Adrian Zegada Nudes

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Date of Birth: September 7

This study sought, first, to study consumption patterns of gay-oriented sexually explicit media (SEM) by men who have sex with men (MSM); and second, to investigate a hypothesized relationship between gay SEM consumption and HIV risk behavior. While older studies used the term “pornography” for SEM, more recent studies (1, 2), including those by our team, have replaced “pornography” with SEM, given that the terms “pornography” or “porn” have become value-laden with highly negative connotations for some people (3). In defining SEM, we use Hald’s (4) definition as “any kind of material aiming at creating or enhancing sexual feelings or thoughts in the recipient and, at the same time, containing explicit exposure and/or descriptions of the genitals and clear and explicit sexual acts.”

Visual depictions of male-male sex date back at least 2,500 years (5). Commentators note SEM has “always had an exalted position in gay culture” (6), is highly acceptable to gay men (7), and ubiquitous in the gay community (8). Economically, in 2007, it was estimated that gay SEM constituted 33–50 of all revenue generated by the adult industry (6, 8, 9). Extrapolating these figures, in the US the gay SEM market is a $1.3–6.5 billion industry annually (3). Producers of gay SEM claim its role in validating homosexuality, creating an outlet for desire and exploration, and strengthening community (10). Other researchers have noted that SEM may play a positive role in young MSM’s development and sexual education (11–13), with young MSM describing SEM as a major source of sexual information (14).

While these papers have highlighted the benefits of SEM, others have expressed concern at potential negative health effects. In particular, Tydén and Rogala (15) speculate on the effects of gay SEM consumption on HIV risk behavior. “All the [HIV prevention] efforts to modify sexual behavior by increasing condom use and increasing risk awareness may be jeopardized by the global pornography industry through its efficient distribution channels, such as internet, cable television and videos, where amongst others, ‘unsafe sex’ is promoted.” (p. 590).

Compared to heterosexual SEM, gay SEM is more likely to depict condoms (16). In the late 1980s, the major gay SEM producers in the USA committed to show all anal sex between men depicting condoms (17, 18). This self-imposed industry standard lasted for about a decade before the re-emergence of SEM depicting unprotected anal sex between men, dubbed “bareback SEM” (19). Since then, the use or non-use of condoms in gay SEM has remained controversial, with industry safer sex advocates arguing to retain the standard both to protect actors and to model safer sex behavior, while others argue that consumer demand and competition from amateur SEM producers necessitate bareback production (20).

Little empirical research has investigated the effects of gay sexually explicit media (SEM) on the health and HIV risk behavior of men who have sex with men (MSM) (3). We lack solid empirical data that enumerates what effect, if any, gay SEM consumption has on HIV risk behavior as only a handful of studies have been published on the association between SEM and HIV sexual risk behaviors or attitudes in MSM. In these studies SEM consumption or specific SEM genres have been found to be positively associated with finding anal sex activities appealing, having sex with two or more men at the same time and engaging in unprotected anal intercourse (8, 13, 21–23). Further, use of SEM during partnered sex among MSM has been found to be negatively correlated with condom use during first intercourse with the most recent partner and positively correlated with experience with group sex (24). Major shortcomings pertaining to this previous research include small sample sizes, highly biased sampling procedures, unusual eligibility criteria, restriction of samples to certain local urban areas rather than nationwide, focus on attitudes rather than behavior, measurement of SEM exposure as times (versus duration), a failure to differentiate between accidental and intentional exposure (3, 8, 23).

In the largest study to date, Stein et al.(23) investigated SEM consumption in “high risk” MSM in New York (N=2,552). After excluding men in monogamous relationships and those not reporting anal intercourse, 821 (32) provided both information on their SEM consumption and risk behavior with casual male partners. Almost all participants reported viewing gay SEM (99), with 95 reporting seeing depictions of protected anal intercourse (PAI) and 94 reporting viewing unprotected anal intercourse (UAI). The median time spent viewing gay SEM per week was 60 minutes. The media used for gay SEM were the Internet (96), digital video disks or DVDs (57), magazines (18) and other media (2). Over half (55) reported that viewing SEM influenced their sexual behavior, with increasing percentages of viewing UAI in gay SEM associated with increasing odds of engaging in UAI. The authors concluded that viewing SEM depicting UAI was significantly associated with engaging in UAI for high risk MSM. Limitations of the study included partial recruitment from gay SEM sites, the study having unusual eligibility criteria (restricting the sample to high risk MSM), and the study being limited to one urban epicenter, all of which may limit generalizability of findings.

Research on preferences in viewing safer sex versus bareback SEM has the potential to advance our understanding of the reasons why MSM engage in safer sex and unsafe sex. From script theory (25), to the extent that viewing SEM may influence preferences for sex, depictions of safer sex may prompt or reinforce consistent condom use and depictions of unsafe sex may prompt or reinforce inconsistent or non-condom use. The most commonly cited reasons for condom use in actual sexual encounters include prevention of HIV and sexually transmitted diseases (26, 27) and for HIV-positive men, altruism (26, 28). The most commonly cited reasons for non-condom use include personal pleasure, physical sensation and a belief that condoms spoil sex (27, 29, 30). But personal protection or pleasure do not explain preferences for viewing or not viewing condoms in gay SEM. Thus, to advance long-term HIV prevention strategies, we were interested in discovering whether MSM have preferences for or against viewing condoms in gay SEM. In addition we were interested in what relationship, if any, exists between such preferences and HIV risk.

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