Relationship dynamics and sexual health of sero-discordant MSM couples

Purpose: While 68% of new HIV infections occur among primary partners, highlighting the need to involve both partners in HIV intervention programs, most transmission prevention efforts among MSM in the United States continue to focus on individuals, ignoring the potentially vital the role the primary partner could be playing in the prevention of further transmission. Methods: As part of a qualitative study on relationship dynamics and sexual behaviors of serodiscordant MSM couples, 25 serodisordant male couples (50 individual participants) were recruited to complete a face-to-face semi-structured interview. Participants were asked open ended questions about their romantic and sexual relationship experiences, perceptions related to HIV risk and acquisition, and decision-making processes around HIV risk and protective behaviors. Interviews lasted 60-90 minutes, individuals were compensated $25 each, and data were analyzed using standard thematic techniques. Results: Participants expressed a desire for intimacy, friendship, trust and connection. Couples described a variety of prevention practices including condoms, strategic positioning, and sexual behaviors other than anal intercourse. While HIV was present in the lives of couples, it was not dominant in the daily interactions around sexual behavior. Although nearly all participants said they did not utilize PrEP or PEP, most mentioned the importance of suppressed viral load among the partner living with HIV influencing sexual decision making. Conclusions: These data aim to shed light on the effect of HIV status on sexual behaviors within primary partnerships in order to create effective intervention stratetgies to reduce HIV transmission among MSM.