Archives of Sexual Behavior

, Volume 48, Issue 4, pp 1203–1216 | Cite as

Do Male Couples Agree on Their Sexual Agreements? An Analysis of Dyadic Data

  • Akshay SharmaEmail author
  • Robert Garofalo
  • Marco A. Hidalgo
  • Samuel Hoehnle
  • Matthew J. Mimiaga
  • Emily Brown
  • Jennie Thai
  • Anna Bratcher
  • Taylor Wimbly
  • Patrick S. Sullivan
  • Rob Stephenson
Original Paper


Male couples often formulate sexual agreements, but little is known about the extent to which partners concur about their exact terms. Disagreements, particularly with respect to sex outside the relationship, may induce stress and potentially increase the risk of HIV and other sexually transmitted infections. Our study sought to describe concordance between male partners on several aspects of their sexual agreements, overall, as well as stratified by dyadic HIV serostatus and relationship duration. Between July 2014 and May 2016, we collected bidirectional data from 160 male couples residing in Atlanta, Boston, and Chicago. Overall, we observed weak concordance for whether or not couples had a mutual agreement about sex with outside partners. Even among 110 couples in which both partners reported having an agreement, there was weak-to-moderate concordance for general rules that might apply to having sex outside the relationship (e.g., forming emotional relationships is not allowed, outside sexual activities must be disclosed), and for specific sexual behaviors allowed or disallowed (e.g., topping without a condom, bottoming without a condom). Concordance for the type of sexual agreement was higher within HIV seroconcordant negative partnerships compared to HIV serodiscordant partnerships, and lower within relationships ≥ 5 years and 1 to < 5 years compared to those < 1 year. Dyadic interventions for male couples (e.g., couples HIV testing and counseling, relationship education programs) can offer unique opportunities for skills building around negotiating sexual agreements and might especially benefit HIV serodiscordant partnerships, and those in the formative stages of their relationships.


Sexual and gender minorities Sexual behavior Sexual partners HIV infections Sexually transmitted diseases Sexual orientation 



This publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD075655 (mPIs: Garofalo, Mimiaga, and Stephenson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support was provided by the Boston University Peter T. Paul Career Development Professorship and the MAC AIDS Fund.


  1. Beougher, S. C., Bircher, A. E., Chakravarty, D., Darbes, L. A., Mandic, C. G., Neilands, T. B., … Hoff, C. C. (2015). Motivations to test for HIV among partners in concordant HIV-negative and HIV-discordant gay male couples. Archives of Sexual Behavior, 44(2), 499–508.PubMedGoogle Scholar
  2. Brennan, P. F., & Hays, B. J. (1992). Focus on psychometrics the kappa statistic for establishing interrater reliability in the secondary analysis of qualitative clinical data. Research in Nursing & Health, 15(2), 153–158.Google Scholar
  3. Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46(5), 423–429.PubMedGoogle Scholar
  4. CDC. (2016). HIV infection risk, prevention, and testing behaviors among men who have sex with men: National HIV Behavioral Surveillance, 20 U.S. cities, 2014. HIV Surveillance Special Report 15. Accessed 31 Oct 2018.
  5. CDC. (2017a). HIV among gay and bisexual men. Fact Sheet. Accessed 31 Oct 2018.
  6. CDC. (2017b). Sexually transmitted disease surveillance 2016. Accessed 31 Oct 2018.
  7. 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.PubMedPubMedCentralGoogle Scholar
  8. Cicchetti, D. V., & Feinstein, A. R. (1990). High agreement but low kappa: II. Resolving the paradoxes. Journal of Clinical Epidemiology, 43(6), 551–558.PubMedGoogle Scholar
  9. Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20(1), 37–46.Google Scholar
  10. Cuervo, M., & Whyte, J. (2015). The effect of relationship characteristics on HIV risk behaviors and prevention strategies in young gay and bisexual men. Journal of the Association of Nurses in AIDS Care, 26(4), 399–410.PubMedGoogle Scholar
  11. Feinstein, A. R., & Cicchetti, D. V. (1990). High agreement but low kappa: I. The problems of two paradoxes. Journal of Clinical Epidemiology, 43(6), 543–549.PubMedGoogle Scholar
  12. Gamarel, K. E., Starks, T., Dilworth, S., Neilands, T., Taylor, J., & Johnson, M. (2014). Personal or relational? Examining sexual health in the context of HIV serodiscordant same-sex male couples. AIDS and Behavior, 18(1), 171–179.PubMedPubMedCentralGoogle Scholar
  13. 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.PubMedPubMedCentralGoogle Scholar
  14. Girianelli, V. R., & Thuler, L. C. S. (2007). Evaluation of agreement between conventional and liquid-based cytology in cervical cancer early detection based on analysis of 2,091 smears: Experience at the Brazilian National Cancer Institute. Diagnostic Cytopathology, 35(9), 545–549.PubMedGoogle Scholar
  15. Golub, S. A., Tomassilli, J. C., & Parsons, J. T. (2009). Partner serostatus and disclosure stigma: Implications for physical and mental health outcomes among HIV-positive adults. AIDS and Behavior, 13(6), 1233.PubMedGoogle Scholar
  16. Gomez, A. M., Beougher, S. C., Chakravarty, D., Neilands, T. B., Mandic, C. G., Darbes, L. A., & Hoff, C. C. (2012). Relationship dynamics as predictors of broken agreements about outside sexual partners: Implications for HIV prevention among gay couples. AIDS and Behavior, 16(6), 1584–1588.PubMedGoogle Scholar
  17. Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., Sanchez, J., Grinsztejn, B., … Buchbinder, S. P. (2012). What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE, 7(11), e50522.PubMedPubMedCentralGoogle Scholar
  18. Hernández-Romieu, A. C., Sullivan, P. S., Rothenberg, R., Grey, J., Luisi, N., Sanchez, T., … Rosenberg, E. S. (2016). Concordance of demographic characteristics, sexual behaviors, and relationship attributes among sex dyads of black and white men who have sex with men. Archives of Sexual Behavior, 45(6), 1463–1470. Scholar
  19. Hoff, C. C., & Beougher, S. C. (2010). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39(3), 774–787.PubMedGoogle Scholar
  20. Hoff, C. C., Beougher, S. C., Chakravarty, D., Darbes, L. A., & Neilands, T. B. (2010). Relationship characteristics and motivations behind agreements among gay male couples: Differences by agreement type and couple serostatus. AIDS Care, 22(7), 827–835.PubMedPubMedCentralGoogle Scholar
  21. 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.PubMedPubMedCentralGoogle Scholar
  22. Hoff, C. C., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Darbes, L. A. (2012). Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS Patient Care and STDs, 26(12), 738–745.PubMedPubMedCentralGoogle Scholar
  23. Hosking, W. (2013). Agreements about extra-dyadic sex in gay men’s relationships: Exploring differences in relationship quality by agreement type and rule-breaking behavior. Journal of Homosexuality, 60(5), 711–733.PubMedGoogle Scholar
  24. Mak, H. K., Yau, K. K., & Chan, B. P. (2004). Prevalence-adjusted bias-adjusted κ values as additional indicators to measure observer agreement. Radiology, 232(1), 302–303.PubMedGoogle Scholar
  25. Markman, H. J., & Rhoades, G. K. (2012). Relationship education research: Current status and future directions. Journal of Marital and Family Therapy, 38(1), 169–200.PubMedPubMedCentralGoogle Scholar
  26. McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282.PubMedPubMedCentralGoogle Scholar
  27. Mitchell, J. W. (2013). HIV-negative and HIV-discordant gay male couples’ use of HIV risk-reduction strategies: Differences by partner type and couples’ HIV-status. AIDS and Behavior, 17(4), 1557–1569.PubMedPubMedCentralGoogle Scholar
  28. Mitchell, J. W. (2014). Aspects of gay male couples’ sexual agreements vary by their relationship length. AIDS Care, 26(9), 1164–1170.PubMedPubMedCentralGoogle Scholar
  29. Mitchell, J. W., Moskowitz, D. A., & Seal, D. W. (2012). Understanding the agreements and behaviors of men who have sex with men who are dating or married to women: Unexpected implications for a universal HIV/STI testing protocol. International Public Health Journal, 4(4), 393–402.Google Scholar
  30. Newcomb, M. E., Macapagal, K. R., Feinstein, B. A., Bettin, E., Swann, G., & Whitton, S. W. (2017). Integrating HIV prevention and relationship education for young same-sex male couples: A pilot trial of the 2GETHER intervention. AIDS and Behavior, 21(8), 2464–2478.PubMedPubMedCentralGoogle Scholar
  31. Nieto-Andrade, B. (2009). The effect of HIV-discordance on the sexual lives of gay and bisexual men in Mexico City. Journal of Homosexuality, 57(1), 54–70.Google Scholar
  32. 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.PubMedGoogle Scholar
  33. Perry, N. S., Huebner, D. M., Baucom, B. R., & Hoff, C. C. (2016). Relationship power, sociodemographics, and their relative influence on sexual agreements among gay male couples. AIDS and Behavior, 20(6), 1302–1314.PubMedGoogle Scholar
  34. Prestage, G., Mao, L., McGuigan, D., Crawford, J., Kippax, S., Kaldor, J., & Grulich, A. (2006). HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care, 18(2), 166–172.PubMedGoogle Scholar
  35. Pruitt, K. L., White, D., Mitchell, J. W., & Stephenson, R. (2015). Sexual agreements and intimate-partner violence among male couples. International Journal of Sexual Health, 27(4), 429–441.Google Scholar
  36. Purcell, D. W., Mizuno, Y., Smith, D. K., Grabbe, K., Courtenay-Quirk, C., Tomlinson, H., & Mermin, J. (2014). Incorporating couples-based approaches into HIV prevention for gay and bisexual men: Opportunities and challenges. Archives of Sexual Behavior, 43(1), 35–46.PubMedPubMedCentralGoogle Scholar
  37. Séguin, L. J., Blais, M., Goyer, M.-F., Adam, B. D., Lavoie, F., Rodrigue, C., & Magontier, C. (2017). Examining relationship quality across three types of relationship agreements. Sexualities, 20(1–2), 86–104.Google Scholar
  38. Sim, J., & Wright, C. C. (2005). The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Physical Therapy, 85(3), 257–268.PubMedGoogle Scholar
  39. Stephenson, R., Suarez, N. A., Garofalo, R., Hidalgo, M. A., Hoehnle, S., Thai, J., … Sullivan, P. (2017). Project stronger together: Protocol to test a dyadic intervention to improve engagement in HIV care among sero-discordant male couples in three US cities. JMIR Research Protocols, 6(8), e170.PubMedPubMedCentralGoogle Scholar
  40. Stephenson, R., White, D., Darbes, L., Hoff, C., & Sullivan, P. (2015a). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior, 19(3), 553–560.PubMedPubMedCentralGoogle Scholar
  41. Stephenson, R., White, D., & Mitchell, J. W. (2015b). Sexual agreements and perception of HIV prevalence among an online sample of partnered men who have sex with men. Archives of Sexual Behavior, 44(7), 1813–1819.PubMedGoogle Scholar
  42. Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23(9), 1153–1162.PubMedGoogle Scholar
  43. Sullivan, P. S., Stephenson, R., Grazter, B., Wingood, G., Diclemente, R., Allen, S., … Grabbe, K. (2014a). Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: An application of the ADAPT-ITT framework. SpringerPlus, 3(1), 249.PubMedPubMedCentralGoogle Scholar
  44. Sullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J., Dasgupta, S., … Stephenson, R. (2014b). Safety and acceptability of couples HIV testing and counseling for US men who have sex with men: A randomized prevention study. Journal of the International Association of Providers of AIDS Care, 13(2), 135–144.PubMedGoogle Scholar
  45. Whitton, S. W., Weitbrecht, E. M., Kuryluk, A. D., & Hutsell, D. W. (2016). A randomized waitlist-controlled trial of culturally sensitive relationship education for male same-sex couples. Journal of Family Psychology, 30(6), 763–768.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Akshay Sharma
    • 1
    • 2
    Email author
  • Robert Garofalo
    • 3
    • 4
  • Marco A. Hidalgo
    • 5
    • 6
  • Samuel Hoehnle
    • 3
  • Matthew J. Mimiaga
    • 7
    • 8
  • Emily Brown
    • 7
  • Jennie Thai
    • 3
  • Anna Bratcher
    • 9
  • Taylor Wimbly
    • 9
  • Patrick S. Sullivan
    • 9
  • Rob Stephenson
    • 1
    • 2
  1. 1.Center for Sexuality and Health DisparitiesUniversity of MichiganAnn ArborUSA
  2. 2.School of NursingUniversity of MichiganAnn ArborUSA
  3. 3.Ann and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  4. 4.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  5. 5.Children’s Hospital Los AngelesLos AngelesUSA
  6. 6.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  7. 7.The Fenway InstituteFenway HealthBostonUSA
  8. 8.School of Public HealthBrown UniversityProvidenceUSA
  9. 9.Rollins School of Public HealthEmory UniversityAtlantaUSA

Personalised recommendations