Sexual Agreements: A Scoping Review of Measurement, Prevalence and Links to Health Outcomes

Abstract

A sexual agreement is a mutual understanding between two partners regarding sexual and relational behaviors both within and outside of their relationship. Sexual agreements have been central to research and programming efforts around HIV prevention, primarily for male couples. A comprehensive scoping review of the primary literature on sexual agreements, including negotiated safety, was performed to identify what is known about sexual agreements among couples (n = 66). Results indicate a wide range of prevalence of agreements and measurements used to characterize sexual agreements. Findings also report associations between sexual agreements and health and relational outcomes. Several knowledge gaps were identified; specifically, the need to expand sexual agreements research beyond MSM populations and the need to better understand agreement breaks, break disclosure, and how variation in agreement categorization may impact reported prevalence. This review demonstrates the importance of broadening the evidence-base of sexual agreements research and programmatic focus.

Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships

“…This construct is closely related to sexual agreements and breaks within sexual agreements. Our study builds upon previous literature, indicating that breaks within sexual agreements widely vary, however, reasons for breaks and consequences for breaks are less known (Rios-Spicer et al, 2019). For YGBM in our study, breaking a sexual agreement may constitute in ending a relationship.…”

Testing the drug use and condomless anal sex link among sexual minority men: The predictive utility of marijuana and interactions with relationship status

“…Hurdle models are uniquely suited to detecting this kind of process because they separate out the prediction of the mere occurrence of risk (the binary component of the model) and the prediction of amount or frequency of risky among those who are risky (Hu et al, 2011). Previous research has found that monogamous men report fewer instances of CAS with casual partners compared to single and non-monogamous men (Mitchell et al, 2012;Spicer et al, 2019;; however, these studies examined overall frequencies. These results reveal that while monogamous men may be at lower risk of HIV transmission overall, those who do experience risk are in urgent need of prevention.…”

“…This gap in the literature is important because research from the past decade has indicated that sexual agreements -the rules or boundaries couples establish related to sex with partners outside their relationship -are a consistent predictor of sexual behavior with casual partners and drug use. Men in relationships in which explicit agreements around monogamy have been formed -where sex with casual partners is prohibited -are less likely to have sex with casual partners compared to those in non-monogamous relationships (Parsons, Starks, et al, 2013;Spicer et al, 2019;. They are also less likely to use club drugs and marijuana compared to those in non-monogamous relationships Parsons & Starks, 2014).…”

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, “Strengthening Our Vows”: Study protocol and baseline data

“…Though unprotected sex with concurrent partners remains the primary mode of HIV acquisition in heterosexual CNC in Africa, couples lack evidence-based pragmatic, communication and action-focused strategies to aid in their decision-making to protect their marriages from HIV. Our ‘Strengthening Our Vows’ approach aims to incorporate this combinative strategy with CVCT, an already proven, cost-effective strategy and adapts strategies previously used to provide a platform for couples to discuss concurrent partnerships and HIV prevention [ 75 , 76 ].…”

“…Studies on sexual agreements with heterosexual couples are more limited and mostly assess feasibility of sexual agreements, self-reported monogamy agreements, or perceptions of western providers about agreements [ 105 , 106 ]. In a comprehensive scoping review of the primary literature on sexual agreements, including negotiated safety, Rios-Spicer and colleagues identified several knowledge gaps including the need to expand sexual agreements research beyond MSM populations and the need to better understand agreement breaks and break disclosure [ 75 ].…”