McKirnan D J, Ostrow D G, Hope B
Department of Psychology, University of Illinois at Chicago 60607-7137, USA.
AIDS Care. 1996 Dec;8(6):655-69. doi: 10.1080/09540129650125371.
The lack of an effective HIV vaccine or other biomedical intervention means that behavioural change will continue to be critical to the prevention of HIV infection. Despite near universal knowledge of HIV and sexual safety, and widespread intentions to be safe, rates of unprotected sex and HIV sero-conversion remain high among gay and bisexual men. Explanatory models that link risk-taking and prevention to rational processes such as knowledge, social norms, behavioural intentions, or perceived vulnerability to infection, cannot fully account for the continued risk behaviours observed in virtually all cohorts of gay men. We feel that innovative conceptions of risk and risk prevention are needed, that emphasize non-rational, affective processes in risk-taking and decision-making. Consistent with recent models from social psychology, we propose that for many people sexual risk does not stem from a lack of community norms or personal standards, but from a desire to escape cognitive awareness of very rigorous norms and standards. Being self-aware of HIV risk arouses anxiety and precludes highly-desired activities: fatigue, fatalism, or other negative affect over HIV may lead people to 'cognitively disengage' within the sexual situation, and not to follow their norms or intentions toward safety. We propose that both substance use and the approach of high stimulation or other sexual settings facilitates this cognitive disengagement, wherein people enact 'automatic' sexual scripts and/or become more responsive to external pressures toward risk. We briefly review current psychosocial models of HIV risk behaviour, outline a cognitive escape model with particular emphasis on substance use as a behavioural risk factor, and discuss implications of an escape model for behavioural interventions among gay and bisexual men.
缺乏有效的艾滋病毒疫苗或其他生物医学干预措施意味着行为改变对于预防艾滋病毒感染仍将至关重要。尽管人们对艾滋病毒和性安全几乎普遍知晓，且普遍有保持安全的意愿，但男同性恋者和双性恋男性中的无保护性行为率和艾滋病毒血清转换率仍然很高。将冒险行为和预防措施与知识、社会规范、行为意图或感知的感染易感性等理性过程联系起来的解释模型，无法完全解释在几乎所有男同性恋者群体中观察到的持续风险行为。我们认为需要创新的风险和风险预防概念，强调冒险和决策中的非理性情感过程。与社会心理学的最新模型一致，我们提出，对许多人来说，性风险并非源于缺乏社区规范或个人标准，而是源于逃避对非常严格的规范和标准的认知意识的愿望。意识到艾滋病毒风险会引发焦虑，并排除了人们非常渴望的活动：对艾滋病毒的疲劳、宿命论或其他负面影响可能会导致人们在性情境中“认知脱离”，不遵守他们的安全规范或意图。我们提出，物质使用以及高刺激或其他性情境的方式会促进这种认知脱离，即人们按照“自动”的性脚本行事，和/或对外部的风险压力反应更加敏感。我们简要回顾了当前关于艾滋病毒风险行为的心理社会模型，概述了一个认知逃避模型，特别强调物质使用作为行为风险因素，并讨论了逃避模型对男同性恋者和双性恋男性行为干预的影响。
