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.

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. Susser�s VEE)

16. 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

19. 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

23. 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�