Assessing Motivation for Condom Use Among MSM: Effort Discounting as a Novel Measure of Sexual Risk

Abstract

Among men who have sex with men (MSM), motivation for condom use in sexual situations varies as a function of trait-level characteristics and state-level contextual factors. To-date, however, condom use motivation has been assessed in cross-sectional research designs by single use, questionnaire-based self-report measures. This study describes the development and validation of a novel sexual effort discounting task that was designed to rapidly assess individual differences in motivation for condom use by measuring how much effort a participant would invest into acquiring a condom prior to engaging in anal intercourse with a partner of unknown HIV and STI status. The task was repeatedly administered as part of an ecological momentary assessment (EMA) study of condom use motivation to a pilot group of 55 MSM who regularly engaged in risky sexual behavior. Results demonstrated good reliability across administrations, and validity was supported by significant longitudinal associations with daily fluctuations in motivation to use condoms, significant correlations with self-reported sexual behavior, condom use, and cognitions related to condom use (e.g., intentions to use condoms), and significant positive associations with performance on a newly-developed EMA version of the well-established Sexual Delay Discounting Task (Johnson and Bruner in Drug Alcohol Depend 123:15-21, 2012). Use of the novel sexual effort discounting task may allow for greater insight into how differing levels of motivation for condom use may impact sexual decision-making among MSM, both in terms of indexing individual differences in motivation for condom use and assessing the impact of changing contextual variables on motivation in repeated-measures research designs.

Keywords: Condom use; Ecological momentary assessment; Effort discounting; Men who have sex with men; Motivation.