Beyond the Sexual Monad: Combining Complementary Cognitions to Explain and Predict Unsafe Sex among Gay Men

Successful HIV prevention depends on delivering messages appropriate for specific, targeted audiences. In this article we document the existence of three naturally-occurring clusters of Flemish gay men based on their patterns of participation in eight forms of sexual behavior. MANOVA and discriminant analysis indicate that the clusters differ significantly in the assessment of both the pleasures and dangers of unprotected penetrative sexual practices. The complementarity of group differences underscores the critical importance of the dyadic dynamics in the etiology of risk taking with respect to the potential transmission of HIV during a sexual encounter. This dyadic approach to understanding risky behavior is contrasted with the individualistic paradigms which currently dominate the field of AIDS prevention research. We find that most of the social and psychological variables used in previous models lose their explanatory power when they are analyzed using groups based on sexual style rather than on the etic dimension of riskiness. The implications of the findings for the design of HIV interventions are discussed.