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Characteristics of Sex Events, Partners, and Motivations and Their Associations with HIV-Risk Behavior in a Daily Diary Study of High-Risk Men Who Have Sex with Men (MSM)

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Abstract

In the United States, men who have sex with men (MSM) continue to be at high-risk for HIV and other STIs, and condoms represent the most popular, affordable, and accessible method of prevention. Although a vast body of research has explored various factors associated with condom use in MSM, fewer studies have explored situation-level characteristics that affect their decisions about sex partners and condom use. Daily diary studies are well-suited to help improve our understanding of these event-level factors in detail, including the sex events themselves, partner characteristics, and motivations. As part of a larger study using ecological momentary assessment methods, high-risk MSM completed daily diary surveys about their sexual behavior on their smartphones each day for 30 days. This study explored detailed descriptive characteristics of sex events, partner characteristics, and motivations for sex and condom use, and examined whether specific aspects of these characteristics were associated with having condomless anal sex (CAS) with high-risk partners. High-risk CAS was common among MSM, with the majority of participants having met their partners online and many reporting sex the same day they met. Results showed that the odds of CAS were not higher with partners met online versus those met in other ways, but MSM were more likely to have asked online partners about their HIV status and testing history before sex. The odds of engaging in high-risk CAS was higher when MSM reported intimacy or self-assurance motives. Not having condoms readily available was a CAS motivation reported more commonly when MSM had sex with high-risk partners. Findings suggest that interventions should incorporate strategies that help MSM be safer specifically when meeting partners online and when having sex for intimacy or re-assurance. Interventions that remind MSM to carry condoms at opportune moments may also help reduce some HIV risk.

Resumen

En los Estados Unidos, los hombres que tienen sexo con hombres (HSH) siguen teniendo un alto riesgo de contraer VIH y otras ITS, y los condones representan el método de prevención más popular, asequible y accesible. Aunque una gran cantidad de investigaciones han explorado varios factores asociados con el uso del condón en HSH, pocos estudios han explorado las características al nivel de situación que afectan las decisiones de HSH sobre sus parejas sexuales y el uso de condones. Los estudios que hacen uso de una agenda diaria son adecuados para mejorar nuestra comprensión de estos factores al nivel del evento en detalle, en particular los eventos sexuales en sí, las características de la pareja y las motivaciones. Como parte de un estudio más amplio que utiliza métodos de evaluación ecológica y momentánea, los HSH de alto riesgo completaron en sus teléfonos inteligentes encuestas en el formato de agendas diarias sobre su comportamiento sexual cada día durante 30 días. Este estudio exploró características descriptivas detalladas de los eventos sexuales, las características de la pareja, las motivaciones para tener sexo y las motivaciones para usar condones. El estudio examinó si existían aspectos específicos de estas características que se asociaban con tener sexo anal sin condón (CAS) con parejas de alto riesgo. El CAS de alto riesgo era común entre los HSH, ya que la mayoría de las parejas se habían conocido por internet y muchos reportaron haber tenido relaciones sexuales el mismo día que se conocieron. Los resultados mostraron que las probabilidades de CAS no eran mayores en las parejas que se conocieron por internet comparadas con las parejas que se conocieron de otras maneras, pero los HSH tenían más probabilidades de haberle preguntado a sus parejas conocidas por internet sobre su estado de VIH y su historial de pruebas antes del sexo. Las probabilidades de participar en CAS de alto riesgo eran más altas cuando MSM reportaban motivos de intimidad o seguridad en sí mismo. No tener condones disponibles fue una motivación reportada más comúnmente en porque los HSH tenían relaciones sexuales con parejas de alto riesgo. Los resultados sugieren que las intervenciones deberían incorporar estrategias que ayuden a los HSH a ser más cuidadosos específicamente cuando se encuentran con parejas conocidas por medio del internet y cuando tienen relaciones sexuales con la motivación de tener intimidad o tranquilidad. Las intervenciones que recuerdan a los HSH de llevar condones en los momentos oportunos también pueden ayudar a reducir el riesgo de contraer el VIH.

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Acknowledgements

This manuscript was supported by P01AA019072 (to PM) and L30AA023336 (to TW) from the National Institute on Alcohol Abuse and Alcoholism.

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  1. Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, 02906, USA

    Tyler B. Wray & Peter M. Monti

  2. Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA

    Tyler B. Wray

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Wray, T.B., Monti, P.M. Characteristics of Sex Events, Partners, and Motivations and Their Associations with HIV-Risk Behavior in a Daily Diary Study of High-Risk Men Who Have Sex with Men (MSM). AIDS Behav 24, 1851–1864 (2020). https://doi.org/10.1007/s10461-019-02760-w

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