Skip to main content

Advertisement

SpringerLink
Log in

Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013–2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time; (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use; and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-sample (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.

Resumen

Utilizando datos de encuestas repetidas y transversales de Australia, evaluamos las tendencias relacionadas con los acuerdos de exclusividad sexual y el sexo casual entre hombres gays y bisexuales VIH-negativos y no probados que tuvieron parejas regulares durante 2013–2018. Realizamos tres análisis: (i) análisis de tendencias temporales en los acuerdos de exclusividad sexual y el sexo casual; (ii) análisis bivariante comparando participantes que usan PrEP versus los que no lo usan para identificar los factores asociados con el uso de PrEP; y (iii) regresión logística multi-variable para identificar los factores independientes asociados con el uso de PrEP. El análisis de las tendencias sobre el tiempo incluyó 21 593 hombres, de los cuales usamos una submuestra (n=3764) para comparar participantes que usan PrEP versus los que no lo usan. Encontramos un gran aumento de acuerdos que permitían el sexo sin condón con parejas casuales, particularmente por parte de participantes en las relaciones que usan PrEP (casi el 40% de los cuales tenían dicho acuerdo). Otro 34% de participantes que usan PrEP informaron que tuvieron sexo sin condón sin un acuerdo que permitiera ese comportamiento, mientras que el 13% de personas que no usan PrEP también informaron que tuvieron sexo sin condón con parejas casuales sin un acuerdo. Los usuarios de PrEP eran más activos sexualmente y reportaron prácticas sexuales de mayor riesgo. Nuestros hallazgos muestran un cambio de los acuerdos de exclusividad en los que el sexo sin condón solo se sancionaba entre parejas habituales.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. https://csrh.arts.unsw.edu.au/research/publications/gcps/.

References

  1. Kippax S, Noble J, Prestage G, et al. Sexual negotiation in the AIDS era: negotiated safety revisited. AIDS. 1997;11(2):191–7.

    Article  CAS  Google Scholar 

  2. Kippax S, Crawford J, Davis M, Rodden P, Dowsett G. Sustaining safe sex: a longitudinal study of a sample of homosexual men. AIDS. 1993;7(2):257–63.

    Article  CAS  Google Scholar 

  3. Crawford JM, Rodden P, Kippax S, Van de Ven P. Negotiated safety and other agreements between men in relationships: risk practice redefined. Int J STD AIDS. 2001;12(3):164–70.

    Article  CAS  Google Scholar 

  4. Holt M. Gay men’s HIV risk reduction practices: the influence of epistemic communities in HIV social and behavioral research. AIDS Educ Prev. 2014;26(3):214–23.

    Article  Google Scholar 

  5. Jin F, Crawford J, Prestage GP, et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23(2):243–52.

    Article  Google Scholar 

  6. Kippax S, Stephenson N. Socialising the biomedical turn in HIV prevention. London: Anthem Press; 2016.

    Google Scholar 

  7. Mao L, Holt M, Newman C, Treloar C. Annual report of trends in behaviour 2018: HIV and STIs in Australia. Sydney: Centre for Social Research in Health, UNSW Sydney; 2018.

    Google Scholar 

  8. Holt M, Lea T, Mao L, et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: Results of repeated behavioural surveillance in 2013–17. Lancet HIV. 2018. https://doi.org/10.1016/S2352-3018(18)30072-9.

    Article  PubMed  Google Scholar 

  9. Holt M, Lea T, Mao L, Zablotska I, Prestage G, de Wit J. HIV prevention by Australian gay and bisexual men With casual partners: the emergence of undetectable viral load as one of a range of risk reduction strategies. J Acquir Immune Defic Syndr. 2015;70(5):545–8.

    Article  Google Scholar 

  10. Cohen MS, Muessig K, Smith M, Powers K, Kashuba A. Antiviral agents and HIV prevention: controversies, conflicts, and consensus. AIDS. 2012;26(13):1585–98.

    Article  CAS  Google Scholar 

  11. Fonner VA, Dalglish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83.

    Article  Google Scholar 

  12. Zablotska IB. Likely impact of pre-exposure prophylaxis on HIV epidemics among men who have sex with men. Sex Health. 2017;14(1):97–105.

    Article  Google Scholar 

  13. Holt M. Progress and challenges in ending HIV and AIDS in Australia. AIDS Behav. 2017;21(2):331–4.

    Article  Google Scholar 

  14. Holt M, Lea T, Bear B, et al. Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011-2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav. 2018. https://doi.org/10.1007/s10461-018-2368-y.

    Article  PubMed  Google Scholar 

  15. Hammoud MA, Vaccher S, Jin F, et al. HIV pre-exposure prophylaxis (PrEP) uptake among gay and bisexual men in Australia and factors associated with the non-use of PrEP among eligible men: Results from a prospective cohort study. J Acquir Immune Defic Syndr. 2019. https://doi.org/10.1097/QAI.0000000000002047.

    Article  PubMed  Google Scholar 

  16. Ryan KE, Mak A, Stoove M, et al. Protocol for an HIV pre-exposure prophylaxis (PrEP) population level intervention study in Victoria Australia: the PrEPX study. Front Public Health. 2018;6:151.

    Article  Google Scholar 

  17. The Kirby Institute. Monitoring HIV pre-exposure prophylaxis in Australia (Issue 1). UNSW Sydney, Sydney NSW: The Kirby Institute; 2019.

    Google Scholar 

  18. PBAC. December 2017 PBAC meeting—Postive recommendations. 2018; http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2017-12/positive-recommendations-12-2017.pdf. Accessed 14 Feb 2018.

  19. Wright E, Grulich A, Roy K, et al. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018. J Virus Erad. 2018;4(2):143–59.

    PubMed  PubMed Central  Google Scholar 

  20. Mitchell JW, Lee JY, Woodyatt C, Bauermeister J, Sullivan P, Stephenson R. HIV-negative male couples’ attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement. AIDS Care. 2016;28(8):994–9.

    Article  Google Scholar 

  21. Hoff CC, Chakravarty D, Bircher AE, et al. Attitudes towards PrEP and anticipated condom use among concordant HIV-negative and HIV-discordant male couples. AIDS Patient Care STDs. 2015;29(7):408–17.

    Article  Google Scholar 

  22. Starks TJ, Doyle KM, Shalhav O, John SA, Parsons JT. An examination of gay couples’ motivations to use (or forego) pre-exposure prophylaxis expressed during couples HIV testing and counseling (CHTC) sessions. Prev Sci. 2018. https://doi.org/10.1007/s11121-018-0892-7.

    Article  Google Scholar 

  23. Malone J, Syvertsen JL, Johnson BE, Mimiaga MJ, Mayer KH, Bazzi AR. Negotiating sexual safety in the era of biomedical HIV prevention: relationship dynamics among male couples using pre-exposure prophylaxis. Cult Health Sex. 2018;20(6):658–72.

    Article  Google Scholar 

  24. Holt M, Lea T, Mao L, et al. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health. 2017;14(1):72–9.

    Article  Google Scholar 

  25. Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health. 2011;8(3):272–9.

    Article  Google Scholar 

  26. Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston: Pearson; 2013.

    Google Scholar 

  27. Prestage G, Mao L, McGuigan D, et al. HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care. 2006;18(2):166–72.

    Article  CAS  Google Scholar 

  28. Hoff CC, Beougher SC. Sexual agreements among gay male couples. Arch Sex Behav. 2010;39(3):774–87.

    Article  Google Scholar 

  29. Bonello K. Gay monogamy and extra-dyadic sex: a critical review of the theoretical and empircal literature. Counsel Psychol Rev. 2009;24:51–65.

    Google Scholar 

  30. Hosking W. Agreements about extra-dyadic sex in gay men’s relationships: exploring differences in relationship quality by agreement type and rule-breaking behavior. J Homosex. 2013;60(5):711–33.

    Article  Google Scholar 

  31. LaSala M. Extradyadic sex and gay male couples: comparing monogamous and nonmonogamous relationships. Fam Soc. 2004;85(3):405–12.

    Article  Google Scholar 

  32. Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med. 2015;49(2):177–86.

    Article  Google Scholar 

  33. Kesler MA, Kaul R, Myers T, et al. Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada. AIDS Care. 2016;28(11):1378–85.

    Article  Google Scholar 

  34. Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal fluctuations in behavior, perceived HIV risk, and willingness to use pre-exposure prophylaxis (PrEP). Arch Sex Behav. 2018. https://doi.org/10.1007/s10508-017-1100-8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA. 2019;321(14):1380–90.

    Article  Google Scholar 

  36. Bavinton BR, Duncan D, Grierson J, et al. The meaning of ‘regular partner’ in HIV research among gay and bisexual men: implications of an Australian cross-sectional survey. AIDS Behav. 2016;20(8):1777–84.

    Article  Google Scholar 

  37. Bavinton BR, Grulich AE, Duncan D, Zablotska IB, Prestage GP. How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men. Sex Health. 2017;14(6):523–32.

    Article  Google Scholar 

  38. UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Guidelines for second generation HIV surveillance. Geneva: UNAIDS/WHO; 2013.

  39. Grulich AE, de Visser RO, Badcock PB, et al. Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health. 2014;11(5):439–50.

    Article  Google Scholar 

  40. Martinez JE, Jonas KJ. Pre-exposure prophylaxis sorting among men who have sex with men. AIDS Care. 2019;31(3):388–96.

    Article  Google Scholar 

Download references

Acknowledgements

The Centre for Social Research in Health and the Kirby Institute are supported by the Australian Government Department of Health. The GCPS are funded by state and territory health departments. JM is in receipt of an Australian Government Research Training Program Scholarship. BB is supported by a National Health and Medical Research Council Early Career Fellowship. No pharmaceutical grants were received for this research.

Author information

Authors and Affiliations

  1. Centre for Social Research in Health, UNSW Sydney, Level 2, John Goodsell Building, UNSW, Kensington, NSW, 2052, Australia

    James MacGibbon, Timothy Broady, Kerryn Drysdale, Evelyn Lee, Limin Mao & Martin Holt

  2. Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, UNSW, High Street, Kensington, NSW, 2052, Australia

    Benjamin Bavinton & Garrett Prestage

Authors
  1. James MacGibbon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy Broady
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerryn Drysdale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Bavinton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evelyn Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Limin Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Garrett Prestage
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MH, TM, EL, LM, BB and GP designed this study and oversaw the collection of the data. JM drafted the manuscript and conducted the quantitative analyses, supported by BB, KD and MH. All authors reviewed and commented on several versions of the manuscript and agreed with the final version.

Corresponding author

Correspondence to James MacGibbon.

Ethics declarations

Conflict of interest

The Centre for Social Research in Health and the Kirby Institute are supported by the Australian Government Department of Health. The funding source did not have any involvement in the collection, analysis and interpretation of data, or in the writing of this manuscript and decision to submit for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

MacGibbon, J., Broady, T., Drysdale, K. et al. Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data. AIDS Behav 24, 1389–1399 (2020). https://doi.org/10.1007/s10461-019-02737-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02737-9

Keywords

Search

Navigation