As described in my previous post, attachment anxiety is commonly expressed as concerns about being abandoned or the fear that the self is unworthy of love and acceptance. In this post, I review research that suggests these kinds of beliefs about the self are related to the decisions people make about sex.

I have posted before about the fact that many couples believe that changes in HIV or STI prevention behavior—deciding not to use condoms or quitting that pre-exposure prophylaxis (PrEP) prescription—demonstrate commitment. Sometimes these beliefs increase the risk of sexual HIV transmission.

Complementary research conducted mostly with cisgender sexual minority men suggests that those who are high on anxious attachment—those most worried that people will not love them or find them good enough—are generally more likely to have anal sex without using a condom (Starks et al., 2017; Starks & Parsons, 2014). In other words, guys who are worried that a boyfriend or partner will think they are not good enough are more likely to agree to have sex “bareback.” The association between attachment anxiety and PrEP is less clear. At least one study suggests that sexual minority men who are worried that HIV prevention will interfere with intimacy are more interested in PrEP (Gamarel & Golub, 2015). Other studies suggest that some worry PrEP signals a lack of trust or commitment in a relationship (Bosco et al., 2021; Starks et al., 2019).

Attachment anxiety even has the potential to connect drug use to sex in relationships. At least one study found that sexual minority men who scored higher on attachment anxiety were also more likely to believe that using drugs facilitated relationships in some way.........

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