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.

Keywords:

• gay couples
• discordant couples
• HIV risk
• safer sex
• safety agreements

Acknowledgements

The authors extend their thanks to the participants, to Research Assistants Brianne Amato, Luis Ciprez, Rand Dadasovich, Michael Díaz, Anthony Freeman, Walter Gómez, Binh Nguyen, and Brad A. Vanderbilt, and to Postdoctoral Fellows Carmen Gómez Mandic and Anu Manchikanti Gómez. This research was supported by grants RO1 MH 75598 and MH 65141 from the National Institute of Mental Health.