A Theory-Based Exploration of Condomless Anal Intercourse Intention Among Young Men Who Have Sex with Men of Different Sexual Roles in Taiwan
- 110 Downloads
In recent years, men who have sex with men (MSM) have accounted for over 80% of all new HIV cases in Taiwan. More than 70% of new cases have occurred in those aged 15–34 years. Condomless anal intercourse (CAI) has been identified as the main route of HIV transmission among MSM. To systematically examine CAI intention and associated factors among young MSM in Taiwan, an anonymous online survey based on the Theory of Planned Behavior (TPB) was conducted. Data from 694 MSM aged 15–39 years were included in the analysis. This study found that, overall, all five TPB factors (i.e., attitudes toward positive and negative outcomes regarding CAI, perceived support for CAI from important others, and perceived behavioral control of CAI under facilitating and constraining conditions) were significantly associated with CAI intention. When data were stratified by sexual role (i.e., receptive, versatile, and insertive), the associations between TPB factors and CAI intention varied. Of the five TPB factors, positive attitudes toward positive outcomes regarding CAI were most strongly associated with high CAI intention (AOR 5.68 for all young MSM; AOR 3.80–15.93, depending on sexual role). Findings from this study could inform the development of theory-driven HIV prevention programs as well as future research and practice. These results also highlight the importance of tailoring HIV prevention initiatives for young MSM of different sexual roles to optimize the program effectiveness.
KeywordsCondomless anal intercourse Men who have sex with men (MSM) Theory of Planned Behavior Sexual roles HIV Taiwan Sexual orientation
Preparation of this manuscript was supported in part by grants MOST 103-2410-H-002-225-MY2, NSC 102-2410-H-002-220-, and NSC 100-2410-H-002-174-MY2 from the Ministry of Science and Technology, Taiwan (formerly, National Science Council) awarded to Dr. Jiun-Hau Huang.
- Calabrese, S. K., Reisen, C. A., Zea, M. C., Poppen, P. J., & Bianchi, F. T. (2012). The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men. AIDS Patient Care and STDs, 26, 430–435. doi: 10.1089/apc.2011.0428.CrossRefPubMedPubMedCentralGoogle Scholar
- Cheng, W., Tang, W., Zhong, F., Babu, G. R., Han, Z., Qin, F., & Wang, M. (2014). Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: Implication of a serial cross-sectional study in Guangzhou., China. BMC Infectious Diseases, 14, 696. doi: 10.1186/s12879-014-0696-8.CrossRefPubMedPubMedCentralGoogle Scholar
- Chow, E. P., Chen, X., Zhao, J., Zhuang, X., Jing, J., & Zhang, L. (2015). Factors associated with self-reported unprotected anal intercourse among men who have sex with men in Changsha city of Hunan province, China. AIDS Care, 27, 1332–1342. doi: 10.1080/09540121.2015.1058892.CrossRefPubMedGoogle Scholar
- Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health, 6, 505–518. doi: 10.1177/1557988312455214.CrossRefPubMedPubMedCentralGoogle Scholar
- Koerner, J., Shiono, S., Ichikawa, S., Kaneko, N., Tsuji, H., Machi, T., & Onitsuka, T. (2012). Factors associated with unprotected anal intercourse and age among men who have sex with men who are gay bar customers in Osaka, Japan. Sexual Health, 9, 328–333. doi: 10.1071/SH11081.CrossRefPubMedGoogle Scholar
- Kramer, S. C., Schmidt, A. J., Berg, R. C., Furegato, M., Hospers, H., Folch, C., & Network, E. (2016). Factors associated with unprotected anal sex with multiple non-steady partners in the past 12 months: Results from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS 2010). BMC Public Health, 16, 47. doi: 10.1186/s12889-016-2691-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Li, D., Li, C., Wang, Z., & Lau, J. T. (2015). Prevalence and associated factors of unprotected anal intercourse with regular male sex partners among HIV negative men who have sex with men in China: A cross-sectional survey. PLoS ONE, 10, e0119977. doi: 10.1371/journal.pone.0119977.CrossRefPubMedPubMedCentralGoogle Scholar
- Lim, S. H., Bazazi, A. R., Sim, C., Choo, M., Altice, F. L., & Kamarulzaman, A. (2013). High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia. Sexually Transmitted Infections, 89, 642–649. doi: 10.1136/sextrans-2012-050995.CrossRefPubMedGoogle Scholar
- Lim, S. H., Guadamuz, T. E., Wei, C., Chan, R., & Koe, S. (2012). Factors associated with unprotected receptive anal intercourse with internal ejaculation among men who have sex with men in a large Internet sample from Asia. AIDS and Behavior, 16, 1979–1987. doi: 10.1007/s10461-012-0233-y.CrossRefPubMedPubMedCentralGoogle Scholar
- Meng, X., Zou, H., Fan, S., Zheng, B., Zhang, L., Dai, X., & Lu, B. (2015). Relative risk for HIV infection among men who have sex with men engaging in different roles in anal sex: A systematic review and meta-analysis on global data. AIDS and Behavior, 19, 882–889. doi: 10.1007/s10461-014-0921-x.CrossRefPubMedGoogle Scholar
- Prabawanti, C., Dijkstra, A., Riono, P., & Hartana Tb, G. (2014). Preparatory behaviours and condom use during receptive and insertive anal sex among male-to-female transgenders (waria) in Jakarta, Indonesia. Journal of the International AIDS Society, 17, 19343. doi: 10.7448/IAS.17.1.19343.CrossRefPubMedPubMedCentralGoogle Scholar
- Tang, W., Huan, X., Mahapatra, T., Tang, S., Li, J., Yan, H., & Detels, R. (2013). Factors associated with unprotected anal intercourse among men who have sex with men: Results from a respondent driven sampling survey in Nanjing, China, 2008. AIDS and Behavior, 17, 1415–1422. doi: 10.1007/s10461-013-0413-4.CrossRefPubMedGoogle Scholar
- TCDC. (2016). Statistics of HIV/AIDS 2014-2016. http://www.cdc.gov.tw/professional/downloadfile.aspx?fid=CF697A305BCC94CF.
- Wagner, G. J., Tohme, J., Hoover, M., Frost, S., Ober, A., Khouri, D., & Mokhbat, J. (2014). HIV prevalence and demographic determinants of unprotected anal sex and HIV testing among men who have sex with men in Beirut, Lebanon. Archives of Sexual Behavior, 43, 779–788. doi: 10.1007/s10508-014-0303-5.CrossRefPubMedPubMedCentralGoogle Scholar
- Zhang, H., Lu, H., Pan, S. W., Xia, D., Zhao, Y., Xiao, Y., & Shao, Y. (2015). Correlates of unprotected anal intercourse: The influence of anal sex position among men who have sex with men in Beijing, china. Archives of Sexual Behavior, 44, 375–387. doi: 10.1007/s10508-014-0396-x.CrossRefPubMedGoogle Scholar