Use of a life course approach in assessing sexual risks among men who have sex with men

Background. Sexual health promotion requires a comprehensive approach to the interaction of multiple components associated with sexuality. Understood within this context, variability in sexual risk is mediated by multiple factors that can independently affect outcomes, presenting substantial problems for understanding this interaction. Methods. A life course approach was incorporated in a study of men who have sex with men (MSM) because it provides a useful theoretical foundation for managing these types of complexities. This approach considers the personal histories of individuals and the timing of their lives in history, as well as the social and cultural systems in which they are embedded, and thus provides a potent tool for managing the complexity of interacting biological, behavioral, and psychosocial processes across the lifespan. Results. The use of a life course approach, rather than a conventional linear approach, improved our ability to assess the interaction between age and sexual risk. Analysis of chronological age alone did not illuminate the understanding of sexual risk in this group, in part because the types of pressures associated with the life course among HIV+ MSM including challenges related to partner selection, HIV-status disclosure, and the use of drugs for sexual performance that are not necessarily uniformly distributed in relation to age. Conclusions. Incorporating a life course approach can lead to a better understanding of the role of, and interaction between different pathways related to health disparities among MSM and other vulnerable populations and contribute to improved public health response.