Behavioral and Cognitive Barriers to Safer Sex Between Men in Steady Relationships: Implications for Prevention Strategies

Abstract

Steady partners are a major source of HIV infection among gay men. To better understand sexual risk taking in steady relationships, we examined characteristics of the first incident of unprotected anal intercourse (UAI) between steady male partners. We also examined cognitive barriers to safer sex by way of associating beliefs regarding UAI with protective behavior. Questionnaires assessing sexual behavior and related cognitions were completed by 324 gay men, aged 18-34. Of the men who had UAI with their steady partners, 55% (103/189) did so within the first 3 months of the relationship, and 46% did not discuss having UAI with their partner before it occurred. Analyses revealed that perceiving UAI as a symbol of trust and believing that the partner desired UAI were associated with less condom use but also with a higher likelihood that men established HIV-negative seroconcordance and made sexual agreements (i.e., practiced negotiated safety). Perceiving UAI as more gratifying was associated with having risky UAI. Our findings suggest that interventions can make use of beliefs regarding trust and partner's desire for UAI to promote negotiated safety. In relationships where negotiated safety cannot be implemented, HIV prevention should regard the above beliefs, in particular the perception that UAI is more gratifying, as important barriers to safer sex. Furthermore, our findings regarding the early onset of risk in relationships emphasize how little time is at hand to prevent sexual risk before it occurs. One solution could be to target single gay men for promoting safer sex with future steady partners.

Relationship Characteristics Associated with Sexual Risk Behavior Among MSM in Committed Relationships

“…Attachment (for concordant positive and discordant couples) and intimacy (for concordant negative couples), two variables that convey relationship closeness, were positively associated with UAI with one's primary partner, findings that fit nicely with existing research on why many couples typically avoid condoms. 7,10,13 Loneliness, (for concordant positive couples) and HIV-specific social support (for concordant positive couples and discordant couples) were associated with lower odds of UAIPP. Feeling lonely could diminish one's desire for sex and having a partner who provides more HIV-specific social support may reduce the odds of UAI with one's primary partner, which could decrease the chances of HIV transmission to the HIV-negative partner in discordant relationships or reduce the transmission of STIs among concordant HIVpositive couples.…”

“…The fact that many of the discordant couples in this study engaged in UAI may support earlier findings of condom fatigue, perception of low risk due to undetectable viral load, and the sense that condoms represent a barrier to establishing trust, intimacy, and pleasure. 4,7,13,16,18,24 Relationship dynamics associated with sexual behavior revealed differences as well as similarities by partner type (i.e., primary vs. outside partners of discordant or unknown HIV status) and couple serostatus. Attachment (for concordant positive and discordant couples) and intimacy (for concordant negative couples), two variables that convey relationship closeness, were positively associated with UAI with one's primary partner, findings that fit nicely with existing research on why many couples typically avoid condoms.…”

“…[6][7][8]10,[13][14][15][16][17][18] They may also do so as a result of their agreements about sex, preferences for sexual positions, or in light of each partner's HIV status. 1,3,5,6,10,13,19 While knowledge and disclosure of HIV status is critical in condom decision-making, testing rates among HIV-negative MSM in committed relationships, are lower than those in the general MSM population, even in the presence of risky sexual behavior. 20 Finally, MSM in relationships may experience condom fatigue or mistakenly perceive themselves to be low risk due to their relationship status or access to new biomedical interventions.…”

“…Yet few models exist that MSM couples may use to navigate the disclosure of breaks when they happen. 13,21,[30][31][32][33] In addition, Interdependence Theory posits that men prioritize the needs of their relationship over their personal health when making decisions-which could make negotiation and/or disclosure of broken agreements even more difficult. 34,35 These complexities between individual and partner-level priorities highlight the need to examine the influence of relationship dynamics on sexual risk behavior in MSM couples.…”

Sintomas de ansiedade, depressão, nível de estresse, uso de álcool e outras drogas e repertório de habilidades sociais como fatores relacionados ao comportamento sexual de risco em pessoas infectadas pelo HIV em tratamento na cidade de São Paulo

“…Geralmente, o casal opta por usá-lo apenas como contraceptivo, quando a mulher não pode fazer uso de outro método, ou seja, é usado apenas quando não se deseja engravidar. Quando a mulher exige o uso, o parceiro muitas vezes interpreta como desconfiança (Ali, Cleland, Shah, 2004 (Bogart, Thorburn 2005;Davidovich, de Wit, Stroebe, 2004). Também notam-se algumas peculiaridades, como a crença de que não haveria risco de contaminação pelo fato de a carga viral estar baixa e por estar em tratamento antirretroviral (Bouhnik et al, 2007;Camoni et al, 2011).…”