The relationship between use of sexually explicit media and sexual risk behavior in men who have sex with men: exploring the mediating effects of sexual self-esteem and condom use self-efficacy.

This study tests the following three hypotheses: 1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and STI-related sexual risk behavior among men who have sex with men (MSM), 2) The association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem, and 3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the USA was conducted in 2011. The results confirmed hypothesis 1 and 3 while hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.