Objectives Although pornography is widely available and frequently used among many adults in the USA, little is known about the relationship between pornography and risk factors for HIV transmission among men who have sex with men.

Baseline assessments from a behavioural intervention trial for at-risk men who have sex with men were conducted in Atlanta, GA in 2009. Univariate and multivariate generalised linear models were used to assess the relationships between known risk factors for HIV infection, time spent viewing pornography, and sex behaviours.

One hundred forty-nine men reporting HIV-negative status and two or more unprotected anal sex partners in the past 6 months were enrolled in an intervention trial and completed survey assessments. Time spent viewing pornography was significantly associated with having more male sexual partners (B = 0.45, SE = 0.04, P < 0.001) and unprotected insertive anal sex acts (B = 0.28, SE = 0.04, P < 0.001). Moreover, increased substance use (drug use, B = 0.61, SE = 0.14, P < 0.001; alcohol use, B = 0.03, SE = 0.01, P < 0.01) and decreased perception of risk for HIV infection (B = –0.09, SE = 0.04, P < 0.05) were found to be significantly associated with greater time spent viewing pornography.

This exploratory study is novel in that it sheds light on the associations between viewing pornography and sexual risk taking for HIV infection. Future studies in this area should focus on understanding how the content of pornography; in particular, the viewing of unprotected and protected sex acts, may affect sexual risk taking behaviour.