Restrictions In Sexual Expression To Prevent HIV Induced Safer Sex Fatigue And Promote Risk-Talking In Men Who Have Sex With Men (Msm).

Background: 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, which increases sexual risk-taking (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 (1) propose that safer sex fatigue reflects a prolonged restraint of sexual behaviors, and (2) expect that affected men want to behave in less controlled ways. Methods: In an online cohort study of 433 men MSM in The Netherlands (mean age=35), sexual risk-taking with casual partners was assessed in the second bi-annual assessment (July 2006). The first assessment (January 2006) included measures of safer sex fatigue (4 items; alpha=.84), sexual restraint (5 items; alpha=.82), and desire for less restricted sex (6 items; alpha=.82). HIV-positive men (4%) were excluded from the reported analyses. Results: Most respondents (69%) had sex with casual partners, and 32% of these men had unprotected anal intercourse. Risk-taking was significantly related to safer sex fatigue (O.R.=2.7, 95% C.I. 1.9–3.8). Safer sex fatigue was higher when men perceived more previous restraint of their sexuality (r=.28, p<.001). Perceived restraint increased with age (r=.22, p<.001). Safer sex fatigue was also related to men wanting to behave in less restricted ways (r=.42, p<.001), which, as expected, predicted risk-taking (O.R=1.4,95% C.I. 1.1–2.0). Conclusions: Findings confirm that safer sex fatigue is a major predictor of sexual risk taking in MSM. Importantly, this study demonstrates that sexual risk-taking is intricately related to individuals’ sexual experiences, which are negatively affected by the prolonged restraint of sexual expression, and instill a desire for less controlled sex, at least in some men. HIV-education should hence be concerned with sexuality, in addition to health.