M IDDLE EAST TECHNICAL UNIVERSITY

1. MIDDLE EAST TECHNICAL UNIVERSITY Health Locus of Control and Coping Styles as Predictors of HIV-Related Risky Sexual Behavior among Turkish Gay Population Özlem BOZO, Ph.D.,Onur BASAT, Emine OKUR Middle East Technical University,Psychology Department, Ankara TÜRKİYE • Abstract The aim of the present study is to investigate the impact of coping styles, health locus of control, and self- reported frequency of unprotected anal intercourse (UAI) on HIV/AIDS risk behavior engagement among Turkish men who have sex with men (MSM). The data was collected from 80 participants from KAOS GL and Lambda Istanbul organizations working for the empowerment of gay, lesbian, bisexual, and transgender community. The questionnaire set included a socio-demographic information form and three self-report questionnaires: Health Locus of Control Scale (HLOC), Ways of Coping Inventory (WCI), and an index measuring the frequency of UAI with a casual or steady partner in the last three months. The results were: (1) participants who had external locus of control engaged in more UAI than participants who had internal locus of control, (2) participants who used problem focused coping strategies engaged in lower UAI than the ones who use emotion focused coping strategies, and (3) participants with steady partners engaged in more UAI than the individuals with casual partners. Theoretical and practical implications of the findings were discussed. • According to the correlational analyses, it was found that the participants who can express their sexual orientation more freely, have higher educational level; and interestingly, have less knowledge about STD. It can be proposed that the participants having much knowledge about STD might refrain from expressing their sexual orientation because of the probability of being stigmatized as a risk person for STD. • Participants using problem focused coping strategies reported less frequent UAI, emotion focused coping strategies failed to predict more frequent UAI. • Higher scores in external health locus of control predicted more UAI, yet no such prediction is viable for internal health locus of control. • Participants who have a steady partner reported more frequent UAI than the ones having a casual partner. • Individuals holding the belief that factors beyond his control could be dominant over health related issues may perceive the potential threats as inevitable and may be acting as if they have no control over them. • Individuals may be perceiving the protective behaviors as a threat to their intimacy, or a situation that verifies a possible polygamy rather than perceiving it as a threat to their health. • Limitations • The serostatus of the participants, being HIV positive or not, was not questioned in the study, which is an important indicator of condom use or which can have a dramatic effect on the ways of coping. • There was only one item to assess the frequency of UAI, culminating with less reliable information for UAI. • The sample size was small and the data was collected from participants who are the members of KAOS GL Ankara and Lambda İstanbul, eventuating in an insufficient number of participants and unrepresentative sample of gay population in Turkey. • Health locus of control scale is still global for this study examining the HIV-related risky sexual behavior. • It is possible that the particiants gave socially desirable answers to items regarding the condom usage to eliminate the biased judgments about themselves. • Introduction • According to UNAIDS/WHO 2006 Epidemic update, there are 39.5 million people living with HIV with an increase of 14.000 people in every day. • Defined as a risk group, men who have sex with men (MSM), accounting for 70% of all reported HIV infections among male adults and adolescents is an important issue of interest for HIV infection and AIDS (Center for Disease Control, 2004). • Not using a condom during anal sex is a significant threat to the sexual health of MSM and this emphasizes the importance of focusing on prevention efforts by adopting safe sex practices on those who are living with HIV (CDC, 2006) • Coping strategy, defined as the use of thoughts and actions to manage the stressful situations and negative emotions related to stress (Folkman & Lazarus, 1985) may be one of the factors predicting UAI. • Emotion focus coping can be defined as attempting to regulate the negative emotions that occur as a result of stressful conditions. • Problem focused coping is the overt behavioral efforts to alter or to control the problem (Folkman & Lazarus, 1985). • Klein and Knauper (2003) stated that cognitive avoidance of sexually transmitted infection thoughts was associated with less consistent condom use. • Another recognized factor that may predict engaging in UAI is the locus of control which refers to the degree to which individuals feel that outcomes are caused by their own inputs (internal) or outside forces (external) (Rotter, 1966). • Fisher and Misovich (1990) found that gay men with a high internal locus of control, who feel that outcomes are caused by their own inputs, were more likely to practice safer sex behavior than externals, who feel that outcomes are caused byoutside forces. • The hypotheses of the current study are: • Participants who had external locus of control would engage in more UAI than participants who had internal locus of control, • Participants who used emotion focused coping strategies would have more UAI than the ones who use problem focused coping strategies, • Participants having steady partners would engaged in more UAI than the participants who have casual partners. • Measures • The Questionnaire set included an informed consent, Ways of Coping Inventory (WCI), Multidimensional Health Locus ofControl Scale (MHLC), and an index measuring the frequency of UAI with a casual or steady partner in the last three months. • Procedure • A total of 100 questionnaires were given to the voluntary homosexual men and 80 (80 %) of them were returned. • Multiple regression analysis was used to find out the effects of predictor variables, which are locus of control (internal, external), coping style (problem focused, emotion focused) on criterion variable which is engaging in unprotected anal intercourse (UAI). • Independent samples T-test was performed to measure the difference between relationship status (steady partner, casual partner) for the same criterion variable. 23 6 • Results • Bivariate correlational analysis was performed for some specific background variables, namely educational background, SES, knowledge about STDs, and the expression of sexual orientation. • Expression of sexual orientation was significantly correlated with both education level and knowledge about STDs at p < .01 level. • Multiple regression analysis was used to test whether health locus of control (internal health locus of control, external health locus of control) and coping style (problem focused coping, emotion focused coping) predicted the dependent variable, engaging in risky sexual behavior. • Scoring high in external health locus of control significantly predicted risky sexual behavior in a positive direction (ß= .421, p < .001), indicating that individuals high in external locus of control engaged in risky sexual behaviors more frequently. • Problem focused coping predicted risky sexual behavior negatively (ß= -.562, p < .001), indicating that individuals high in problem focused coping engaged in risky sexual behaviors less frequently. • A final analysis was performed to measure the difference between the individuals having steady partners and the individuals having one night stands in terms of engagement in UAI. • Individuals having a steady relationship engaged in UAI more frequently than the individuals having one night stands and having unprotected sexual intercourse, t(31) = 7.121, p < .001. . References Bennett, P., & Bozionelos, G. (2000). The theory of planned behaviour as predictor of condom use: A narrative review. Health & Medicine, 5, 307-326. Burns, M. J., & Dillon, F. R. (2005). AIDS health locus of control, self-efficacy forsafer sexual practices, and future time orientation as predictors of condom use inafrican american college students. Journal of Black Psychology, 31, 172-188. Browes, S. (2006). Health psychology and sexual health assessment. Nursing Standard, 21, 31-39. CDC. (2006). HIV/AIDS among men who have sex with men. Retreived December 12, 2006, from Center for Disease Control and Prevention Web site: www.cdc.gov/hiv/topics/msm/resources/factsheets/ msm.htm. Hoyt, M. A., Nemeroff, C. J., Huebner, D. M. (2006). The effects of HIV-related thought suppression on risk behavior: Cognitive escape in men who have sex with men. Health Psychology, 25, 455–461. Martin, J. I., Pryce, J. G., & Leeper, J. D. (2005). Avoidance coping and HIV riskbehavior among gay men. Heath & Social Work, 30, 193-201. Peterson, J. L., & Bakeman, R. (2006). Impact of beliefs about HIV treatment and peer condom norms on risky sexual behavior among gay and bisexual men. Journal of Community Psychology, 34, 37– 46. • Method • Participants • 80 Turkish gay men (mean age = 26.6, SD = 5.16, range = 20-45) from İstanbul and Ankara. • The subjects were contacted via the organizations KAOS GL and Lambda İstanbul that work for the empowerment of gay, lesbian, bisexual and transgender community. • 75% had at least university education, 22.5% had a high school, and 2.5% had a primary school degree. • 96.3% of the participants were single, the rest were married (2.5 %) and divorced (1.3 %). • Discussion • The data and analyses provided partial support for the suggested predictors of UAI: external locus of control and problem focused coping strategies predicted the UAI. In terms of self-reported frequency of UAI, there was also a significant difference between the participants with casual partners and with steady partners found.