What's Impulsivity Got to Do with It? Exploring the Association Between Delay Discounting and Risky Sexual Behavior in Men Who Have Sex with Men Open Access

Jones, Jeb Stuart (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/qv33rx39r?locale=en


Men who have sex with men (MSM) experience the highest number of new diagnoses of human immunodeficiency virus (HIV) each year in the United States despite comprising approximately 2% of the population. Additional interventions are needed to increase condom use to reduce HIV transmission in this key group. Delay discounting is a measure of impulsivity that might be related to sexual risk-taking. Delay discounting has the potential to serve as an indicator of risk and as a target for behavioral HIV risk-reduction interventions. We conducted three studies to illustrate the possible role of delay discounting in HIV risk among MSM. In the first study, we examined the association between monetary and sexual discounting in an online sample of MSM in the United States. Monetary discounting suffers from less social desirability bias compared to measures of sexual delay discounting and, therefore, might provide a more reliable proxy measure of sexual risk. Among 1,012 MSM we did not observe an association between sexual and monetary discounting. In the second study, we used the same online sample of MSM to examine the association between sexual and monetary discounting and condomless anal intercourse (CAI) in the past 12 months. We did not observe an association between monetary discounting and CAI; however, we did observe a robust association between sexual discounting and CAI. This suggests that men who discount condom-protected sex are more likely to engage in sex without a condom and that monetary discounting would not be a good proxy measure for sexual risk-taking. In the third study, we used an agent-based model to estimate the potential impact of a delay-discounting intervention on population-level incidence of HIV. Depending on the assumptions that were used in the model, we show that 4-14% of infections could be averted over a ten-year period. These findings suggest that sexual, but not monetary, delay discounting is associated with sexual risk-taking among MSM and that an intervention targeting delay discounting could result in meaningful decreases in HIV incidence. Future cohort studies should assess the longitudinal relationship between delay discounting and CAI and explore strate gies for discounting-based risk-reduction interventions.

Table of Contents

Chapter 1: Background and Significance. 1

Chapter 2: Assessing the concordance between monetary and sexual delay discounting in an online study of men who have sex with men. 18

Chapter 3: Assessing the association between monetary and sexual delay discounting and risky sexual behavior in an online sample of men who have sex with men. 40

Chapter 4: Estimating the Potential Impact of a Delay Discounting Intervention to Reduce HIV Transmission Using Agent-Based Modeling. 65

Chapter 5: Conclusions and Public Health Implications. 86

References. 97

Appendix A. Survey. 120

Appendix B. Components of a network model of a delay discounting intervention for MSM. 170

Appendix C. Key parameters in a network model of a delay discounting intervention for MSM. 171

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