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. 2025 May 29.
doi: 10.1007/s10461-025-04753-4. Online ahead of print.

The Effect of Behavioral Regulation on Condomless Anal Sex Among Young Sexual Minority Men: Influences of Sex-Related Substance Use, Partnership Type, and PrEP Use

Stephen D Ramos  1   2 , Bryce F Stamp  3 , Kimberly A Powers  3 , Lisa Hightow-Weidman  4 , Erik D Storholm  5 , Zachary R Soberano  4 , Jacob B Stocks  4 , Matthew T Rosso  4 , Keith J Horvath  6
Affiliations

The Effect of Behavioral Regulation on Condomless Anal Sex Among Young Sexual Minority Men: Influences of Sex-Related Substance Use, Partnership Type, and PrEP Use

Stephen D Ramos et al. AIDS Behav. .

Abstract
in English, Spanish

The disproportionate HIV burden among young sexual minority men (YSMM) necessitates the study of neurodevelopmental decisional factors impacting transmission-relevant behaviors. We investigated the impact of behavioral regulation on condomless anal sex among YSMM, considering PrEP use, partnership type, and substance use as potential effect measure modifiers. YSMM (n = 120) completed an online baseline survey assessing behavioral regulation, PrEP use, and sociodemographics, and digital daily surveys on sexual behaviors, substance use, and partner type over eight weeks. We used modified Poisson regression, controlling for age, race, ethnicity, and education, to examine the relationship between behavioral regulation index (BRI) scores and condom use during anal sex. We used interaction terms to assess effect measure modification by substance use before or during sex and partnership type, stratified by PrEP use status. Difficulties in behavioral regulation (higher scores) increased the probability of condomless sex while using substances, but this association was not present in the absence of substance use. Behavioral regulation difficulties also contributed to a higher probability of condomless sex with main partners among PrEP non-users. Higher BRI scores were linked to condomless sex in particular contexts (i.e., sex with substances or main partners). These findings highlight the complex relationships between behavioral regulation and sexual behavior in the context of biomedical HIV prevention options and relationship dynamics for YSMM.

La carga desproporcionada del VIH entre los hombres jóvenes de minorías sexuales (YSMM) requiere el estudio de los factores de decisión del neurodesarrollo que impactan los comportamientos relevantes para la transmisión. Investigamos el impacto de la regulación conductual en el sexo anal sin condón entre YSMM, considerando el uso de PrEP, el tipo de pareja y el uso de sustancias como posibles modificadores de la medida del efecto. YSMM (n = 120) completó una encuesta de referencia en línea que evaluó la regulación conductual, el uso de PrEP y los datos sociodemográficos, y encuestas diarias digitales sobre comportamientos sexuales, uso de sustancias y tipo de pareja durante ocho semanas. Utilizamos la regresión de Poisson modificada, controlando por edad, raza, etnia y educación, para examinar la relación entre las puntuaciones del índice de regulación conductual (BRI) y el uso del condón durante el sexo anal. Utilizamos términos de interacción para evaluar la modificación de la medida del efecto por el uso de sustancias antes o durante el sexo y el tipo de pareja, estratificado por el estado de uso de PrEP. Las dificultades en la regulación conductual (puntuaciones más altas) aumentaron la probabilidad de sexo sin condón mientras se consumen sustancias, pero esta asociación no estaba presente en ausencia de consumo de sustancias. Las dificultades para regular la conducta también contribuyeron a una mayor probabilidad de tener relaciones sexuales sin preservativo con sus parejas principales entre quienes no usaban PrEP. Las puntuaciones más altas en el BRI se asociaron con las relaciones sexuales sin preservativo en contextos específicos (es decir, relaciones sexuales con sustancias o con parejas principales). Estos hallazgos resaltan la compleja relación entre la regulación de la conducta y la conducta sexual en el contexto de las opciones biomédicas de prevención del VIH y la dinámica de las relaciones en los YSMM.

Keywords: Behavioral regulation; Condomless sex; Substance use; Young sexual minority men.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no financial or non-financial interests to disclose that are directly or indirectly related to the work submitted for publication. Ethical Approval: All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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