A single session of focused cognitive counselling may be able to reduce rates of unprotected sex amongst gay men with compulsive sexual behaviour, according to a study published in the May 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Sexually compulsive behaviour is a term used to describe out of control sexual behaviour which has become preoccupying and interferes with relationships or work. Compulsive sexual behaviour has been associated with a high risk of infection with HIV.
Treatment for gay men with compulsive sexual behaviour consists of group psychotherapy or the use of SSRI antidepressants.
In a study involving 336 individuals, investigators in San Francisco recently demonstrated that a single session of cognitive therapy can produce a swift and sustained reduction in HIV risk behaviour amongst gay men who have multiple HIV tests. They wished to see if this therapy helped rates of unprotected sex with casual partners that potentially involved a risk of HIV transmission amongst men with compulsive sexual behaviour.
The therapy involves an individual providing a detailed account of a recent episode of unprotected anal sex with a casual partner who was either HIV-positive or of unknown HIV infection status. During this they examined the thoughts, attitudes and beliefs involved in the decision to engage in unprotected sex.
Sex compulsion was assessed using the Kalichman Sexual Compulsivity Scale. This has ten items and is on a four-point scale. Individuals’ sexual compulsivity is classified from low to high in quartiles. A score above 2.2 is in the highest quartile and is classified as highly sexually compulsive. The men were followed up twelve months later.
Men with the least compulsive sexual behaviour has a 16% (p = 0.06) reduction in their risky sexual behaviour after the single cognitive counselling session. But men in the next two quartiles showed a 20% and 6% increase (both p = 0.06) increase in reported unprotected anal sex with men who were HIV-positive or of unknown infection status. The authors do not comment on this trend.
Men with the most compulsive behaviour, however, had a 48% (p = 0.06) reduction in the rate of reported unprotected sex with men who were HIV-positive or of unknown HIV status.
The investigators write, “this decrease in unprotected anal intercourse, although not at the traditional level of statistical significance, still raises the possibility that this cognitively based counseling approach may have been of use to the men rated as the most sexually compulsive in gaining some control over their sexual impulses…this preliminary finding suggests that further research in this area is warranted.”
Dilley JW et al. Sexual compulsiveness and change in unprotected anal intercourse. Unexpected results from a randomized controlled HIV counseling intervention study. J Acquir Immune Defic Syndr 48: 113 – 114, 2008.