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Studies of Gay Discordant Couples

Jul 30, 1997

Has any study been conducted on gay discordant couples? Is so, what were the results? I have read some literature for heterosexual couples where the uninfected person sero-converted from about 1% for those using condoms on a regular basis to about 12% for those either not using them or using them on an irregular basis.

Response from Mr. Sowadsky

Hi. Thank you for your question. There have been several studies looking at HIV risks in Gay discordant couples (where one partner is HIV-positive, and the other is HIV-negative). Most of these studies looked at how often these couples engaged in high risk activities (especially unprotected anal intercourse). Some interesting patterns have arisen over the years.

Generally speaking, it has been shown that Gay men (regardless of HIV status) are less likely to use condoms for anal sex with their regular (long-term) partners, than they are with casual/anonymous partners. It has also been reported that in some (but not all) Gay men, anal intercourse with their regular partner represented their commitment to each other. Some Gay couples look at condoms as being a barrier to intimacy, and that not using condoms shows love and trust in their relationship. Also one study has shown that there may be a sense of invincibility (a sense that one cannot get HIV) from a partner in a long-term and intimate relationship. Couples who did not talk to each other about HIV or safer sex, were also found to have engaged in unprotected anal intercourse more often, even when the risk for HIV was known. Studies have shown that in some Gay relationships, some couples did not consistently use condoms (or use them at all) even when one of the partners was already known to be positive. In other words, the decision whether to use condoms or not, was sometimes based on the status of the relationship (regular partner vs. casual partner), rather than just the HIV status of the partner. Decisions on condom use among Gay couples are sometimes based on love and trust, rather than knowledge of HIV transmission.

Condom use among discordant couples (where one partner is HIV-positive, and the other is HIV-negative) is often greater than condom use among concordant couples (where either both partners are HIV-negative, or both are HIV-positive). Also, one study suggested that the "bottom" partner often has a greater influence regarding the decision on whether to use condoms or not.

Rather than using condoms for anal sex, some discordant couples have chosen other ways of reducing the risk to the negative partner. Some have had unprotected anal intercourse without ejaculation. Some have chosen to have anal intercourse with the positive partner as the receptive ("bottom") partner. Some have chosen to engage only in oral sex, rather than anal sex. These strategies may somewhat reduce the risk, but they certainly won't eliminate the risk! In all of these cases, the negative partner would still be at significant risk of infection for HIV, and other Sexually Transmitted Diseases as well. For related topics, see the posts, "Inadvertently Exposed" and "Oral Sex."

In summary, although most Gay discordant couples do use condoms consistently, there are some discordant couples who do not use condoms every time (or at all). We therefore cannot assume that discordant couples will always use condoms, especially if they are in a long-term relationship. There is much more to the decision to use condoms, than just knowing the HIV status of ones partner. There are multiple factors that determine condom use (like those described above). Risk reduction messages to the Gay community must take all of these factors into account.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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