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The purpose of this study was to examine associations between risky sexual behavior, stressful life events, and patterns of coping among gay and bisexual men. The study hypothesized that higher scores on stress and avoidance coping would predict risky sexual behavior.
The rationale for the study was based on consistent evidence that HIV incidence has been increasing among men in the U.S. since at least 2000 (CDC, 2005, 2006a), with the overwhelming majority of them becoming infected through sex with other men (MSM). The most popular explanation for this trend is that MSM no longer see HIV as a significant threat, especially due to advances in medical treatments (e.g., Stolte et al., 2004). However, this explanation does not take into consideration the meanings or purposes of sexual behavior or how contextual and structural factors might impact such behavior.
In light of evidence that gay/bisexual men might use sex to cope with stress (Martin, Pryce, & Leeper, 2005), the amount and sources of stress among them, along with the ways in which they cope with stress, would seem to be an important focus for research. One study (Simoni, Walters, Balsam, & Meyers, 2006) did find that victimization experiences predicted sexual risk behavior among gay/bisexual or two-spirited American Indian men. But no studies have examined whether stressful life experiences and coping might predict risky sexual behavior in a general population of gay/bisexual men.
Methods:
In this cross-sectional study, participants anonymously completed an internet-hosted questionnaire that included standardized measures of coping and stressful life events, and questions about victimization, demographics, and sexual behavior. We recruited the sample from Craigslist forums and classified ads, LGBT community agency websites, and two commercial websites that target people living with HIV/AIDS. Participants had to self-identify male gender, U.S. residence, age of 18 years or older, and either gay/bisexual sexual orientation or that they have sex with other men. A voluntary lottery for a $50 gift certificate served as an incentive for participation. Of 403 individuals who met the selection criteria and who began the survey, 297 completed it.
Results:
About half of the sample reported unprotected anal sex (UAS) during the previous six months, and over a third of them reported UAS that was risky due to HIV serodiscordance or unknown serostatus. Many participants reported recent victimization experiences. Victimization scores varied by UAS, c2(3)=18.09, p<.01. Avoidance coping scores also varied by UAS, F(3,293)=6.14, p<.01. For both variables, those reporting UAS with nonprimary partners scored higher than those reporting no UAS. Using logistic regression, higher scores on avoidance coping and victimization, and positive HIV-serostatus among participants predicted UAS with nonprimary partners. Conclusions and Implications:
The findings supported the hypothesis among men who reported UAS with nonprimary partners. These findings add support to the theory that HIV prevention should target the ways in which gay/bisexual men cope with stressful events. Because victimization experiences—rather than general stressful events—predicted UAS, the findings also suggest that HIV prevention should address structural causes of stress among gay/bisexual men.