SEX CORE MEMORIES

1
SEX CORE MEMORIES

• Heino F. L. Meyer-Bahlburg
• NYSPI Dept. Psychiatry, Columbia University
• Looking Back, Looking Forward. HIV-Center 03-27-08

2
AIDS Knowledge 1986-87

• An Immune Deficiency Syndrome,
• Acquired by
• Sex
• Risk groups especially gay men, Haitians, women
  partners of high-risk men
• Risk practices
• In gay men, receptive anal sex
• In heterosexual sex, peno-vaginal sex
• In both homo-and heterosexual sex, lifetime
  number of partners
• Intravenous drug use
• Blood transfusion
• Neither an effective treatment nor a vaccine
  available, i.e., prevention crucial
• After a varied course, fatal outcome

3
Behavioral Studies Needed in 1986

• Natural history studies of the disease and its
  impact on diverse domains of psychological
  functioning including sex activity and function
• Determinants studies focused on predictors of
  HIV-risk behavior, especially risky sex, risky
  substance use, to flesh out theoretical models of
  sex-risk behavior
• Preventive interventions focused on HIV-risk
  behaviors (especially risky sex, risky substance
  use) and their underlying factors

4
Sexology at CPMC 1986-87

• No sex-dysfunction clinic, but individual
  clinicians who included sex therapy in their
  practice
• Transsexual program closed down
• Sexuality teaching at the medical school reduced
• Sex-Behavior Clinic (focused on sex offenders,
  paraphilias)
• Child abuse program in pediatrics
• Program of Developmental Psychoendocrinology in
  Child Psychiatry, including intersex, prenatal
  sex-hormone exposure, precocious puberty, GID
  (plus past experience in other areas of clinical
  sexology)

5
Sex-Research Needs in 1987

• Psychiatry in general and most researchers at
  NYSPI/CPMC in particular had little familiarity
  with clinical or research sexology
• Discomfort with sexuality and gender issues was
  common (and seemed enhanced with AIDS)
• Little was available in terms of standardized
  assessments of sexual risk behavior

6
Concerns About Sexual Assessment in Psychiatry,
IRBs, Congress, etc.

• Will interviews about sexuality exacerbate severe
  mental illness?
• Will sex-research interviewing activate sexual
  behavior in
• Psychiatric inpatients
• Prison inmates
• Children and adolescents
• Will sex-research interviewing (and sex-risk
  counseling) condone or promote immoral or
  illegal sex such as
• Extramarital sex
• Homosexuality
• Prostitution
• What are the risks to sex interviewees from
  disclosing tabooed, banned, or illegal
  activities?

7
Needed Core

• Thus, the HIV Center would need to include among
  its methodological Cores one that would address
  all of these sexuality-related issues and
  concerns. The decision was to set up a
  Psychosexual Assessment Core, aka Sex Core.

8
Psychosexual Assessment Core 1987 Expertise

• Anke Ehrhardt Heino Meyer-Bahlburg
• Intersex, child sexual abuse, GID-C, GID-A,
  sexual dysfunctions development of systematic
  assessment methods, e.g., the SEBAS-A.
• Judith Becker
• Sex dysfunctions, sex offenders
• John L. Martin
• MSM
• Martha Calderwood Rhoda Gruen
• Sex education and sex research interviewing

9
Psychosexual Assessment Core 1987-92 Structure
and Members (1)

• PI Heino F. L. Meyer-Bahlburg, Dr. rer. nat.
• Co-PI Anke A. Ehrhardt, Ph.D.
• Co-PI Judith V. Becker, Ph.D.
• Core Advisor John L. Martin, Ph.D., M.P.H.
• Co-I? Co-PI Theresa Exner, Ph.D.
• Sex Interviewing Training
• Martha Calderwood, M.A.
• Rhoda Gruen, M.A.
• Data Analysis
• Thomas Yager, Ph.D.
• Gerda Lorenz, Ph.D.
• Cornelia A. Dellenbaugh, M.P.H.
• Curtis Dolezal, Ph.D.

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11
Psychosexual Assessment Core 1987-92Structure
and Members (2)

• Minority Investigator
• Alex Carballo-Dieguez
• Postdocs
• (Jennifer Lish, Ph.D.)
• Richard Pleak, M.D.
• J. Roy Gillis, Ph.D.
• Christiane Noestlinger, Ph.D.
• Secretary
• Dorothy Lewis, M.A.
• Patricia Connolly, B.A.

12
Psychosexual Assessment Core 1987-92Structure
and Members (3)

• Research Assistants
• Jennifer Hay, B.A.
• Gregg Gottehrer, B.A.
• Hayden Kleiner, M.A.
• (Marion Viera)
• Ramani S. Durvasula, B.A.
• Robin Faigeles, B.A.
• Jill Postelnek, B.A.
• Marion Schwartz, B.A.
• Julie Hannibal, B.A.

13
Psychosexual Assessment Core 1987 Functions

• Method development (7 modules)
• Sexual history
• Current sexual activity
• Gender history and status
• AIDS knowledge, beliefs, attitudes
• Effects of AIDS awareness on sexual behavior
• Current sexual dysfunctions
• Psychosexual effects of encephalopathy
• Development of Hispanic versions
• Reliability studies
• Interviewer training
• Interviewer monitoring
• Data analysis
• Information resource

14
SEBAS ? SERBAS

• Emphasis on quantifiable behavior (bean
  counting) and transmission risk
• Partner numbers
• Partner gender
• Partner types
• Main, casual, commercial, etc.
• Sexual practices
• Vaginal, anal, oral, manual, and details
• Drug use with sex
• Safe-sex practices
• Re STI later also re contraception (dual
  protection)

15
Sex Interviewing Techniques

• Influenced by Kinsey / Pomeroy, J. Money, plus
  emerging lit. (e.g., J. Catania)
• Facilitating rapport between interviewer and
  interviewee - where in a battery to place a sex
  interview and sensitive topics within it
• Explaining the purpose of asking for details
  about sex
• Stressing the importance of factual accuracy for
  risk ascertainment
• Defining sexual terms
• Linking terms to vernacular, but with caution
• Using time markers
• Assessing practices by individual partners
  (avoiding numbers out of the hat)
• Checking for data consistency
• Data integration (risk indices, e.g. Sussers
  VEE)

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Interviewer Selection

• Apart from good general interviewing
  capacity/skill, the sex interviewer should be
• Comfortable with sexual matters
• Non-judgmental (no sexual hot-button issues)
• Matched to interviewees (to some extent) by
  gender, sexual orientation, age, ethnic/cultural
  background, in order to facilitate rapport and
  self-disclosure

17
Interviewer Training Monitoring

• Manualized training protocols (with Rhoda Gruen,
  Terry Dugan)
• The interview as a social situation
• Sex-talk desensitization / value clarification
• Familiarization with population-specific
  vernacular
• Discussion of guidelines for interviews at
  non-office locations (homes, restaurants)
• Discussion of sex-interviewing-specific ethical
  guidelines
• Interview practice (mock v. real)
• Monitoring to check interviewer drift
• Audiotape checks
• Group supervision

18
Sex Interviews Feasibility, Reliability

• Early SERBAS interviews with, for instance,
• HIV IVDU men and women, HIV gay men
• Urban adolescents runaways homosexuals
• SMI hospitalized homeless
• Male street prostitutes
• Early adolescents from inner-city HIV families
  (gated interviews)
• Sex-related qualitative interviews with
• Urban boys and girls from 6-12yrs

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Sex Interviews Later Techniques

• Increasingly formative-qualitative and
  ethnographic work on risk sex in the US and
  abroad
• Sex diaries
• Elaborate interview schedules integrating
  detailed sex-behavior assessments and selected
  determinants
• ACASI

20
Sex-Risk Research 20 Years Later

• A changed scene
• Much increased numbers of investigators and
  research interviewers with experience in
  interview-based sex-behavior assessment
• Much increased numbers of NGOs with experience in
  sex talk in terms of HIV sex-related counseling
• Decreased stigma of HIV/AIDS and related
  sexuality topics in Western industrialized
  countries, especially in the urban centers
• Increased use of ACASI
• Increased awareness of the need to complement
  individual- and group-level interventions with
  structural changes (policy modifications on
  various levels, including regarding sex
  education)
• Increased emphasis on work with resource-poor
  countries and their specific cultural contexts

21
Sex Core 20 Years Later

• Merged into an Interdisciplinary Research Methods
  Core that helps integrating sexual,
  psychosocial, and psychiatric assessment,
  quantitative and qualitative approaches, and
  determinants and intervention studies

22
Sex Core History

• Center I 1987-92 (P50)
• Psychosexual Assessment Core
• Center II 1992-97
• Psychosexual Core
• Center III 1997-2002
• Psychosexual Core
• Center IV 2002-2008 (P30)
• Interdisciplinary Research Methods Core merger
  of Psychosexual Core, Psychosocial/Qualitative
  Core, Intervention Consultants, Ethnography
  Consultants
• Center V 2008-2012
• Interdisciplinary Research Methods Core

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Interdisc. Res. Methods C. 2008-12 (1)

• Co-Directors
• Heino Meyer-Bahlburg - Clin. Psych. sexology
  developmental
• Susan Tross - Clin. Psych. psychosocial
  qualitative substance use prev. interventions
• Jennifer Hirsch - Anthropology ethnography
  qualitative methods
• Members
• Pamela Collins - Psychiatry SMI
• Curtis Dolezal - Social Psychol. ACASI data
  analysis
• Shari Dworkin - Sociology gender/economics
  women qualitative
• Anke Ehrhardt - Clin. Psychol. developmental
  sexology women, prev. intervention
• Theresa Exner - Clin. Psychol. sexology
  women prev. intervention
• Claude Mellins - Dev. Clin. Psychol.
  neuropsychol. HIV families
• Ilan Meyer - Social Psychol. psychi.
  epidemiol. MSM stigma
• Judith Rabkin - Clin. Psychol. HIV adults
  psychopharm.
• Theo Sandfort - Social psychol., sexology MSM
• Milton Wainberg - Psychiatry SMI prev.
  interventions

24
The Future?

• On the individual level, continuing tension
  between desire for novelty/unfettered sex and
  self-constraint through reasoned action
  motivated by the wish for a secure long-term
  partner bond and the concern about endemic STIs
  (incl. HIV/AIDS)
• On the policy level, continuing tension between
  sex-realists and sex-moralists
• Nevertheless, also on the policy level, through
  the many-faceted efforts of Centers like ours and
  NGOs, gradually expanding community involvement
  resulting in openness to sex education and
  related STI/HIV-prevention education for all age
  levels in most sections of society, aided by
  educational websites
• Thereby, gradual expansion of reasoned action