Researchers exploring unsafe sex practices in the HIV positive interviewed 125 men and 58 women infected with the virus. Both homosexual and heterosexual participants from multiple races completed a demographic questionnaire that promised anonymity. The questionnaire, using seven point self rating scales, explored sexual practices and beliefs about condoms, substance abuse, as well as deception about their HIV status, personal attributes of impulsivity and thrill-seeking. Just over 60 percent of all of the group, all homosexual and heterosexual males, and all women, were sexually active. Over half of this group reported occasional unprotected sex. There was no difference in condom use between those living with someone or living alone, or monogamous vs. non-monogamous participants. Heterosexual men were the group most likely to always use condoms. Non-monogamous sex had a direct relationship to impulsivity, substance abuse, and deception. The authors provide a statistical interpretation that, "Mediated by a sense of self-efficacy, their [those practicing unsafe sexual behavior] intentions to use condoms and their self-reported actual condom use are affected by whether they personally expect positive or negative consequences from using condoms and whether they believe that their sex partners and friends approve of condom use." The authors then advise that "physicians could play a critical role in slowing the spread of new infections by routinely involving psychologists in the treatment of these patients."
Physicians, including psychiatric physicians, have a much larger role in the prevention of HIV infection than routinely referring to psychologists. For example, they need to take the time to develop a trusting and non-judgmental relationship with their patients so that risk-taking behavior can be identified and a plan for successful intervention developed.
HIV-positive individuals who knowingly expose others to infection through unsafe sex may do so for a variety of reasons, from inappropriate expressions of anger at their own infection to psychotic activity having to do with a delusional system resulting from the AIDS virus. The authors' recognition that "risky sexual behavior may be the manifestation of a more general pattern of risk-taking that emerges from personality dispositions," begs the question of how likely such a risk-taker will be to voluntarily seek out psychotherapy in order to have this behavior changed. These individuals could benefit from psychiatric assessment and treatment, which may need to be a requirement at the time of sentencing.
A safer bet is to see that everything possible is done to educate the risk-taker's potential partners so that they can insist upon responsible sexual behavior thereby stemming the spread of HIV transmission.
Wulfert et. al. (1999). Cognitive. Behavioral, and personality Correlates of HIV-Positive Persons' Unsafe Sexual Behavior... Journal of Applied Social Psychology, 1999, 29:2, pp. 223-244.
