Characteristics and Allowed Behaviors of Gay Male Couples’ Sexual Agreements

Abstract

Research has shown that gay male couples’ sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the United States by using paid Facebook ads. Findings revealed that couples discussed their HIV status before having unprotected anal intercourse (UAI) but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples’ agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples.

Acknowledgments

This manuscript was supported by the Center for AIDS Intervention Research (P30-MH52776; PI: J. Kelly) and National Research Service Award (T32-MH19985; PI: S. Pinkerton) grants from the National Institute of Mental Health.

Notes

^a Other included MSM who self-identified as Asian, Native American Indian, Native Hawaiian/Pacific Islander, or having another race not listed.

^b GED represents general equivalency diploma, an exam that is the equivalent of a high school diploma.

^c Data represents self-reports of UAI that occurred during the three months prior to assessment.

^d Reported by 506 MSM who indicated having a sexual agreement with their main partner.

^e Reported by 207 couples who concurred about having established a sexual agreement.

^a Data on types of sexual agreements are based on men (n = 506) who reported having an established sexual agreement with their main partner.

^b Percentages are among the 46 men who self-reported recently breaking the sexual agreement.

^c Percentages reflect the 14 men who disclosed their recent sexual agreement break to the main partner.

^d Percentages reflect the 32 men who did not disclose their recent sexual agreement break to the main partner.

^e Data reported by participants are events that happened within the previous three months.

^a Other also included six men who indicated how they recently broke the sexual agreement with their main partner but not the reason why (e.g., had unprotected anal intercourse with someone else).

^a Row percentages are based on the 166 gay male couples who concurred about their original type of sexual agreement.

^b Row percentages are based on the 174 gay male couples who concurred about their current type of sexual agreement.

^c Row percentages are based on the 207 gay male couples who concurred about establishing a sexual agreement.

*p < 0.05. **p < 0.01. ***p < 0.001.

Note. Among gay couples who concurred about their current type of sexual agreement, column percentiles represent the proportion of men who selected the allowed sex-related behavior by partner type (only with main partner versus only with others versus all, indicating everyone/anyone) based on their current type of sexual agreement.

Note. Data within the type of sexual agreement column includes only the couples who concurred that they established a sexual agreement (i.e., 174 couples of the 207 couples). Similarly, data within the adherence to sexual agreement column only includes couples who concurred about their current type of sexual agreement (i.e., 174 couples).

^a Fisher's exact and Pearson's chi-square tests of association were used to assess whether a significant association existed between the demographic characteristics of the couples and aspects of their sexual agreement; the unit of analysis was the couple.

^b YMSM represents young men who have sex with men couples.

*p < 0.05. **p < 0.01. ***p < 0.001.