AIDS and Behavior

, Volume 16, Issue 3, pp 626–632 | Cite as

The Critical Role of Intimacy in the Sexual Risk Behaviors of Gay and Bisexual Men

  • Sarit A. GolubEmail author
  • Tyrel J. Starks
  • Gregory Payton
  • Jeffrey T. Parsons
Original Paper


Research indicates that high numbers of gay and bisexual men report infrequent or inconsistent condom use, placing them at risk for HIV and other STDs. The present study examined positive and negative condom-related attitudes along three dimensions—risk reduction, pleasure reduction, and intimacy interference—and examined their relative predictive power in determining condom use among a sample of sexually risky gay and bisexual men in New York City. In a multivariate model, both risk reduction and intimacy interference attitudes emerged as significant predictors of unprotected sex; however, the variance accounted for by a model including intimacy interference was almost three times that accounted for by a model including risk reduction alone. These data suggest a pivotal role for intimacy in shaping condom attitudes and behavior among gay and bisexual men. HIV prevention interventions should consider incorporating intimacy as a motivating factor for sexual behavior and a potential barrier to condom use.


MSM HIV Risk Intimacy Condom use 


Resultados de investigaciones indican que gran cantidad de hombres gay y bisexuales reportan uso infrecuente o inconsistente de condones, poniendolos en riesgo de contraer VIH y enfermedades de transmisión sexual. La investigación presente examinó actitudes positivas y negativas sobre condones en tres dimensiones—la reducción del riesgo, la reducción del placer, y la interferencia con la intimidad—asi como su relativo poder para predecir el uso de condones en hombres gay y bisexuales de la Ciudad de Nueva York, cuyo comportamiento sexual es de alto riesgo. En un modelo de multivariados, la actitudes sobre reducción de riesgo e interferencia de intimidad emergieron como predictores significativos de sexo sin protección; sin embargo, la variación representada por la interferencia de intimidad resultó tres veces mayor que aquella representada por la reducción de riesgo. Estos datos indican que la intimidad cumple una funcion primordial en la formacion de actitudes sobre condones y en el comportamiento sexual de hombres gay y bisexuales. Las intervenciones de prevención del VIH deben considerar la incorporación de intimidad como un factor de motivación del comportamiento sexual, asi como un obstáculo para el uso de condones.



The Young Men’s Health Project was supported by a grant from the National Institute on Drug Abuse (NIDA) (R01- DA020366, Jeffrey T. Parsons, Principal Investigator). The authors gratefully acknowledge Dr. Corina L. Weinberger, the Project Director, and the contributions of the Young Men’s Health Project team—Michael Adams, Anthony Bamonte, Kristi Gamarel, Christian Grov, Chris Hietikko, Catherine Holder, John Pachankis, Mark Pawson, Jonathan Rendina, Kevin Robin, Anthony Surace, Julia Tomassilli, Andrea Vial, Ja’Nina Walker, Brooke Wells, and the CHEST recruitment team. We would also like to thank Richard Jenkins for his support of the project.


  1. 1.
    CDC. HIV/AIDS Surveillance Report, 2008. In. Atlanta: US Department of Health and Human Services; 2010.Google Scholar
  2. 2.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:170–211.CrossRefGoogle Scholar
  3. 3.
    Catania JA, Kegeles SM, Coates TJ. Towards an understanding of risk behavior: an AIDS risk reduction model (ARRM). Health Educ Q. 1990;17:53–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Prochaska JO, Redding CA, Harlow LL, Rossi JS, Velicer WF. The transtheoretical model of change and HIV prevention: a review. Health Educ Q. 1994;21:471–86.PubMedCrossRefGoogle Scholar
  6. 6.
    MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11:263–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Nanín JE, Parsons JT. Club drug use and risky sex among gay and bisexual men in New York City. J Gay Lesbian Psychother. 2006;10:111–22.CrossRefGoogle Scholar
  8. 8.
    Pollock JA, Halkitis PN. Environmental factors in relation to unprotected sexual behavior among gay, bisexual, and other MSM. AIDS Educ Prev. 2009;21:340–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis. 2007;34:113–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among sex who have sex with men: barebacking—from behavior to identity. AIDS Behav. 2007;11:277–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Albarracin D, McNatt PS, Klein CT, Ho RM, Mitchell AL, Kumkale GT. Persuasive communications to change actions: an analysis of behavioral and cognitive impact in HIV prevention. Health Psychol. 2003;22:166–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23:39–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23:243–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr. 2008;49:212–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Grady WR, Klepinger DH, Billy JO, Tanfer K. Condom characteristics: the perceptions and preferences of men in the United States. Fam Plann Perspect. 1993;25:67–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Jadack RA, Fresia A, Rompalo AM, Zenilman J. Reasons for not using condoms of clients at urban sexually transmitted diseases clinics. Sex Transm Dis. 1997;24:402–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Shernoff M. Condomless sex: gay men, barebacking, and harm reduction. Soc Work. 2006;51:106–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Crosby RA, Yarber WL, Sanders SA, Graham CA. Condom discomfort and associated problems with their use among university students. J Am Coll Health. 2005;54:143–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Blechner MJ. Intimacy, pleasure, risk, and safety: discussion of Cheuvront’s high-risk sexual behavior in the treatment of HIV-negative patients. J Gay Lesbian Psychother. 2002;6:27–33.CrossRefGoogle Scholar
  20. 20.
    Halkitis PN, Parsons JT, Wilton L. Barebacking among gay and bisexual men in New York City: explanations for the emergence of intentional unsafe behavior. Arch Sex Behav. 2003;32:351–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Scott-Sheldon LA, Marsh KL, Johnson BT, Glasford DE. Condoms + pleasure = safer sex? A missing addend in the safer sex message. AIDS Care. 2006;18:750–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Scott-Sheldon LA, Johnson BT. Eroticizing creates safer sex: a research synthesis. J Prim Prev. 2006;27:619–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Berg RC. Barebacking: a review of the literature. Arch Sex Behav. 2009;38(5):754–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Harawa NT, Williams JK, Ramamurthi HC, Bingham TA. Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: implications for heterosexual transmission. J Urban Health. 2006;83:682–94.PubMedCrossRefGoogle Scholar
  25. 25.
    Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among sex who have sex with men: Barebacking—from behavior to identity. AIDS Behav. 2006;11:277–87.CrossRefGoogle Scholar
  26. 26.
    Bauermeister JA, Carballo-Dieguez A, Ventuneac A, Dolezal C. Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts (“bareback sex”) among men who have sex with men. AIDS Educ Prev. 2009;21:156–68.PubMedCrossRefGoogle Scholar
  27. 27.
    Frost DM, Stirratt MJ, Ouellette SC. Understanding why gay men seek HIV-seroconcordant partners: intimacy and risk reduction motivations. Cult Health Sex. 2008;10:513–27.PubMedCrossRefGoogle Scholar
  28. 28.
    Shernoff M. Condomless sex: considerations for psychotherapy with individual gay men and male couples having unsafe sex. J Gay Lesbian Psychother. 2005;9:149–69.CrossRefGoogle Scholar
  29. 29.
    Slavin S. “Instinctively, I’m not just a sexual beast”: the complexity of intimacy among Australian gay men. Sexualities. 2009;12:79–96.CrossRefGoogle Scholar
  30. 30.
    Grov C, Bux D, Parsons J, Morgenstern J. Recruiting hard-to-reach men who have sex with men into an intervention study: lessons learned and implications for applied research. Subst Use Misuse. 2009;44:1603–19.Google Scholar
  31. 31.
    Parsons J, Halkitis P, Bimbi D, Borkowski T. Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students. J Adolesc. 2000;23:377–91.PubMedCrossRefGoogle Scholar
  32. 32.
    Parsons J, Halkitis P, Wolitski R, Gomez C. Correlates of sexual risk behaviors among HIV-positive men who have sex with men. AIDS Educ Prev. 2003;15:383–400.PubMedCrossRefGoogle Scholar
  33. 33.
    Sobell MB, Sobell LC. Problem drinkers: guided self-change treatment. New York: Guilford Press; 1993.Google Scholar
  34. 34.
    Carey MP, Carey KB, Maisto SA, Gordon CM, Weinhardt LS. Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12:365–75.PubMedCrossRefGoogle Scholar
  35. 35.
    Irwin TW, Morgenstern J, Parsons JT, Wainberg M, Labouvie E. Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data. AIDS Behav. 2006;10:299–307.PubMedCrossRefGoogle Scholar
  36. 36.
    Weinhardt LS, Carey MP, Maisto SA, Carey KB, Cohen MM, Wickramasinghe SM. Reliability of the timeline follow-back sexual behavior interview. Ann Behav Med. 1998;20:25–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Fals-Stewart W, O’Farrell TJ, Freitas TT, McFarlin SK, Rutigliano P. The timeline followback reports of psychoactive substance use by drug-abusing patients: psychometric properties. J Consult Clin Psychol. 2000;68:134–44.PubMedCrossRefGoogle Scholar
  38. 38.
    Belsley D, Kuh E, Welsch R. Regression diagnostics: identifying influential data and sources of collinearity. New York: John Wiley; 1980.CrossRefGoogle Scholar
  39. 39.
    Frost DM, Stirratt MJ, Ouellette SC. Understanding why gay men seek HIV-seroconcordant partners: intimacy and risk reduction motivations. Cult Health Sex. 2008;10:513–27.PubMedCrossRefGoogle Scholar
  40. 40.
    Blechner M. Intimacy, pleasure, risk and safety: commentary on Cheuvront’s High-risk sexual behavior in the treatment of HIV-negative patients. J Gay Lesbian Psychother. 2002;6:27–34.CrossRefGoogle Scholar
  41. 41.
    Dowsett G. Practicing desire: homosexual sex in the era of AIDS. Stanford: Stanford University Press; 1996.Google Scholar
  42. 42.
    Diaz R, Ayala G. Love, passion and rebellion: Ideologies of HIV risk among Latino gay men in the USA. Cult Health Sex. 1999;1:277–93.CrossRefGoogle Scholar
  43. 43.
    Prager K. The psychology of intimacy. New York: Guilford Press; 1995.Google Scholar
  44. 44.
    Sullivan P, Salazar L, Buchbinder S, Sanchez T. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23:1153.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Sarit A. Golub
    • 1
    • 2
    • 3
    Email author
  • Tyrel J. Starks
    • 2
  • Gregory Payton
    • 2
  • Jeffrey T. Parsons
    • 1
    • 2
    • 3
  1. 1.Department of Psychology, Hunter CollegeCity University of New York (CUNY)New YorkUSA
  2. 2.Center for HIV/AIDS Educational Studies and Training (CHEST)New YorkUSA
  3. 3.Social & Personality Psychology Doctoral Subprogram, The Graduate Center, CUNYNew YorkUSA

Personalised recommendations