High-Risl< Sexual Behavior Interventions with Vulnerable Populations PREVENTION IN PRACTICE LIBRARY SERIES EDITOR Thomas P. Gullotta Child and Family Agency, New London, Connecticut ADVISORY BOARD George W. Albee, University of Vermont Evvie Becker, University of Connecticut Martin Bloom, University of Connecticut Emory Cowen, University of Rochester Roger Weissberg, University of Illinois Joseph Zins, University of Cindnnatl HIGH-RISK SEXUAL BEHAVIOR: Interventions with Vulnerable Populations Ewle Becker, Elizabeth Rankin, and Annette U. Rickel REDUCING THE RISKS FOR SUBSTANCE ABUSE: A Lifespan Approach Raymond P. Daugherty and Carl Leukefeld SUCCESSFUL AGING: Strategies for Healthy Living Waldo C. Klein and MartIn Bloom TYPE A BEHAVIOR: ITS DIAGNOSIS AND TREATMENT Meyer Friedman High-Risl< Sexual Behavior Interventions with Vulnerable Populations Ewie Becker Elizabeth Rankin University of Connecticut Storrs, Connecticut and Annette U. Rickel Georgetown University Medical Center Washington, D.C. Springer Science+ Business Media, LLC Library of Congress Cataloging-in-Publication Data On file ISBN 978-0-306-45858-3 ISBN 978-1-4899-0107-1 (eBook) DOI 10.1007/978-1-4899-0107-1 © 1998 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1998 10987654321 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface In this volume, we describe how sexual behavior puts individuals at risk for a myriad of negative consequences, from sexually transmitted diseases, such as AIDS, to unwanted pregnancy. The consequences of these adverse outcomes for society as a whole are enormous, including the fiscal burden of health care costs, as well as the vicious cycle put in motion by teen pregnancy, lack of education, poverty, and the intergenerational transmission of this downward spiral. Specific inter ventions are described in each chapter, with attention to the needs of especially vulnerable populations. In Chapter I, the relationship between high-risk sexual behavior and its potential negative consequences is described. Specifically, various sexually transmitted diseases (STDs) are discussed, including HIV infection and AIDS, as well as less life-threatening but still dangerous STDs such as chlamydia, gonorrhea, and genital herpes. Teen pregnancy is examined in light of the cycle created by lack of opportunity, lack of education, and poverty. Consequences of un wanted pregnancy beyond the teen years are also noted, including the risks of child maltreatment for unwanted children. In the second chapter, we describe some of the mediators and moderators of high-risk sexual behavior, including psychological fac tors, use of alcohol and other drugs, risk awareness, poverty, and a history of childhood maltreatment. Models of prevention are discussed in Chapter 3, including gen eral theoretical models of how humans change behavior, as well as specific models for changing high-risk sexual behavior. Tests of these models, along with specific prevention programs, are described. v vi Preface Chapter 4 reviews the literature on ethnicity and social class considerations related to high-risk sexual behavior. Guidelines are suggested based on current research findings related to ethnic differ ences and socioeconomic factors. Alcohol and other drug use is also discussed in this context. In Chapter 5, women's unique risks are discussed. Partner intimi dation and/or violence, alcohol and other drug use, rape, history of abuse in childhood, psychological consequences of abortion, risk from partner's injected drug use, and transmission of HIV from mother to child are among the issues addressed. Chapter 6 describes guidelines for intervention with gay men, outlining findings of research and prevention efforts with the gay community, as well as intervention and treatment of gay men with AIDS and their partners. Issues of grief and loss in the gay community are also addressed. In writing this volume, we envisioned a world where prevention of sexual risk is the norm, and individuals make choices that enhance their lives and the lives of those with whom they are intimate. Like B.F. Skinner, we imagine a world where all individuals "are adequately clothed, fed, cared for, respected, able to make important choices, able to grow, able to learn, and able to love" (Biglan, 1993, p. 4). We are committed to finding ways to create such a world. This work is dedicated to that vision. Evvie Becker Elizabeth Rankin Annette Rickel Acknowledgments We would like to give special thanks to our research assistants, Jennifer Ganter and Manuel Morales, for their excellent support. We would also like to express our appreciation to the Department of Psychology at the University of Connecticut for providing us with the resources and support to complete this work. Finally, we are especially grateful to our series editor, Tom Gullotta, for his thorough reading of the manuscript and his perceptive comments, and to Mariclaire Clou tier of Plenum Press, for her editorial expertise in completing this project. vii Contents Chapter 1. What's at Stake: Consequences of Risky Sexual Behavior ................................... . Chapter 2. Factors that Influence Sexual Behavior: Causes, Mediators, and Moderators of High-Risk Sexual Behavior .................................... 31 Chapter 3. Models of Prevention . . . . . . . . . . . . . . . . . . . . . . . . .. 51 Chapter 4. Guidelines for Prevention, I: Ethnicity and Social Class Considerations .......................... 79 Chapter 5. Guidelines for Intervention, II: Women ........... 101 Chapter 6. Guidelines for Intervention, III: Gay Men and Bisexuals .................................... 121 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 143 References ............................................ 145 Index ................................................. 163 ix High-Risl< Sexual Behavior Interventions with Vulnerable Populations