Adherence to a Sexual Agreement Reduces HIV Risk among HIV-negative Seroconcordant Gay Male Couples

Some HIV-negative seroconcordant gay male couples have established a sexual agreement (SA) to allow unprotected anal intercourse (UAI) while reducing their risk for HIV. The effectiveness of SAs as a HIV prevention strategy has been debated. In the U.S., limited research with this population exists to quantitatively support that adherence to a SA would reduce HIV risk, especially when UAI is practiced within the relationship, and sex may occur with secondary sex partners. The present study quantitatively assessed whether a gay male who adhered to his SA would be less likely to have had UAI with a secondary sex partner when UAI was practiced with his main partner. In this cross-sectional study, dyadic data were collected through an anonymous electronic questionnaire from couples in Portland, OR and Seattle, WA to provide a convenience sample of 144 dyads. Relationship factors, UAI, and characteristics of SAs were examined among a sub-sample of 58 couples who were concordant about their type of SA. Odds ratios and their associated 95% confidence intervals (CI) were calculated by using a multilevel logistic random-intercept regression model. Results indicated that men who adhered to their SA with their main partner were significantly less likely to have had UAI with a secondary sex partner (OR = 0.06, 95% CI 0.01 – 0.54). Other results, including factors that increase the likelihood of adherence to a SA will be presented and implications about SAs as a HIV prevention strategy for gay male couples will be discussed.