Marriage, monogamy and risk: A study of HIV/STI risk perception, testing and diagnosis among LGBT individuals in the Midwest

Background: The promotion of monogamous relationships has been recognized as a feasible strategy reducing the risk for HIV and sexually transmitted infections (STI). This strategy presents challenges for lesbian, gay, bisexual, and transgender (LGBT) couples who often lack the option of legally recognized relationships. This study examined differences in perceived risk, testing, and diagnosis of HIV/STI among married, exclusively partnered, and non-partnered LGBT persons. Methods: A community-based participatory research approach was utilized to develop an online anonymous survey. Participants (N=770) were recruited via advertisements, press releases, and listserves. Participants represented western Iowa (same-sex partnership recognition) and Nebraska (no same-sex partnership recognition). Results: No differences were found among groups for HIV and STI diagnosis and HIV testing. Testing for STIs other than HIV was significant across all groups, X2 (2, N=748)=13.486, p < .01; those not in a married or exclusively partnered relationship were more likely to have been tested in the past year (n=111, 33.1%) while married persons were least likely to have been tested (n=15, 16.0%). One-way ANOVA revealed unpartnered LGBT persons were more likely than married and exclusively partnered persons to have a higher perceived risk for STIs, including HIV [F(2, 661)=19.382, p<.01]. However, while statistically different, single individuals had relatively low levels of perceived risk (M=8.51 on 18 point scale). Conclusions: While results suggest that monogamy is seen by partnered LGBT as a viable risk reduction strategy, continued efforts to raise HIV/STI risk perception among individuals who are not in exclusive relationships are needed.