Marseille 2007
Marseille 2007
Abstract book
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Abstract #124  -  Safer sex fatigue promotes risk-taking among predominantly HIV-negative MSM. An assessment of underlying processes.
Session:
  21.1: Vulnerable populations (Parallel) on Monday @ 16.30-18.30 in 5 Chaired by William Fisher, Tomas Campbell
Authors:
  Presenting Author:   Dr De Wit John B.F. - Utrecht University, Netherlands
 
  Additional Authors:  Dr Philippe C.G. Adam,  
Aim:
For many individuals, prevention of HIV entails prolonged behavioral adjustments that profoundly affect their sexual experiences. A recent study in MSM exemplifies that some men consequently experience safer sex fatigue (Ostrow et al., 2002). The current study addresses psychological processes that make up the experience of safer sex fatigue, and explain its influence on sexual risk-taking. We propose that safer sex fatigue is a motivational state that reflects a sense of restraint of sexual behaviors, as well as a desire to behave in less controlled ways. We expect that men experience safer sex fatigue to the extent that condom use is evaluated less positively and more effort is needed to self-regulate their (protective) sexual behaviors.
 
Method / Issue:
In an online cohort study of 400 MSM in The Netherlands (mean age=35; 4% HIV-positive), sexual risk-taking with casual partners was assessed in the second bi-annual assessment (July 2006). The first assessment (January 2006) included a measure of safer sex fatigue derived from Ostrow et al. (2002; 4 items; alpha=.84), as well as new measures of sexual restraint (5 items; alpha=.82), and desire for less controlled sex (6 items; alpha=.82). The first assessment also included measures of attitudes towards condom use, optimistic beliefs about condom use, habitual condom use [adapted from Verplanken & Orbell, 2004]), sexual sensation seeking [cf. Kalichman et al., 1994], and experienced control over sexual expression [cf. Exner et al., 1992]). In addition, we measured intention to use condoms and willingness to engage in unprotected sex.
 
Results / Comments:
Most men (70%) reported having had sex with casual partners in wave 2, and 31% of these men had unprotected anal intercourse. Risk-taking was significantly related to safer sex fatigue (O.R.=2.28, p<.001, and this effect remained significant, albeit less strong, after controlling for previous risk-taking and intention to use condoms reported in wave 1. However, willingness to engage in condom use mediated the effect of safer sex fatigue on behavior. As expected, a multivariate linear regression analyses showed that safer sex fatigue reflected both the extent to which men perceived previous restraint of their sexuality (beta=.16, p=.002), and desired to behave in less restricted ways in the future (beta=.30, p<.001). Furthermore, safer sex fatigue was higher when individuals held less favourable attitudes towards condom use, thought condoms were less needed now that effective treatments are available, used condoms less habitually, scored higher on sexual sensation seeking and experienced less control over their sexual expression.
 
Discussion:
Findings show that safer sex fatigue is a major predictor of sexual risk-taking in MSM, that affects behavior through an increased willingness to enact opportunities for unsafe sex. Importantly, this study demonstrated that safer sex fatigue is an active motivational sate that does not only reflect sexual restraint, but also a desire for what we term sexual recovery. Findings further confirm our hypotheses that safer sex fatigue is more likely to arise when condom use is evaluated less positively, practiced less routinely, and requires more self-regulation of desired but risky behaviors. Implications for prevention will be discussed.
 
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