenon in terms of a culture of violence and sexual entitlement among South African men, as well as in terms of potentially abusive personal histories among men who rape.

As usual, HIV infection co-occurs with those who are most risky, seemingly a universal problem: who are physically violent towards women are twice as likely to be HIV-positive. They are also more likely to pay for sex and to not use condoms.

Any woman raped by a man over the age of 25 has a one in four chance of her attacker being HIV-positive.

There is also a methodological note: they used PDAs and in the field to collect the data anonymously, which seems to have worked in lessening social desirability responding (!). They also used finger-sticks to create dry samples to test for HIV, which they analyzed later (leaving the men anonymous but not informing them of their HIV status).

A dramatic example of the hard barrier culture can represent.

Friday, June 5, 2009

Can Moral identity tell us about cognitive escape and health risk?

…affirming a moral identity leads people to feel licensed to act immorally. However, when moral identity is threatened, moral behavior is a means to regain some lost self-worth.

Sachdeva, S., Iliev, R., & Medin, D. L. (2009). Sinning Saints and Saintly Sinners: The Paradox of Moral Self-Regulation. [Article]. Psychological Science, 20(4), 523-528. Link here

In our quest to understand why people behave badly we have examined several theoretical frames, most of which concern "personality" or "drive" -like constructs. So, a few weeks ago I posted a paper on self-control versus impulsive "systems" (that we never got to discuss in lab). That "dual-systems" paper takes adopts a quasi-drive model, to suggest that overt behavior represents a compromise between two incompatible motivations. The relative strength of self-control versus impulse drives controls how well we self-regulate our sexual, dietary or other appetites.

Similarly, the "self-regulation as a muscle" view has it that self-regulatory action is a limited resource that literally gets fatigued as it is expended. In this view we self-regulate as much as we are able – since we really do want to be healthy and regulated – but at some point we just get tired.

Moving away from drive or capacity models toward a more cognitive view invokes an escape perspective. This may better characterize our participants' struggles in resisting unsafe sex, drug use, or other highly tempting behaviors. Here the conflict is not so much between regulatory versus impulse drives, but between our self-perception as a healthy / good / in-control person, versus our temptation to do those bad things that we really desire.

This view may articulate with older cognitive consistency models from social psychology. These views – best articulated in Leon Festinger's theory of cognitive dissonance – assume that we want to have a positive self-perception, and that to do so we must view our behaviors as being consistent with our values. If I both value smartness and think I am smart, but see myself doing something patently stupid, I may blame that behavior on someone else (I was talked into it!!) so as to maintain my positive self-perception. Similarly B.B. King's excuse for cheating: "…honey, you know it don't count if I was high." ("How Blues can you get").

Sachdeva et al. (2009) present an interesting variation on this theme in terms of moral behavior. When participants are primed to think of themselves in positive, moral terms, they are less likely to actually show moral behavior (contribute to a charity, recycle) than if they have no prime. Alternately, those primed with a threat to their self-worth end up showing more altruistic behavior.

The common denominator is that people have a sort of "set point" for self-worth. If they are given a "surplus" of self-worth (by being asked to recall a string of positive self-descriptions) they have self-worth to burn, and are therefore licensed to be self-centered for a while. In contrast, if their self-worth is threatened they are in deficit. They can restore the balance by doing something nice to prove to themselves that they are good after all.

This reflects a common problem noted in the environmental behavior literature. People will engage in some trivial environmental behavior – buying a carbon offset – and use it to rationalize a larger environmental sin (unnecessary flights, driving instead of walking, etc.) The person's self-worth (or even sense of moral superiority) remains intact by doing a little good to offset a larger bad.

Is this a variation on cognitive escape? How much to people rationalize their problem behaviors not by literally escaping (e.g., via drug use, sensation seeking, etc.), but by maintaining their self-worth via this "offsetting" or "licensing" behavior.

If I have been "good" for a week can I get high and have unsafe sex on Saturday? Have I "earned" that, despite my knowledge that such rationalizations are medical nonsense? Does this only apply if my "moral set point" is relatively high? – what if I just view myself as a loser?

This view may lend itself to intervention applications. We assume that one antidote to escape motivation is self-awareness – getting people to actually see what they are doing when they, e.g., use drugs to escape or regulate affect. Might behavioral interventions also include explicit cognitive dissonance exercises?


Tuesday, June 2, 2009

Chiago AIDS surveillance data bleak: Young AAMSM

All --

CDPH HIV/AIDS surveillance data to be released soon shows a bleak picture for the MSM community generally, and younger African-American men specifically. To quote:

A first-of-its-kind study looking at HIV infection rates found that half of gay men in Chicago who have HIV did not know they were infected, and two-thirds of infected black men were unaware. In addition, infection rates for black men were more than twice the rates for whites and Hispanics.

An overview of the findings is in the Chi-Town News here. These data are very similar to those published by the CDC a number of years ago - and even look worse than some of the national data. In particular, 50% of all HIV+ gay men being "HIV unaware" is shocking; those were the figures for the most at-risk men in previous years!!

One implication of these findings is that the men we studied in MIX are unusual. Only 8% of them had not been tested recently, suggesting that very high risk, drug-using men actually are getting their results. It may be a more moderate risk, less conspicuous group who are not getting tested but are risky enough to get infected. Of course these men - who may assume themselves to be HIV-negative - may be the core intervention target.

This really calls for us to get the clinical data from MIX to see how many ostensibly HIV-negative men were actually infected.

All the more reason for us to get funded for YMCA!