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

M. Williams, W. Elwood, A. Bowen

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 McKirnan, 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.