Cognitive Escape From Discrimination and Hate Crimes Related to Increases in Sexual Risk

Introduction: During much of the twenty-year history of research on high-risk sexual behavior there has been a great deal of focus on rational decision-making processes as they relate to decisions around sex. These models of sexual risk behaviors have, in turn, engendered the use of prevention models that emphasize rationality. More recently, models of high-risk sexual behaviors have begun to examine more contextual and affective factors. One such model includes the cognitive escape model. In the cognitive escape model, non-rational, affective processes act in concert with contextual issues to influence risk-taking behavior and decision-making. In this model, awareness of HIV risk arouses anxiety and other negative affect leading people to ‘cognitively disengage’ within sexual situations and failure to follow intentions toward sexual safety. Discrimination related to sexual orientation may also induce a need for cognitive escape. This study examines the relationship between perceived discrimination due to sexual orientation, reported hate crimes in a community and various high-risk sexual behaviors as mediated through negative affect and sex after excessive alcohol use.  

Methods: A community sample of 109 men who self-identifed as gay were recruited from 15 different metropolitan areas to participate in an online survey regarding gay-related discrimination, various risk related behaviors, and affect. Participants were asked to report on these as experienced within the past month. Rates of hate crimes in each of the 15 metropolitan areas were calculated from the United States Uniform Crime Report covering the same time period as the study. The total sample was ethnically diverse, with 22% reporting a non-white racial category and participants ranged in age from 18 to 61 years old (M=37.4, SD=11.11).  

Results: Results from a path analysis show that number of male sexual partners were related to perceptions of gay-related discrimination (b=0.25, p<0.001) and to negative affect (b=-0.05, p<0.001). Total reported number of unprotected anal sexual acts was related to rate of reported hate crimes (b=4.46, p=0.006) and sex after too much to drink (b=1.25, p<0.001). Negative affect and sex with alcohol were also negatively related (b=-1.19, p=0.002). Negative affect mediated paths between discrimination and number of male partners (b=-0.05, p=0.04). The relationship between perception of discrimination and number of male sexual partners was mediated through both sex after drinking and negative affect (total indirect effect: b=0.03, p=0.03).

Conclusions: Results suggest that perceptions of discrimination and actual rates of hate crimes in a community are related to individual sexual behaviors. These relationships appear to be mediated by negative affect and through combining sex with alcohol in such a way that negative affect is reduced but results in increased sexual risk behavior.  The need to escape affect associated with discrimination may be an effective target for HIV prevention efforts.