Risks worth taking: Safety agreements among discordant gay couples

Abstract

As HIV research and prevention efforts increasingly target gay men in relationships, situational factors such as couple serostatus and agreements about sex become central to examinations of risk. Discordant gay couples are of particular interest because the risk of HIV infection is seemingly near-at-hand. Yet little is known about their sexual behaviors, agreements about sex, and safer sex efforts. The present study utilized longitudinal semi-structured, qualitative interviews to explore these issues among 12 discordant couples. Findings show that nearly every couple had agreements about reducing the likelihood of HIV transmission from one partner to the other. Negotiating these agreements involved establishing a level of acceptable risk, determining condom use, and employing other risk-reduction techniques, such as seropositioning and withdrawal. For half of the couples, these agreements did not involve using condoms; only two couples reported consistent condom use. Despite forgoing condoms, however, none reported seroconversion over the course of data collection. Additional issues are raised where long-term HIV prevention is concerned. Future prevention efforts with discordant couples should work with, rather than fight against, the couple’s decision to use condoms and endeavor to complement and accentuate their other safer sex efforts.

Younger Gay and Bisexual Men's Condom Use With Main Regular Sexual Partner in New Zealand

“…However, some YMSM were found to report low condom use with both their main regular and casual partners. This contradicts previous research and troubles presumptions about strategically-deployed condom use (Beougher et al, 2012); it also supports recent findings that highlight the challenge in negotiating sexual experiences and maintaining sexual agreements between partners (Adam, 2006).…”

“…Young men who indicated they had sex with at least four additional regular partners in the past six months were significantly less likely to report high condom use with their boyfriend with whom they had the most sex compared with participants who reported a single boyfriend. Despite low condom use with their primary boyfriend, if these participants were consistently using condoms with their other regular partners, this may represent negotiated safety (Beougher et al, 2012). However, given the previous discussion of habitual nonuse of condoms across main regular and casual partners by some YMSM, this could also represent a potential behavioral nexus of high risk for HIV acquisition and forward transmission (frequent sex, multiple partners, and low condom use) between regular sex partners.…”

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

“…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.…”

“…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. 1,11,[21][22][23][24][25] While the literature lays the foundation for understanding HIV risk for MSM couples, much of it fails to include both partners and few studies attempt to account for the relationship dynamics above.…”

Trust, Commitment, Love and Sex: HIV, Monogamy, and Gay Men

“…In concert with a move to no longer use condoms, the heightened level of trust signified by monogamy consolidated the intimacy and significance of a couple's love. Previous research has indicated that men in relationships are motivated to give up using condoms due to such feelings as increased intimacy, trust, love, and sexual pleasure, and that familiarity with a partner, assumed knowledge of serostatus and use of alternative risk-reduction strategies mediate their calculations of risk (Beougher et al, 2012;Mitchell et al, 2012;Prestage et al, 2006). Among these men, the risks of HIV implicitly raised the stakes of their relationships, while creating a space in which they could share their "true" self.…”