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Generational Perspectives on Sex Positions and HIV Risk in Black Gay & Bisexual Men, Study

People behave differently as they age – including how they protect themselves from HIV infection. A recent study found that gay and bisexual men in younger generations often feel compelled to “bottom” and engage in unprotected anal sex, while men in older generations feel more comfortable advocating for their preferred sexual position and using condoms.

The study findings, which will soon be published in AIDS and Behavior, include interviews with 26 Black gay and bisexual men of various ages recruited from a community center in Los Angeles that supports LGBT people of color. Since condomless receptive anal intercourse (“bottoming”) increases men’s risk of becoming infected with HIV, researchers set out to understand men’s perspectives about why they have bottomed in the past. For many men, not using condoms and bottoming was generational.

Participants mentioned that getting older made them start paying more attention to sexual health, including using condoms more often. Two participants reflected on their perceptions of condoms as teenagers:

“Being that I didn’t ever heard nothing about HIV, I didn’t know what the point of condoms were…” said the first participant. “The only thing I ever heard about condoms in the past was it prevents pregnancy, … and I’m like, well if two guys can’t have no babies, so I didn’t think it was a big deal.”

“When you’re that young, you don’t see the point of condoms until you start getting older,” added the second participant. “You don’t start seeing the importance of condoms until you get older, you know, people start catching AIDS and all these different diseases.”

Getting older changed men’s perspectives about their lives in areas other than sexual health, too. Another participant noted:

“[When] you get older, you think about things you don’t normally think about. I was more protective of myself in my 30s than I was in my 20s because I was older.”

Participants under 30 years of age described having condomless sex with partners to establish trust and pursue long-term relationships. For younger participants, taking sexual risks was a means to secure an ideal romantic partner. One participant noted:

“I think that I wasn’t using condoms… because I was wanted to trust the other person. That’s really the main goal to all of this is to find a long-term partner… it’s the intimacy level, you know.”

As people get older, they felt more empowered to assert their sexual preference especially when it came to topping their sexual partners. One participant discussed:

“Learning that I don’t have to do what somebody else wants me to do… if I don’t like getting fucked, although I did do it, and as I got older it wasn’t even about top or bottom to me, it was about good sex.”

These men also reflected on how they attached emotional meaning to their sexual positioning practices with partners. Describing his preference to top when he was younger, one man mentioned:

“I enjoyed it, but I felt that people wanted me more if they topped me, so that’s why I would let them do that more, because it felt like they were more connected to me in that way.”

Many men also described relying on body language and masculinity stereotypes as cues to determine whether they would top or bottom. If their partner was muscular or “thuggish,” they were more likely to bottom.

Derek Dangerfield II, the lead author of the study and postdoctoral fellow at Johns Hopkins School of Nursing, described how the findings of this study could improve public health programs.

“Utilizing the life course framework,” said Dangerfield, “could help programs and providers better assess the most vulnerable periods in client lives to provide better timing of interventions such as PrEP.”

The results of this study suggest that HIV prevention interventions for gay and bisexual men should include training on how to negotiate sexual positioning and condom use with partners. Dangerfield cautioned that readers should not interpret the study as criticizing sexual behaviors or people who bottom without condoms.

“Readers should understand that we are not pathologizing the sexual behaviors of gay bisexual or other men who have sex with men,” added Dangerfield. “We rather are shedding light on the psychological and social issues that could increase vulnerabilities to infections as men engage in sexual relationships.”

Almost half of the men in the study reported a history of child sexual abuse before they reached the age of 12. Many of these men connected their difficulty negotiating sex positions with their previous experience of abuse. As one participant described, “it’s almost like déjà vu.”

Altogether, these results show that researchers need to pay more attention to issues of generational differences and childhood sex abuse when studying sexual behavior and HIV risk.