Predictors of long-term maintenance of safer sex and lapse/relapse: A nine-year follow-up of the chicago CCS/MACS cohort

Understanding the antecedents of long-term patterns of sexual risk behavior is important for HIV/AIDS prevention research. This study assessed various psychosocial and demographic predictors of safer anal intercourse maintenance and of lapses to unsafe sex between 1984 and 1993 among 906 homosexually active men from the Chicago Coping and Change Study/MACS cohort. Semiannual self-reports of sexual activities were used to classify anal intercourse behavior patterns over a series of 2-year intervals. Two sorts of safer sex were evaluated: (1) definite safety, consistent condom use with all partners or abstinence and (2) modified safety, a broader standard that also included unprotected anal intercourse limited to a monogamous relationship. Results showed that the percentage of men who maintained definitely safe behavior increased from 16% of participants after the first 2 years of study to almost 63% during the 8th and 9th years (38% to 82% rates for modified safety). Lapses from definite safety peaked at 22% during the 3rd and 4th years, and 41% of the men lapsed from unfailing condom use at least once during the study (29% lapsed or relapsed by modified-safety criteria). Key predictors of long-term propensities (9-year rates)-both maintaining safer sex and lapse/relapse-included consistency of participation (a possible marker for behavior change intentions), predisposition toward risk taking, and age. Thus, personality traits that determine a person's level of commitment to behavior change, tendencies for risk taking, and age need to be considered when designing effective long-term HIV prevention interventions.