Transitions in romantic ideations associated with transitions in condomless sex among emerging adult gay, bisexual, and other YMSM: The P18 cohort study

Background: Emerging adult gay and bisexual men continue to experience increasingly high rates of HIV.  Many researchers have begun to examine how features of romantic relationship ideation influence sexual behavior; however, many of these studies have been cross-sectional in nature and therefore have not been able to assess the longitudinal relationship between romantic relationship ideations and HIV risk.

Methods: The analytical sample was drawn from four waves of an ongoing prospective cohort study of YMSM (N = 528; Mage = 22) who were assessed every 12-months for 3 years.  Sexual risk behaviors (i.e. condomless insertive, receptive, and total sex) and romantic relationship ideations (i.e. being in control over relationship functioning and being afraid of never finding a romantic partner) were assessed using a timeline follow-back method. Latent growth curve modeling with a Poisson distribution was utilized to assess how changes in romantic ideations were associated with changes in sexual risk behaviors.

Results: Results suggest that frequency of sexual risk behaviors increased over time.  Perceptions of greater romantic relationship fear were associated with an increased likelihood of having total, insertive, and receptive condomless sex over time.  Further, perceptions of greater relationship control were associated with the decreased likelihood of total and insertive condomless sex over time. 

Conclusion: Findings suggest that there are key transitions in perceptions of romantic relationships that may inform decisions around sexual risk taking among emerging adult MSM.  We discuss specific implications for conceptualizing the role of romantic relationship within a holistic framework for HIV prevention programming.