Developmental and Racial Differences in a Situational Model of Sexual Risk in Men Who Have Sex With Men

Men who have sex with men (MSM) are at substantially increased risk for HIV infection, and there are striking differences between racial/ethnic and age groups in terms of HIV incidence. Research on sexual risk behavior has tended to examine group differences based on global predictors of risk (i.e., between-subjects variables), and has largely failed to account for within-persons variability in condom use. The current investigation examined four distinct models of sexual risk in MSM: 1) sexual partnership characteristics, 2) alcohol and substance use, 3) affective influences, and 4) Information-Motivation-Behavioral Skills. Participants were 143 MSM who were diverse in terms of both age and racial/ethnic background and were recruited online. To improve upon previous daily diary approaches that followed participants for one month, prospective weekly diary surveys were utilized in order to observe a larger number of sexual encounters over a 12-week follow-up period. Analyses were conducted with Hierarchical Linear Modeling. Results indicate that it is important to consider both situational within-persons variables as well as group differences in predicting sexual risk, and most predictors did not exert their effects in the same manner for all groups of MSM. This study confirms that several key variables consistently predict sexual risk behavior for all MSM, including alcohol and substance use. For young Black MSM, having older and repeat partners was associated with greater odds of sexual risk. Higher scores on measures of condom use self-efficacy and social norms of condom use were associated with less sexual risk, and a variety of other cognitive variables were associated with risk appraisals of sexual encounters, including HIV knowledge, motivation to stay safe, perceived severity of HIV infection, and perceived riskiness of past sexual behavior. Implications for future research and intervention development are discussed.