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1 The model specifies pathways by which mental health concerns (e.g., psychological distress, substance abuse), population-specific challenges (i.e., the coming-out process and gay-related stress), and other highly pertinent experiences (i.e., childhood sexual abuse and safer sex intentions) may explain sexual risk behaviors. The current report proposes a model of sexual risk behaviors (see Figure 1) that not only incorporates traditional theoretical factors known to influence sexual risk behavior (i.e., safer sex intentions), but that also considers the realities of gay and bisexual men’s lives.
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The sexual risk behaviors of young gay and bisexual men must be understood within the context of the experiences and challenges that these young men confront in their lives. Thus, continued efforts are needed to understand the factors that lead to sexual risk behaviors among YMSM. Indeed, it is these high rates of sexual risk behaviors among men in their teens and 20s that may set the stage for the high prevalence of HIV infection found among men in their 30s and 40s. Over 90% of YMSM have reported having more than one sexual partner in the past six months and between 33% - 49% have had unprotected anal intercourse during the same time ( Valleroy et al., 2000). Although YMSM do not have a higher prevalence of HIV infection than older MSM (e.g., Catania et al., 2001), some research has suggested that YMSM engage in more sexual risk behaviors than older MSM ( Crepaz et al., 2000). The prevalence of HIV infection among YMSM ranges from 2% - 12% across major metropolitan areas ( Valleroy et al., 2000). These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.ĭespite over two decades of work to curb transmission of HIV among men who have sex with men (MSM) and much recent work to address the specific needs of young MSM (YMSM), the epidemic continues ( Catania et al., 2001 Wolitski, Valdiserri, Denning, & Levine, 2001). Further, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population-specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer sex intentions).