Psychological Factors and Decisional Balance to Use Condoms among Young Gay and Bisexual Men: Differences across Race and Ethnicity

Background: Young gay and bisexual men (YGBM; ages 18–24) are experiencing an increase in rates of HIV infection, with Black and Latino YGBM experiencing higher infection rates than White YGBM. Psychological factors are often implicated in YGBM’s HIV/AIDS risk behaviors. However, YGBM’s decision to forego condoms with a partner (i.e., decisional balance to use condoms; DBC) across racial/ethnic groups is inconclusive in the literature.

Methods: Using data from a cross-sectional web-survey of single YGBM across the United States (N=1380; ages 18-24; 9.9% Black; 18.6% Latino; 71.5% White), we performed three race-specific multivariate regression models to explore the association between psychological factors (i.e., depression, anxiety) and DBC, after adjusting for YGBM’s age and their perceived difficulty to implement safer-sex strategies.

Results: Latino participants were significantly more likely to have higher depressive symptoms in the last week than Black participants, and more likely to have higher anxiety symptoms than White and Black participants. In our race-specific regression analyses, we found that greater symptoms of depression were associated with lower DBC to use condoms among Black participants (b =-.268). Greater anxiety symptoms was associated with greater DBC to use condoms among Latinos (b =.207).  We found no association between psychological variables and DBC among White participants.

Conclusions: Psychological factors may be differentially associated with decisional balance to use condoms across racial and ethnic group categories. Health promotion initiatives around condom use may benefit from culturally-tailored interventions that address psychosocial functioning and its role in YMSM's condom use decision-making.