Adult Attachment Insecurity As a Predictor of Sexual Risk Behavior Among Young Black Men Who Have Sex with Men

Introduction: In 2009, 63% of young men who have sex with men (MSM) living with HIV were Black. Although researchers have examined how social support and social networks promote healthy behaviors and decrease vulnerability to HIV, few have examined how affective features of sexual relationships may promote or hinder HIV prevention intervention efforts.  Better understanding these complex social relationships may influence the HIV/AIDS prevention and care needs of young Black MSM (YBMSM).  This mixed-methods study uses an explanatory sequential design to examine the relationship between attachment insecurity, the in ability to create secure close relationships with others, and sexual risk behavior among YBMSM.

Method: Data were collected from a sample of YBMSM living in New York City.  Participants completed an 8-week Web-based diary study. A modified version of the Experiences in Close Relationships Scale (ECR) was used to assess adult attachment insecurity at baseline.  The weekly diary collected weekly reports of unprotected anal intercourse (UAI) and serodiscordant UAI (SD-UAI).  Generalized estimating equation (GEE) models assessed the relationship between the baseline measurements of attachment insecurity and weekly UAI and SD-UAI.  A subsample of 30 men also completed a 60-minute semi-structured interview. The qualitative data were coded and analyzed using a thematic inductive analysis technique to further explore potential linkages between attachment and sexual risk behaviors among YBMSM.

Results: The average age of participants was 25 years old. Men who were avoidantly attached showed a trend towards being more likely to have had UAI during the 8 weeks of the study (OR = 1.17, p < .10). There was no significant association between attachment and SD-UAI.  The qualitative data suggested that factors such as relationship satisfaction, perceived support from a sexual or intimate partner, and relationship type (e.g., casual sexual relationship vs. monogamous relationship) may be pathways by which the relations between attachment avoidance and sexual risk behavior are associated. 

Conclusion: The qualitative findings extended the quantitative findings by helping to achieve a deeper understanding of attachment insecurity and intimate partnerships. Study findings suggest that a closer examination of the process by which individual differences in attachment insecurity impact the lives of YBMSM’s sexual behavior is necessary.