Body Image, Body Satisfaction, and Unsafe Anal Intercourse among Men Who Have Sex with Men

Article excerpt


The popular press and scientific community have shown increased interest in body image in men over the past several years. Pope, Phillips, and Olivardia (2000) estimated that there are more than 50 million "muscle-dissatisfied" men in the United States. Other studies suggest that exposure to media images of lean, muscular men may be contributing to this trend, causing some men to feel depressed, dissatisfied, and unable to achieve a muscular ideal (Agliata & Tantleff-Dunn, 2004; Leit, Gray, & Pope, 2002; Vartanian, Giant, & Passino, 2001).

Men who feel dissatisfied with their body may be more prone to dieting, anxiety, depression, obsessive-compulsive behavior, smoking, alcohol/drug use, and unhealthy weight loss practices such as severely restricting food consumption, binging, and excessive exercise (Barry, Grilo, & Masheb, 2002; Bohne, Keuthen, Wilhelm, Deckersbach, & Jenike, 2002; Carlat & Camargo, 1991; Carlat, Camargo, & Herzog, 1997; Phillips & Diaz, 1997; Robb & Dadson, 2002). Gay men, in particular, may feel more dissatisfied with their bodies than heterosexual men, likely due to the strong emphasis placed on appearance in the gay community (Beren, Hayden, Wilfley, & Grilo, 1996; Herzog, Newman, & Warshaw, 1991; Siever, 1994; Silberstein, Mishkind, Striegel-Moore, Timko, & Rodin, 1989; Yager, Kurtzman, Landsverk, & Wiesmeier, 1988). Depression and low self-valuation may then lead some gay men to use sex encounters as a coping strategy, without considering safer sex practices (Martin & Knox, 1997a, 1997b). A recent study of mood and sexuality in gay men by Bancroft and colleagues (2003) reported that 24% of the gay men surveyed reported increased sexual interest when they experience anxiety, while 14% of the men undergoing in-depth qualitative interviews reported reduced concern about sexual risk when depressed.

While much work has been done to identify and understand the roles of social and behavioral factors in the transmission of STIs and HIV among MSM, few studies have explored how body image may have an impact on the spread of these infections. Using data from the 1998 Men's Health and Sexuality Survey that was collected by the Minnesota AIDS Project, we conducted a secondary analysis to examine the associations of body image with high-risk sexual behavior in MSM and the role of body satisfaction as a mediator in this relationship. We focused on perceived body image in this analysis on the premise that how a person views his own body is more likely to influence his sexual behavior than actual body mass. We hypothesized that a person's body image perception combined with his degree of body satisfaction would influence sexual risk taking. Specifically, we wished to explore whether MSM who perceived themselves as underweight, overweight, or obese would be more likely to be dissatisfied with their bodies than average-weight men and, as a result, engage more frequently in UAI.



The data for this study were collected from a cross-sectional survey of gay men who attended the 2-day 1998 Twin Cities LGBT Pride Festival in Minneapolis. The Twin Cities LGBT Pride Festival typically is attended by more than 100,000 LGBT persons. The festival features social, political, and recreational activities, including child-oriented activities for the many families parented by gay men and lesbians who attend the festival.

To be eligible for inclusion in the study, men must have been 18 years of age or older, male by birth (i.e., not transgendered from female to male), and primarily residents of the Minneapolis/St. Paul area. We limited the sample to the Minneapolis/St. Paul area in an effort to maintain regional cultural homogeneity. For example, safe sex norms may vary by geographic region and ethnicity; we geographically restricted enrollment to control for this potential source of variability. …