Gay identity-related factors and sexual risk among men who have sex with men in San Francisco.

This study explored the relationship between gay identity-related factors (gay community involvement, gay bar attendance, gay identity importance, and self-homophobia) and unprotected anal sex (UA) in the past 3 months among men who have sex with men (MSM) of three different race/ethnicity groups. Four hundred eighty-three MSM (mean age 34) were recruited in the San Francisco Bay Area (33% African American, 34% Latino and 33% White). Compared with White MSM, African American and Latino MSM were less likely to identify as gay, and to attend gay bars/clubs, and more likely to report self-homophobia. Just over one third of the sample reported UA (did not vary by race). Gay community involvement was associated with receptive UA with all partners (adjusted odds ratio [AOR = 1.30, 95% Confidence Interval (CI) = 1.06-1.60). Gay bar attendance was associated with insertive UA with all partners (AOR = 1.20, 95% CI = 1.01-1.43) and with HIV-discordant partners (AOR = 1.35, 95% CI = 1.08-1.69). Implications for prevention include addressing community norms and encouraging alternatives to bars as settings in which to meet and socialize with other MSM.