Abstract
While accounting for approximately 2% of the total United States population, gay and bisexual men who have sex with men (MSM) bear a disproportionate HIV infection burden. MSM roughly accounted for 67% of new HIV diagnoses in 2015. MSM's social network may influence perceptions of health and health risk, including HIV risk. One such social network is the Bear subculture, which accounts for approximately 14-22% of the gay community. Previous research indicated that members of the Bear subculture were more likely to engage in unprotected anal sex, placing these men at-risk for HIV infection. The purpose of this dissertation was to explore how men who identify as Bears make sexual decisions. Utilizing grounded theory methodology for research design, data collection, and data analysis, the researcher interviewed 25 men who identified as Bears in South Florida about how these men made sexual decisions, from meeting sexual partners to perceiving the risks and benefits of making safer and riskier sexual decisions. Participants were recruited from Bear bars and nightclubs, businesses that cater to the Bear subculture, and through snowball sampling. The Theory of Perceiving Sexual Risk among Men who Identify as Bears was constructed from the data. One core category, "Perceiving Sexual Risks", and four categories, "Engaging with the Bear Community", "Searching for Sexual Partners", "Engaging in Sexual Activities", and "Reflecting on Sexual Decisions" describe how men who identify as Bears make sexual decisions. The study highlighted how certain factors such as relationship status, HIV risk perceptions, pre-exposure prophylaxis use, and trust may influence the sexual decisions by these men. Additionally, the study explores how men who identify as Bears find sexual partners, engage in sexual activity, and contemplate consequences related to sexual decisions. The results of this study are analyzed within the context of previous research conducted among MSM and men who identify as Bears when available, and the significance of the study to nursing pedagogy, practice, research, and policy is explored. Additionally, recommendations for future research with men who identify as Bears is provided.