Negotiated safety and other agreements between men in relationships: risk practice redefined

Abstract

This study examines patterns of agreement, knowledge and practice which can prevent or facilitate HIV transmission among men who are in regular ('primary') male-to-male relationships. Data are from a national volunteer phone-in survey of homosexually-active men in Australia. A sub-sample of 1070 men from a larger sample (n=3039) were found to have one or more regular partners for longer than 6 months. Self-reported HIV serostatus of survey participant and his regular partner, type of agreement regarding anal intercourse both within and outside the regular relationship, and engaging in unprotected anal intercourse with regular and with casual partners were examined. Risk practice was defined as unprotected anal intercourse with a regular partner of different or unknown serostatus and/or unprotected anal intercourse with a casual partner. Agreements were classified as: negotiated safety (28.8%); no unprotected anal intercourse (33.6%); unsafe (10.6%) and no agreement (17.0%). Risk practice was reported by 17.8% of the men. Type of agreement was found to be the strongest predictor of risk practice. Negotiated safety agreements were common, and were kept on the whole. Men with unsafe agreements, although only a small proportion of men in relationships, had high levels of risk practice.

Relationship Dynamics as Predictors of Broken Agreements About Outside Sexual Partners: Implications for HIV Prevention Among Gay Couples

“…The most frequently reported reasons for not disclosing the break are: a desire to protect the relationship (89%); fear that their partner would not forgive them (73%); the belief that the break did not put their partner at risk of HIV (73%); and fear of depressing their partner (67%). 8 In multivariate logistic regression analyses, the couple-mean score on each examined relationship dynamic is consistently and significantly associated with breaks in the expected direction (Table I) …”

“…(6,8). One study notes that in situations where agreements prohibit UAI with outside partners, broken agreements could increase HIV transmission risk for both partners (6).…”

Lowering obstacles to HIV prevention services: Effects of a brief, telephone-based intervention using motivational enhancement therapy

“…In addition, there are now a wide variety of harm reduction strategies that MSM are enacting on their own, including selecting partners assumed or known to be of the same HIV status (1), negotiating sexual positions such as insertive or receptive positions during anal intercourse as well as penile withdrawal prior to ejaculation (2), and "safer" relationship contexts (negotiated safety relationships (3,4). These behavioral contexts underlie varying degrees of HIV transmission risks among sexually active MSM.…”

Reasons for HIV Disclosure or Nondisclosure to Casual Sexual Partners

“…Important work in this area has, however, been conducted in Australia, where researchers have also found increases in unprotected anal intercourse . These researchers have suggested that risky sexual behaviors with casual sexual partners may be associated with new treatment optimism (Van de Ven, Crawford, Kippax, Knox, & Prestage, 2000; Van de Ven, Rawstorne, Nakamura, and sexual negotiation skills (Crawford, Rodden, Kippax, & Van de Ven, 2001). Their work has also indicated that disclosure and related risky behavior may be dependent on assumptions about one's partner's serostatus.…”