Modeling Interpersonal Correlates of Condomless Anal Sex among Gay and Bisexual Men: An Application of Attachment Theory

The existing literature has identified that beliefs about the interpersonal meaning of condom use are a significant predictor of condomless anal sex (CAS). Some have suggested that condom use in this context may function as a form of nonverbal communication. This study utilized attachment theory as a framework and tested a hypothesized model linking adult attachment to CAS through communication skills and condom expectancies. An online survey was completed by 122 single, HIV-negative gay and bisexual (GB) men living in the U.S. They completed measures of adult attachment (anxious and avoidant), condom expectancies regarding intimacy and pleasure interference, communication skills, self-assessed mate value, and recent CAS with casual partners. There was a significant, positive bivariate association between anxious attachment and receptive CAS. In path model analyses, two over-arching pathways emerged. In the other-oriented pathway, anxious attachment, self-perceived mate value, and emotional communication predicted the belief that condoms interfere with intimacy. In turn, intimacy interference expectancies were positively associated with the odds of receptive CAS. In the self-oriented pathway, assertive communication skills mediated a link between avoidant attachment and the belief that condoms interfere with sexual pleasure. Pleasure interference expectancies were positively associated with the odds of insertive CAS. The findings highlight the importance of relational or interpersonal concerns in sexual risk-taking among single GB men. Attachment theory may serve as a framework for organizing these interpersonal correlates of CAS. Results are consistent with the conceptualization of condom use as a form of nonverbal attachment-related behavior. Implications for sexual health and risk-reduction interventions are explored in this context.