Sexual Decision Making Among Men Who Identify as Bears: a Grounded Theory Study

Background: Gay and bisexual men who have sex with men (GBM) carry a disproportionate HIV infection burden, approximating 66% of all new HIV infections in 2017. GBM’s social networks may influence health and health risk perceptions, including HIV risk. One such social network is the bear subculture, which accounts for approximately 14–22% of the gay community. Previous research on GBM who identify as bears indicated that these men are more likely to engage in sexual practices such as condomless anal sex (CAS). The purpose of this study was to describe the sexual decision-making process among GBM who identify as bears. Methods: Utilizing a grounded theory approach, 25 in-depth semi-structured interviews were conducted with men who identify as bears, ranging in age from 22 to 77 years. Participants were recruited using purposive and snowball sampling. Results: A theory grounded in the data entitled The Theory of Making Sexual Decisions Among Men Who Identify as Bears emerged that described how these men may make sexual decisions. The theory is constructed of one core category, “Making Sexual Decisions,” and four categories with subcategories: “Interacting with the Bear Subculture,” “Searching for Sexual Partners,” “Engaging in Sexual Activities,” and “Reflecting on Consequences.” Conclusions: Clinicians caring for this population should be aware of the complex nature of sexual decisions, potentially allowing for HIV risk reduction strategies for GBM who identify as bears. Policy Implications: As HIV infection continues to disproportionately impact GBM, health policy campaigns may develop initiatives that include men who identify as bears.