Consumption of Gay Sexually Explicit Media among Men who have Sex with Men in the U.S

Background: How does what we see influence what we do? This study sought to study consumption patterns of gay-oriented sexually explicit media (SEM) by men who have sex with men (MSM); and to investigate a hypothesized relationship between gay SEM consumption and HIV risk behavior. 

Methods: Participants were 1391 MSM living in the US recruited online to complete a SEM consumption and sexual risk survey. We build linear, quadratic, quadratic term and nominal models to assess the relationship between gay SEM consumption and HIV risk behavior

Results: Almost all (98.5%) reported some gay SEM exposure over the last 90 days, with 97.8% reporting watching online. Median dosage was 24.9 minute per day or 2.9 hours per week. While 41% reported a preference to watch actors perform anal sex without condoms (termed “bareback SEM”), 17% preferred to watch actors perform anal sex with condoms (termed “safer sex SEM”) and 42% reported no preference.  Overall SEM consumption was not associated with HIV risk; however, participants who watched more bareback SEM and/or who preferred bareback SEM reported significantly greater odds of engaging in risk behavior. 

Conclusions:  Gay SEM consumption appears normative and extremely common among MSM. While SEM consumption does not predict risk, a preference for bareback SEM and greater exposure to bareback SEM was associated with increased risk behavior. In advancing HIV prevention for MSM, research to investigate causality and to identify new ways to use SEM in HIV prevention, is recommended.