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Bubblylife2 50, Brisbane - Southside, QLD Looking for someone to share my love of life and all that it has to offer and hopefully have some fun along the way. Several studies are also limited by the inclusion of a small number of potential largely demographic covariates; therefore, this work has identified few potential mechanisms by which SEM may contribute to condomless anal sex.
Although the viewing of condomless anal sex in SEM has been previously examined, no prior studies have examined the converse—whether viewing SEM containing anal sex in which condoms were used is associated with greater condom use during anal sex. Given these limitations, additional research is greatly needed. It extends the prior research by examining whether viewing SEM including total amount viewed, compulsive viewing, proportion containing condomless anal sex, and proportion containing anal sex with condoms is associated with more condomless anal sex encounters and whether this association holds after imposing relevant covariates.
Eligible men had to: A total of individuals consented to participate in the study. Finally, 7 eligible surveys were identified as duplicate respondents based on identical IP addresses, followed by matching of participant characteristics.
The duplicate surveys were removed resulting in a final sample of participants for analysis. Participants were recruited via advertisements on Craigslist and Facebook between June and November Elements of time-space sampling [ 12 ] were used to post study advertisements on Craigslist, a highly popular website used by MSM to meet sexual partners [ 13 , 14 ]. We used a random digit generator to select a one-hour increment of time, a geographic location, and a Craigslist category i.
Then, an advertisement was posted at the selected hour, in the appropriate city and category. Recruitment occurred twice a day between the hours of 8: Study advertisements instructed anyone interested in participating to reply and request a link to the Internet survey, which was immediately provided through an automated response from a study e-mail account. To target a broader audience of MSM, Facebook advertisements were also employed.
Facebook is a highly efficient and cost-effective method of recruiting MSM for surveys [ 15 , 16 ]. Individuals who clicked on the study advertisement were taken directly to the online survey. Participants were asked to report the number of times they had anal sex with a man in the past 3 months. For those who reported anal sex, a follow-up question assessed how many of those encounters did not include a condom.
Responses were scored on a 6-point scale: Unlike some past research [ 4 ], we measured and analyzed the proportion of SEM viewed that contained anal sex with a condom and anal sex without a condom as two separate variables rather than a single continuous variable because many MSM may view SEM that contains neither behavior e. Participants also completed the Sexual Sensation Seeking scale [ 18 ].
Items were scored on a 5-point scale none of the time—every time. Descriptive statistics were computed for all variables.
Because condomless anal sex was assessed as a count of the number of condomless anal encounters, we modeled this behavior using negative binomial regression [ 19 ]. Predictor variables included the proportions of Internet SEM viewed in the past 3 months that featured condomless anal sex and anal sex with condoms. Characteristics of the sample are presented in Table 1. Participants viewed, on average, five hours of SEM online per week, engaged in condomless anal sex more than seven times in the past 3 months with an average of 4 partners S1 Dataset.
Nearly everyone reported viewing any SEM online in the past 3 months that featured anal sex in which a condom was used We examined the hypothesis that the type of behaviors viewed in online SEM would be associated with more condomless anal sex encounters during the past 3 months. Bivariate and multivariate models excluded 74 men who reported no anal sex in the past 3 months and 4 additional men who failed to complete the anal sex questions.
These associations between the proportion of behaviors viewed in SEM and number of condomless anal sex encounters were significant even after accounting for a number of covariates. For example, both the number of hours spent viewing SEM online and more compulsive use of online SEM were unrelated to the number of condomless encounters. Although sensation seeking, recruitment source i. Facebook , and relationship status were associated with more condomless encounters, the proportions of SEM viewed featuring condomless anal sex and condomless anal sex encounters remained significant.
To gain additional insights into the potential causal direction between viewing SEM and sexual behaviors, as well as to identify potential mechanisms by which viewing SEM may contribute to sexual behavior, men were asked to report on how much influence SEM had on their behavior and how often viewing SEM resulted in changes in behavior, fantasies, or desires Table 3.
Most men reported that viewing SEM had influenced their sexual desires, led them to fantasize about behaviors they had viewed in SEM, and had led them to seek out sex after viewing SEM in the past 3 months. Perceived influence means are based on a 5-point scale ranging from 1 None to 5 A lot. Frequency means are based on a 5-point scale ranging from 1 None of the time to 5 Every time.
Percent agreement is based on number who reported scores of 2 or more A little—A lot; Some of the time—Every time. This study provides insight into the understudied association between viewing condomless anal sex in SEM and engaging in more condomless anal sex encounters among MSM.
In addition, the study assessed perceived influence of SEM and identified potential mechanisms by which SEM viewing may influence sexual behavior. Contrary to a frequent hypothesis in the field [ 4 , 11 ], we found that viewing more hours of SEM was not associated with more condomless encounters among MSM, thereby providing further evidence against this hypothesis [ 4 ]. Furthermore, we found that compulsive use of online SEM was also not associated with more condomless encounters.
Taken together, these two findings make clear that it is not frequent viewing of SEM in general that is associated with condomless anal sex. Although some have advocated for restricting access to SEM [ 20 , 21 ], these findings suggest that policies to limit access or reduce the viewing of all SEM are unnecessary to prevent condomless anal sex.
They also suggest that MSM who view SEM frequently or compulsively do not necessarily engage in more condomless anal sex. Thus, interventions may not be necessary to address frequent or compulsive SEM use for the purposes of reducing condomless sex. Rather than viewing SEM in general, we found that it was the specific types of behaviors viewed in SEM that were associated with condomless anal encounters.
Viewing a greater proportion of SEM that featured condomless anal sex was associated with a higher number of condomless anal sex encounters. Of critical interest here is that it was not the viewing of any condomless anal sex in SEM that was associated with condomless behaviors. This indicates that regardless of how often MSM view SEM, the proportion of condomless anal sex viewed appears to be critical to behavior. As such, it is not the chronic or compulsive use of condomless SEM that is associated with condomless sex, but even casual viewing of condomless anal sex was associated with more engagement in condomless behaviors if it was a significant proportion of the SEM that participants viewed.
Given that condomless anal sex and anal sex with condoms are portrayed with nearly equal frequency online [ 9 ], our findings, together with those of others [ 4 , 5 , 10 ], suggest that the availability of SEM online that features condomless anal sex may contribute to condomless anal sex among MSM viewers. In addition, we found that viewing a greater proportion of SEM in which performers used condoms during anal sex was associated with fewer condomless anal sex encounters.
By assessing the proportion of SEM in which condoms were used separately from SEM in which condoms were not used, we were uniquely able to identify this positive association. However, as with viewing SEM containing condomless anal sex, it is the proportion viewed that includes condom use that is associated with fewer condomless sexual encounters.
This positive association suggests that calls for restrictions on access to all SEM [ 20 , 21 ] could result in increased condomless behavior by eliminating this type of SEM. Our findings lend support to the argument for greater availability of SEM that contains anal sex in which condoms are clearly used by performers. Although correlational design cannot determine whether MSM are influenced by behaviors they view in SEM or whether MSM choose to view SEM that contains behaviors they already enjoy, our findings do offer some insights into this issue.
Specifically, questions were asked to what extent men believed that viewing SEM had influenced or changed their behaviors. These findings contradict those of some past research [ 6 , 22 ] that found MSM downplayed the contribution of SEM on their own sexual behaviors. Our findings similarly suggest potential mechanisms or pathways by which SEM could influence sexual behaviors.
Specifically, the majority of participants agreed that SEM had influenced the types of sexual behaviors they desire, led them to fantasize about engaging in behaviors similar to those viewed in SEM, acted out behaviors viewed in SEM, and led them to seek out sex immediately after viewing SEM. The validity of these perceptions is partially corroborated by recent findings that found that MSM who believed that condomless SEM influenced their condom use desires and norms were significantly more likely to engage in condomless anal sex and serodiscordant condomless anal sex [ 23 ].
These findings have implications for the SEM industry and public health efforts to regulate condom use in the industry. However, there has been a significant increase in the prevalence of condomless anal sex in Internet-based SEM [ 9 ].
Thus, the Los Angeles City Council [ 24 ] passed regulations mandating condom use among adult film performers for the purposes of occupational safety and a similar ballot initiative will be voted on statewide in California in November [ 25 ].
Our findings offer empirical evidence to inform policy makers seeking to regulate the SEM industry. First, our findings suggest that regulation or limiting access to all types of SEM is unnecessary and unlikely to result in increased condom use. In fact, a reduction in SEM in which condoms are used may result in decreased condom use. However, our finding that those who view a greater proportion of SEM containing condomless anal sex engage in more condomless anal sex encounters suggests that strategies to promote condom use in the SEM industry may have benefits.
Although condom use regulations have frequently been focused on reducing occupational HIV transmission [ 27 ], our findings suggest that such regulations could potentially be beneficial for the viewers of SEM by increasing the proportion of SEM that includes condom use.
The need for condom use regulations may not be reduced by the use of frequent HIV testing or pre-exposure prophylaxis PrEP by SEM performers, as this will still result in consumers viewing SEM containing condomless anal sex. Despite the potential benefits of increasing condom use within SEM for both performers and viewers by state or municipal governments, the potential efficacy of such regulations for reducing the availability of condomless anal sex in SEM are unclear.
Regulations may lead the SEM industry to relocate to places without such regulations including overseas locations. Such relocation may have undesirable consequences for extant industry practices such as frequent HIV testing although the limited effectiveness of frequent testing must be also acknowledged [ 27 ]. These findings also provide information for individual consumers of SEM especially those who are concerned about their own temptations to engage in condomless anal sex to make an informed decision about the types of SEM they choose to view.
Future research on whether individuals in the SEM industry or consumers themselves would be willing to produce, show, or view more SEM containing condom use and reasons against doing so are needed to more fully inform the likelihood of such efforts being successful. The study does have several limitations that require discussion.
First, the study is based on a non-probability sample. Thus, self-selection and recruitment sources may limit the generalizability of these findings. However, the majority of adults use Facebook [ 28 ], and MSM are frequent users of websites like Craigslist for sexual partnering [ 13 , 14 ]. Other limitations include that the sample is predominantly White, urban, and gay-identified; as is often the case in Internet-based research with MSM [ 14 , 30 , 31 ].
The study is also limited in that we were unable to examine whether viewing SEM would have different associations with condomless anal sex with regular partners or casual partners, serodiscordant or seroconcordant partners, or with insertive or receptive partners. Future research examining these more nuanced assessments of sexual behavior would be beneficial.
Furthermore, the growing use of PrEP for HIV prevention that occurred since the data were collected may be a critical factor to account for in future research. Despite the relatively small sample, the use of a continuous outcome served to increase the statistical power and the significant findings make clear that the analyses were not underpowered. Finally, despite the addition of questions to assess the perceived influence of SEM on sexual fantasies, desires, and behaviors, the study was cross-sectional and therefore cannot determine the causal directionality between SEM and condom use.
Future research using longitudinal methods to address causal order or qualitative methods to gain insight into the experiences of MSM and how SEM influences their behaviors would be greatly beneficial.