'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men.

BACKGROUND

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission.

PURPOSE: This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM.

METHODS

AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed.

RESULTS

Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both.

CONCLUSIONS

Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.