Harnessing salutogenesis to improve sexual health in men-who-have-sex-with-men: an empirical, assets based study

Abstract

Background:In high income countries, men-who-have –sex-with-men (MSM) are a high risk group for HIV and other sexually transmitted infections (STIs). Therefore, interventions are urgently needed to improve MSM’s sexual health. Salutogenesis theory guides health promotion through identification of protective health factors. Sense of coherence (SOC) is the measurable construct underpinning the salutogenic approach. It assesses an individual’s ability to understand the world they live in, and make use of internal and external resources towards making health promoting decisions. Here, we examine the role that salutogenesis plays in reducing MSM’s sexual risk behaviours. Methods:A cross-sectional online survey recruited 2043 MSM in Scotland, Wales and Ireland via sociosexual media websites and smartphone apps. Sociodemographic and sexual behavioural data were collected alongside the SOC measure. Uni- and multivariate analyses were performed to identify relationships between SOC, sociodemographics and sexual behaviours. Findings:MSM who reported high risk sex in the last year reported significantly lower SOC than men who reported no high risk sex*. Lower SOC was also significantly related to younger age**, lower qualifications**, being single**, sex partying*, reporting commercial sex work** but not other variables including STI and HIV testing. Multivariate logistic regression suggested that SOC*, relationship status**, recent STI testing** and HIV positive status** were independently predictive of high risk sexual behaviours amongst MSM. Discussion:Lower levels of SOC were related to higher risk sex over and above other predictive variables. We propose an assets-based approach to sexual health promotion, which through improving MSM’s SOC, will reduce sexual risk-taking behaviours. **p<0.01, ***p<0.001