Is Monogamy or Committed Relationship Status a Marker for Low Sexual Risk among Men in Substance Abuse Treatment? Clinical and Methodological Considerations

Abstract

Background HIV prevention interventions often promote monogamy to reduce sexual risk. However, there is little consensus about how to define monogamy. Objective Determine the extent to which recent monogamy and/or being in a committed relationship serve as markers for low sexual risk among men in substance abuse treatment. Methods Participants were 360 men enrolled in the NIDA Clinical Trials Network “Real Men Are Safe” protocol who completed all assessments (baseline, 3 months, 6 months). Self- reported behaviors included: number of sexual partners; type of relationships; frequency of vaginal/anal intercourse; percentage of condom use. Results The rate of self-reported monogamy in the prior 90 days was stable across assessments (54.2%, 53.1%. 58.3%). However, at each assessment 7.5–10% of monogamous men identified their partner as a casual partner, and only 123 (34.2%) reported being monogamous at every assessment. Of these, 20 (5.6%) reported being monogamous with different partners across assessments. Men with both committed relationship and casual partners reported more condom use with their committed relationship partners than men with only a committed relationship partner. Conclusion Clinicians and researchers should consider individual relationship context and behavior, and avoid assuming that recent monogamy or being in a committed relationship denotes low risk. Scientific Significance This study provides evidence that, in male drug users, monogamy does not necessarily reflect low sexual risk. Rather, ‘monogamous’ men actually encompass various combinations of partner types and levels of risk behavior, that are unstable, even over brief time periods. Clinicians and researchers must take these variations into account.

Attachment orientation and sexual risk behaviour among young Black gay and bisexual men

“…Although some researchers contend that sexual risk (e.g., condomless sex) cannot exist within monogamous relationships (Calsyn, Campbell, Tross, & Hatch-Maillette, 2011), for the purpose of this study, sexual risk was defined as something that can occur within or outside of a monogamous relationship. As mentioned before, researchers have found that much of the sexual risk behavior that does occur among gay and bisexual men occurs within relationships (Sullivan et al, 2009).…”

A Critical Examination of Popular Assumptions About the Benefits and Outcomes of Monogamous Relationships

“…That is, as it is currently practiced in contemporary Western cultures, "monogamy" does not necessarily mean that a partner is and always will be one's only sex partner. Moreover, monogamy is defined inconsistently in academic literature, and researchers do not consistently make distinctions between what people are actually practicing (e.g., serial monogamy, ostensible monogamy with infidelity) versus what is implied by the term monogamy, that is, a lifelong, or at least long-term, relationship with only one sexual partner (Calsyn et al, 2011).…”

Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

“…Second, opioid injection and other risk behaviors were assessed via interviews with trained research staff but are based on participant selfreport. Third, the RAB treats oral, vaginal and anal sex as equally risky sexual acts and does not distinguish condom use with a primary partner versus a casual partner, which may confer different HIV risks [57, 58]. Fourth, we did not enroll non-English speaking patients in the study, although several of the participants did speak English as a second language at a level sufficient to provide informed consent and complete study assessments.…”