Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of UAI (AOR = 0.33; 95% CI = 0.13, 0.85); body satisfaction was not found to mediate this association. 13.3% of men who reported overweight/obese body image had engaged in UAI compared with 21.6% of those who reported average weight and 8.2% of those who reported underweight (p<.05). Compared with MSM in exclusive relationships, MSM in non exclusive relationships had increased odds of UAI (AOR = 5.78; 95% CI = 2.96, 11.29) as did men who were not partnered (AOR = 3.20; 3.20; 95% CI =1.72, 5.93). These findings highlight the importance of including body image in sexual behavior models of MSM to better understand body image's role in influencing sexual risk and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) transmission.
Bibliographical noteFunding Information:
Assessment of body image and body satisfaction. Body image was assessed by asking respondents to choose a male body drawing that best resembled them from the Figure Rating Scale adapted from Stunkard, Sorensen, and Schulsinger (1983; see Figure 1). The Figure Rating Scale has been used extensively in body image research due to its ease of administration and high test–retest reliability (α = 0.74, Stunkard, Sorensen, & Schulsinger, 1983) and continues to be used by researchers for these reasons (Bhuiyan, Gustat, Srinivasan, & Berenson, 2003; Perez, Voelz, Pettit, & Joiner, 2002). We categorized both Body Mass Index (BMI) and the Figure Rating Scale responses as underweight, average weight, overweight, or obese as adopted by the National Institutes of Health (1998) and World Health Organization (1995). Body satisfaction was assessed by a single question asking respondents to rate on a five-point scale how satisfied they were with their present weight, with response options that ranged from not satisfied to extremely satisfied.