Sexual delay discounting as a moderator of the association between substance use and condomless anal sex among young black and Latino men who have sex with men

Background This study examined sexual delay discounting (SDD) as a potential factor associated with the relationship between substance use and condomless anal sex (CAS) among Black and Latino men who have sex with men (MSM). Methods Baseline data were drawn from a multi-site HIV testing promotion trial (NIDA-CTN-0083) involving Black and Latino MSM across eight U.S. states and the District of Columbia. Past 90-day CAS and past 12-month substance use were assessed via self-report. SDD was measured using the Sexual Delay Discounting Task and summarized as area under the curve (AUC) values. K-means clustering identified four SDD profiles: high self-control, globally impulsive, immediate-impulsive, and delayed-impulsive. Ordinal logistic regression models examined associations among substance use, SDD profiles, and CAS. Results A total of 271 participants were included. Compared with the high self-control group, the odds of CAS were significantly higher among the delayed-sensitive (OR = 2.978, p = 0.001), immediate-sensitive (OR = 8.970, p < 0.001), and globally high-discounting groups (OR = 9.427, p < 0.001). Alcohol and illicit drug use were modeled separately. Although substance use showed no overall main effect, significant interactions indicated that illicit drug use was more strongly associated with CAS among delayed-sensitive (OR = 1.485, p = 0.039) and globally high-discounting participants (OR = 1.668, p = 0.004). Conclusions SDD profiles were associated with CAS and may shape how illicit drug use relates to sexual risk behavior among Black and Latino MSM. These findings highlight the importance of considering temporal impulsivity in HIV prevention efforts.