Abstract
Stemming from recent evidence that between one- and two-thirds of new HIV transmissions among men who have sex with men (MSM) occur within main partnerships, research and programmatic efforts have begun to recognize the role of the male–male dyad in shaping HIV risk. Central to this new focus has been studies detailing the presence of sexual agreements, which provide guidelines governing permissions around sex with partners outside of the relationship. Using a Facebook-recruited sample of US-partnered MSM (n = 454), this study examines the associations between reporting of sexual agreements and perceptions of HIV prevalence among male sex partners, friends, and local and national MSM populations. Men who perceived that 10–20 % (OR 6.18, 95 % CI 1.28–29.77) and >20 % of their male sex partners were HIV positive (OR 2.68, 95 % CI 1.02–7.08) had significantly higher odds of reporting having an open agreement with their current main partner than men who perceived that less than 10 % of their male sex partners were HIV positive. Partnered men with open sexual agreements may have more sexual partners than those who report monogamy, possibly leading to heightened perceptions of HIV risk, which may result in reporting of perceptions of greater local HIV prevalence. Additionally, men who have made agreements with their partners may have done so due to concerns about HIV risks, and may also be more aware of increased risks of HIV infection, or may have greater knowledge of HIV prevalence through discussions of serostatus with sex partners. Attention is needed to develop prevention efforts, such as toolkits and resources that enable men to form sexual agreements that are based on comprehensive knowledge of the potential risks for acquisition of HIV.
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Aspinwall, L. G., Kemeny, M. E., Taylor, S. E., Schneider, S. G., & Dudley, J. P. (1991). Psychosocial predictors of gay men’s AIDS risk-reduction behavior. Health Psychology, 10(6), 432–444.
Castel, A. D., Befus, M., Willis, S., Griffin, A., West, T., Hader, S., & Greenberg, A. E. (2012). Use of the community viral load as a population-based biomarker of HIV burden. AIDS, 26(3), 345–353. doi:10.1097/QAD.0b013e32834de5fe.
Centers for Disease Control and Prevention. (2010). Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. Morbidity and Mortality Weekly Report (MMWR), 59(37), 1201–1207.
Centers for Disease Control and Prevention. (2013). HIV among gay, bisexual, and other men who have sex with men (MSM). Retrieved February 21, 2014 from http://www.cdc.gov/hiv/topics/msm/index.htm.
Chakravarty, D., Hoff, C. C., Neilands, T. B., & Darbes, L. A. (2012). Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS and Behavior, 16(7), 1944–1948.
Chiasson, M. A., Hirshfield, S., Remien, R. H., Humberstone, M., Wong, T., & Wolitski, R. J. (2007). A comparison of on-line and off-line sexual risk in men who have sex with men: An event-based on-line survey. Journal of Acquired Immune Deficiency Syndromes, 44(2), 235–243.
Crawford, J. M., Rodden, P., Kippax, S., & Van de Ven, P. (2001). Negotiated safety and other agreements between men in relationships: risk practice redefined. International Journal of STD and AIDS, 12(3), 164–170.
Darbes, L., Chakravarty, D., Beougher, S., Neilands, T., & Hoff, C. (2012). Partner-provided social support influences choice of risk reduction strategies in gay male couples. AIDS and Behavior, 16, 159–167.
Das, M., Chu, P. L., Santos, G.-M., Scheer, S., Vittinghoff, E., McFarland, W., & Colfax, G. N. (2010). Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE, 5(6), e11068. doi:10.1371/journal.pone.0011068.
Floyd, D. L., Prentice-Dunn, S., & Rogers, R. W. (2000). A meta-analysis of research on protection motivation theory. Journal of Applied Social Psychology, 30(2), 407–429.
Gass, K., Hoff, C. C., Stephenson, R., & Sullivan, P. S. (2012). Sexual agreements in the partnerships of Internet-using men who have sex with men. AIDS Care, 24(10), 1255–1263.
Gerrard, M., Gibbons, F. X., & Bushman, B. J. (1996). Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119(3), 390–409. doi:10.1037/0033-2909.119.3.390.
Gomez, A., Beougher, S., Chakravarty, D., Neilands, T., Mandic, C., Darbes, L., & Hoff, C. (2012). Relationship dynamics as predictors of broken agreements about outside sexual partners: Implications for HIV prevention among gay couples. AIDS and Behavior, 16, 1584–1588.
Goodreau, S., Carnegie, N., Vittinghoff, E., Lama, J., Sanchez, J., Grinsztejn, B., & Buchbinder, S. (2012). What drives the US and Peruvian HIV epidemics in men who have sex with men? PLoS ONE, 7(11), e50522.
Hoff, C. H., & Beougher, S. C. (2010). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39(3), 774–787.
Hoff, C. C., Chakravarty, D., Beougher, S. C., Darbes, L. A., Dadasovich, R., & Neilands, T. B. (2009). Serostatus differences and agreements about sex with outside partners among gay male couples. AIDS Education and Prevention, 21(1), 25–38.
Hoff, C., Chakravarty, D., Beougher, S., Neilands, T., & Darbes, L. (2012). Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS Patient Care and STDs, 26(12), 738–745.
Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education & Behavior, 11(1), 1–47. doi:10.1177/109019818401100101.
Kalichman, S. C., Simbayi, L. C., Cain, D., & Jooste, S. (2008). Perceived HIV/AIDS prevalence, burden, and risk, Cape Town, South Africa. American Journal of Health Behavior, 32(6), 693–700.
Kelley, C. F., Rosenberg, E. S., O’Hara, B. M., Frew, P. M., Sanchez, T., Peterson, J. L., & Sullivan, P. S. (2012). Measuring population transmission risk for HIV: An alternative metric of exposure risk in men who have sex with men (MSM) in the US. PLoS ONE, 7(12), e53284. doi:10.1371/journal.pone.0053284.
Klepinger, D. H., Billy, J. O. G., Tanfer, K., & Grady, W. R. (1993). Perceptions of AIDS risk and severity and their association with risk-related behavior among U.S. men. Family Planning Perspectives, 25(2), 74–82. doi:10.2307/2136209.
Kowalewski, M. R., Henson, K. D., & Longshore, D. (1997). Rethinking perceived risk and health behavior: A critical review of HIV prevention research. Health Education & Behavior, 24(3), 313–325. doi:10.1177/109019819702400305.
Lieb, S., Prejean, J., Thompson, D. R., Fallon, S. J., Cooper, H., Gates, G. J., & Malow, R. M. (2011). HIV prevalence rates among men who have sex with men in the southern United States: Population-based estimates by race/ethnicity. AIDS and Behavior, 15(3), 596–606. doi:10.1007/s10461-010-9820-y.
Mitchell, J. W. (2014a). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51(3), 316–328.
Mitchell, J. W. (2014b). Aspects of gay male couples’ sexual agreements vary by their relationship length. AIDS Care, 26(9), 1164–1170.
Mitchell, J. W. (2014c). Between and within couple-level factors associated with gay male couples’ investment in a sexual agreement. AIDS and Behavior, 18(8), 1454–1465.
Mitchell, J. W., Champeau, D., & Harvey, S. M. (2013). Actor-partner effects of demographic and relationship factors associated with HIV risk within gay male couples. Archives of Sexual Behavior, 42(7), 1337–1345.
Mitchell, J. W., Harvey, S. M., Champeau, D., Moskowitz, D. A., & Seal, D. W. (2012a). Relationship factors associated with gay male couples’ concordance on aspects of their sexual agreements: Establishment, type, and adherence. AIDS and Behavior, 16(6),1560–1569. doi: 10.1007/s10461-011-0064-2.
Mitchell, J. W., Harvey, S. M., Champeau, D., & Seal, D. W. (2012b). Relationship factors associated with HIV risk among a sample of gay male couples. AIDS and Behavior, 16(2), 404–411.
Mitchell, J. W., & Horvath, K. J. (2013). Factors associated with regular HIV testing among a sample of US MSM with HIV-negative main partners. Journal of Acquired Immune Deficiency Syndromes, 64(4), 417–423. doi:10.1097/QAI.0b013e3182a6c8d9.
Mitchell, J. W., & Petroll, A. E. (2012). Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases, 39(11), 871–876.
Mitchell, J. W., & Petroll, A. E. (2013). Factors associated with men in HIV-negative gay couples who practiced UAI within and outside of their relationship. AIDS and Behavior, 17, 1329–1337.
Montaner, J. S. G., Lima, V. D., Barrios, R., Yip, B., Wood, E., Kerr, T., & Kendall, P. (2010). Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: A population-based study. Lancet, 376(9740), 532–539. doi:10.1016/S0140-6736(10)60936-1.
Mustanski, B. S. (2007). Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care, 19(6), 822–827. doi:10.1080/09540120701237244.
Parsons, J. T., Starks, T. J., DuBois, S., Grov, C., & Golub, S. A. (2013). Alternatives to monogamy among gay male couples in a community survey: Implications for mental health and sexual risk. Archives of Sexual Behavior, 42(2), 303–312.
Prejean, J., Song, R., Hernandez, A., Ziebell, R., Green, T., Walker, F., & Lansky, A. (2011). Estimated HIV incidence in the United States, 2006–2009. PLoS ONE, 6(8), e17502.
Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology, 91(1), 93–114.
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education & Behavior, 15(2), 175–183. doi:10.1177/109019818801500203.
Stephenson, R., White, D., Darbes, L., Hoff, C., & Sullivan, P. (2015). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior, 19(3), 553–560.
Sullivan, P., Salazar, L., Buchbinder, S., & Sanchez, T. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23, 1153–1162.
Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7(4), 355–386.
Xu, F., Sternberg, M. R., & Markowitz, L. E. (2010). Men who have sex with men in the United States: Demographic and behavioral characteristics and prevalence of HIV and HSV-2 infection: Results from National Health and Nutrition Examination Survey 2001-2006. Sexually Transmitted Diseases, 37(6), 399–405. doi:10.1097/OLQ.0b013e3181ce122b.
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Stephenson, R., White, D. & Mitchell, J.W. Sexual Agreements and Perception of HIV Prevalence Among an Online Sample of Partnered Men Who Have Sex with Men. Arch Sex Behav 44, 1813–1819 (2015). https://doi.org/10.1007/s10508-015-0532-2
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DOI: https://doi.org/10.1007/s10508-015-0532-2