Narcissistic personality traits, substance use, and sexual risk behavior in HIV-positive adults

Most HIV-positive individuals take steps to protect their sexual partners, including limiting the number of partners, limiting their sexual partners to other individuals with HIV, and consistent condom use. Previous work has noted an association between sexual risk behavior and psychiatric conditions, including depression, substance use disorders, and posttraumatic stress disorder. Less attention has been paid to associations between personality disorder symptoms and sexual risk. In the present study, HIV-positive adults (N=310) were recruited from an infectious disease clinic. Participants completed a self-administered questionnaire assessing narcissistic personality traits, substance use, and sexual risk behavior. The majority of participants (85%) reported no unprotected vaginal or anal intercourse in the past 3 months with a partner who was HIV-negative or whose HIV status was unknown. Individuals who reported unprotected sex with a partner at risk for HIV scored significantly higher on the narcissism measure (M=23.35, SD = 5.5) than individuals who did not (M=19.78, SD=5.3; t = 4.02, p<.001). Higher narcissism scores were associated with higher rates of having sex after drinking (rho=0.20), having sex after using drugs (rho =0.22), total sexual partners (rho=0.17) and total unprotected sex acts in the past 3 months (rho=0.23; all ps <.01). In a sequential logistic regression equation, narcissistic traits predicted having multiple sexual partners, after accounting for the influence of gender, race, and use of alcohol, marijuana, ecstasy, cocaine, and methamphetamine (OR=1.07, CI=1.01, 1.13). Interventions focused on reducing risk behavior in HIV-positive adults need to take into account associations between narcissism and risk