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Bringing risk prevention into the bedroom : sex motives and risky behaviors in men who have sex with men Puterman, Eli


We are well into the third decade of HIV disease, and unprotected anal intercourse remains the primary mode of transmission in men who have sex with men (MSM). Since 2000, evidence suggests decreased precautionary sex behaviors and increased incidences of HIV in MSM. Traditional models of risky behaviors have focused primarily on cognitive factors related to intention to use condoms. Yet, there is an often-observed gap between intentions and behaviors. This ‘gap’ has fueled calls in the literature to move beyond cognitions and explore other psychological and contextual factors that may predict condom use. In the present study, I examined a functional model of condom use in MSM not in committed, long-term relationships, given their increased risk of HIV transmission vulnerability. Sex motives were examined as predictors of condom use in single MSM as a function of partner type and HIV serostatus. Sex motives examined were having sex to enhance intimacy, gain pleasure, escape a negative affective state, enhance self-esteem, and avoid partner disapproval. For a period of two months, MSM reported condom use for anal intercourse, sex motives, and partner type on a daily basis. Hierarchical logistic regression analyses revealed that consistent with hypotheses, on occasions when participants reported higher levels, as compared to lower levels, of having sex to enhance intimacy, and to cope with a negative affective state, the likelihood of using a condom for anal intercourse was decreased. Further, consistent with hypotheses, when participants reported higher levels, compared to lower levels, of having sex to enhance sexual pleasure, to attain partner approval, and to confirm to oneself a sense of sexual esteem, the more likely they were to use a condom for anal intercourse. Results also indicated that, in general, the relationships between motives and condom use were stronger when having sex with someone considered a regular partner as compared to casual. Finally, relationships were also stronger when participants self-reported HIV seropositive status as compared to seronegative or serostatus unknown. Implications for intervention approaches, at both the individual and community levels, are discussed.

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