Escape from risk: A qualitative exploration of relapse to unprotected anal sex among men who have sex with men

Mark L. Williams, William N. Elwood, Anne Markey Bowen

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Since the advent of the HIV/AIDS epidemic, gay men have reduced their sexual behaviors that put them at risk. Despite these changes, recent studies have found that some men who have sex with men (MSM) who regularly practice safer sex behaviors, periodically engage in risky anal sex. Many of these MSM realize that their “lapses” place them at risk for HIV infection; nevertheless, they engage in unprotected sex. In response to these findings, some behavioral scientists have questioned the ability of existing models of condom use to completely account for all types of HIV sexual risk and risk avoidance behaviors, especially episodic unprotected anal sex by men who otherwise use condoms. A cognitive escape model proposed by McKir-nan, Ostrow, and Hope (1996) is an explanation that may be able to account for periodic “lapses” in condom use by MSM who usually comply with safer sex standards. This manuscript applies that model to textual data from a sample of 41 MSM who have sex in bathhouses. In depth, semi-structured interviews provided the data for the study. We found that MSM in this study recognize strong normative expectations for using condoms during anal sex, and usually comply with these expectations. Participants also report that constant awareness of HIV and the AIDS epidemic and the need to constantly comply with standards of safer sex produce stress. The men noted that they frequented certain settings, including bars and bathhouses, and used alcohol and illicit drugs because these provided the stimuli that facilitated a cognitive disengagement from the norms of safer sex. Among the MSM interviewed who reported unprotected sex, a cognitive escape model appears able to account for their lapses from safer sex standards. Limitations of the study and recommendations for further exploration are discussed.

Original languageEnglish (US)
Pages (from-to)25-49
Number of pages25
JournalJournal of Psychology and Human Sexuality
Volume11
Issue number4
DOIs
StatePublished - Jul 26 2000
Externally publishedYes

Fingerprint

Safe Sex
Unsafe Sex
relapse
Sexual Behavior
Condoms
Recurrence
HIV
Hope
Acquired Immunodeficiency Syndrome
AIDS
avoidance behavior
Avoidance Learning
sex behavior
Aptitude
disengagement
Street Drugs
Risk-Taking
risk behavior
HIV Infections
stimulus

Keywords

  • Bathhouses
  • Cognitive escape
  • Condom use
  • Drug use
  • Gay men
  • Men who have sex with men
  • Relapse behaviors

ASJC Scopus subject areas

  • Applied Psychology
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

Cite this

Escape from risk : A qualitative exploration of relapse to unprotected anal sex among men who have sex with men. / Williams, Mark L.; Elwood, William N.; Bowen, Anne Markey.

In: Journal of Psychology and Human Sexuality, Vol. 11, No. 4, 26.07.2000, p. 25-49.

Research output: Contribution to journalArticle

@article{3d38d652392848268ae555af0ad09d76,
title = "Escape from risk: A qualitative exploration of relapse to unprotected anal sex among men who have sex with men",
abstract = "Since the advent of the HIV/AIDS epidemic, gay men have reduced their sexual behaviors that put them at risk. Despite these changes, recent studies have found that some men who have sex with men (MSM) who regularly practice safer sex behaviors, periodically engage in risky anal sex. Many of these MSM realize that their “lapses” place them at risk for HIV infection; nevertheless, they engage in unprotected sex. In response to these findings, some behavioral scientists have questioned the ability of existing models of condom use to completely account for all types of HIV sexual risk and risk avoidance behaviors, especially episodic unprotected anal sex by men who otherwise use condoms. A cognitive escape model proposed by McKir-nan, Ostrow, and Hope (1996) is an explanation that may be able to account for periodic “lapses” in condom use by MSM who usually comply with safer sex standards. This manuscript applies that model to textual data from a sample of 41 MSM who have sex in bathhouses. In depth, semi-structured interviews provided the data for the study. We found that MSM in this study recognize strong normative expectations for using condoms during anal sex, and usually comply with these expectations. Participants also report that constant awareness of HIV and the AIDS epidemic and the need to constantly comply with standards of safer sex produce stress. The men noted that they frequented certain settings, including bars and bathhouses, and used alcohol and illicit drugs because these provided the stimuli that facilitated a cognitive disengagement from the norms of safer sex. Among the MSM interviewed who reported unprotected sex, a cognitive escape model appears able to account for their lapses from safer sex standards. Limitations of the study and recommendations for further exploration are discussed.",
keywords = "Bathhouses, Cognitive escape, Condom use, Drug use, Gay men, Men who have sex with men, Relapse behaviors",
author = "Williams, {Mark L.} and Elwood, {William N.} and Bowen, {Anne Markey}",
year = "2000",
month = "7",
day = "26",
doi = "10.1300/J056v11n04_02",
language = "English (US)",
volume = "11",
pages = "25--49",
journal = "International Journal of Sexual Health",
issn = "1931-7611",
publisher = "Routledge",
number = "4",

}

TY - JOUR

T1 - Escape from risk

T2 - A qualitative exploration of relapse to unprotected anal sex among men who have sex with men

AU - Williams, Mark L.

AU - Elwood, William N.

AU - Bowen, Anne Markey

PY - 2000/7/26

Y1 - 2000/7/26

N2 - Since the advent of the HIV/AIDS epidemic, gay men have reduced their sexual behaviors that put them at risk. Despite these changes, recent studies have found that some men who have sex with men (MSM) who regularly practice safer sex behaviors, periodically engage in risky anal sex. Many of these MSM realize that their “lapses” place them at risk for HIV infection; nevertheless, they engage in unprotected sex. In response to these findings, some behavioral scientists have questioned the ability of existing models of condom use to completely account for all types of HIV sexual risk and risk avoidance behaviors, especially episodic unprotected anal sex by men who otherwise use condoms. A cognitive escape model proposed by McKir-nan, Ostrow, and Hope (1996) is an explanation that may be able to account for periodic “lapses” in condom use by MSM who usually comply with safer sex standards. This manuscript applies that model to textual data from a sample of 41 MSM who have sex in bathhouses. In depth, semi-structured interviews provided the data for the study. We found that MSM in this study recognize strong normative expectations for using condoms during anal sex, and usually comply with these expectations. Participants also report that constant awareness of HIV and the AIDS epidemic and the need to constantly comply with standards of safer sex produce stress. The men noted that they frequented certain settings, including bars and bathhouses, and used alcohol and illicit drugs because these provided the stimuli that facilitated a cognitive disengagement from the norms of safer sex. Among the MSM interviewed who reported unprotected sex, a cognitive escape model appears able to account for their lapses from safer sex standards. Limitations of the study and recommendations for further exploration are discussed.

AB - Since the advent of the HIV/AIDS epidemic, gay men have reduced their sexual behaviors that put them at risk. Despite these changes, recent studies have found that some men who have sex with men (MSM) who regularly practice safer sex behaviors, periodically engage in risky anal sex. Many of these MSM realize that their “lapses” place them at risk for HIV infection; nevertheless, they engage in unprotected sex. In response to these findings, some behavioral scientists have questioned the ability of existing models of condom use to completely account for all types of HIV sexual risk and risk avoidance behaviors, especially episodic unprotected anal sex by men who otherwise use condoms. A cognitive escape model proposed by McKir-nan, Ostrow, and Hope (1996) is an explanation that may be able to account for periodic “lapses” in condom use by MSM who usually comply with safer sex standards. This manuscript applies that model to textual data from a sample of 41 MSM who have sex in bathhouses. In depth, semi-structured interviews provided the data for the study. We found that MSM in this study recognize strong normative expectations for using condoms during anal sex, and usually comply with these expectations. Participants also report that constant awareness of HIV and the AIDS epidemic and the need to constantly comply with standards of safer sex produce stress. The men noted that they frequented certain settings, including bars and bathhouses, and used alcohol and illicit drugs because these provided the stimuli that facilitated a cognitive disengagement from the norms of safer sex. Among the MSM interviewed who reported unprotected sex, a cognitive escape model appears able to account for their lapses from safer sex standards. Limitations of the study and recommendations for further exploration are discussed.

KW - Bathhouses

KW - Cognitive escape

KW - Condom use

KW - Drug use

KW - Gay men

KW - Men who have sex with men

KW - Relapse behaviors

UR - http://www.scopus.com/inward/record.url?scp=0003444016&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0003444016&partnerID=8YFLogxK

U2 - 10.1300/J056v11n04_02

DO - 10.1300/J056v11n04_02

M3 - Article

AN - SCOPUS:0003444016

VL - 11

SP - 25

EP - 49

JO - International Journal of Sexual Health

JF - International Journal of Sexual Health

SN - 1931-7611

IS - 4

ER -