title: 'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men.
abstract: BACKGROUND
  American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission.
  
  
  OBJECTIVE
  This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM.
  
  
  METHODS
  AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed.
  
  
  RESULTS
  Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both.
  
  
  CONCLUSIONS
  Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.
authors: Department of Psychology, University of Washington, Seattle, USA. knelson6@uw.edu
authors: Kimberly M
authors: KM
authors: Nelson
authors: Jane M
authors: JM
authors: Simoni
authors: Cynthia R
authors: CR
authors: Pearson
authors: Karina L
authors: KL
authors: Walters
mesh_terms: D000328:Adult; D000413:Alaska; D001294:Attitude to Health; D003071:Cognition; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners / Q000523:psychology; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000208:ethnology / Q000523:psychology*; D055815:Young Adult