Three Reasons to Consider the Role of Tiredness in Sexual Risk-Taking Among Gay and Bisexual Men
Numerous factors have been shown to increase sexual risk-taking—especially among gay and bisexual men (GBM), who remain disproportionately affected by HIV and STIs. We present three lines of evidence that highlight the need to consider a previously under-explored situational factor in sexual risk-taking: tiredness. While tiredness has been shown, in sleep science literature, to impair cognition, emotional functioning, and decision-making in a wide range of behaviors, it has yet to be considered in-depth as a risk factor in sexual behavior. Counter to the common-sense assumption that being tired should impede the performance of active, effortful behaviors such as sex, we propose that tiredness may actually increase sexual risk-taking. Analyzing data from an online survey of 1113 HIV-negative GBM, we found that sex with casual partners most commonly occurred at night, especially among younger GBM and those with an evening chronotype, and that sex without condoms more often occurred at or later than one’s usual time of feeling tired (as was reported by 44.2% of men) than did sex with condoms (reported by 36.6%). We also found that tiredness can increase sexual desire in many GBM (endorsed by 29.9%), and increases the likelihood of engaging in receptive positioning in anal sex (endorsed by almost 40% of men with a versatile sexual positioning identity). These findings highlight the importance of considering tiredness as a situational risk factor in sexual health—especially among younger GBM—and of counting sex among the behaviors that can be adversely impacted by poor or overdue sleep.
KeywordsSleep Men who have sex with men (MSM) HIV Sexually transmitted infections (STIs) Sexual risk-taking Sexual orientation
The authors would like to acknowledge the contributions of the other members of the One Thousand Strong Study Team (Dr. Christian Grov, Demetria Cain, Mark Pawson, Ruben Jimenez, Chloe Mirzayi, Raymond Moody, and Thomas Whitfield) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Brian Salfas, Kendell Doyle, and Carlos Ponton). Thank you to Dr. Cheryl Carmichael and Dr. Dustin Duncan. We would also like to thank the staff at Community Marketing Inc (David Paisley, Heather Torch, and Thomas Roth). Finally, we thank Jeffrey Schulden at NIDA and all of our participants in the One Thousand Strong study.
The One Thousand Strong study was funded by a research grant from the National Institute on Drug Abuse (R01 DA036466: Jeffrey T. Parsons & Christian Grov, MPIs). H. Jonathon Rendina was funded in part by a Career Development Award from the National Institute on Drug Abuse (K01-DA039030; H. Jonathon Rendina, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- Centers for Disease Control and Prevention. (2012). HIV transmission risk, 2012. http://www.cdc.gov/hiv/law/pdf/Hivtranmsmision.pdf. Accessed May 1, 2016.
- Centers for Disease Control and Prevention. (2015). Insufficient sleep is a public health epidemic. https://www.cdc.gov/features/dssleep/index.html. Accessed June 1, 2017.
- Centers for Disease Control and Prevention. (2016). HIV Surveillance Report, 2015 (Vol. 27). http://www.cdc.gov/hiv/library/reports/surveillance/html. Accessed 15 June 2017.
- Duncan, D. T., Goedel, W. C., Mayer, K. H., Safren, S. A., Palamar, J. J., Hagen, D., & Jean-Louis, G. (2016). Poor sleep health and its association with mental health, substance use, and condomless anal intercourse among gay, bisexual, and other men who have sex with men. Sleep Health, 2(4), 316–321.CrossRefGoogle Scholar
- Forman, E. M., Schumacher, L. M., Crosby, R., Manasse, S. M., Goldstein, S. P., Butryn, M. L., & Thomas, J. G. (2017). Ecological momentary assessment of dietary lapses across behavioral weight loss treatment: Characteristics, predictors, and relationships with weight change. Annals of Behavioral Medicine, 51, 1–13.CrossRefGoogle Scholar
- Grov, C., Cain, D., Whitfield, T. H., Rendina, H. J., Pawson, M., Ventuneac, A., & Parsons, J. T. (2016). Recruiting a US national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and opportunities. Sexuality Research and Social Policy, 13(1), 1–21.CrossRefGoogle Scholar
- Horne, J. A., & Östberg, O. (1975). A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. International Journal of Chronobiology, 4(2), 97–110.Google Scholar