Behavioral and Cognitive Barriers to Safer Sex Between Men in Steady Relationships: Implications for Prevention Strategies

As steady partners are a major source of HIV infection among gay men, the current study focused on better understanding the sexual risks taken in steady relationships. The authors "examined characteristics of the first incident of unprotected anal intercourse (UAI) between steady male partners. We also examined cognitive barriers to safer sex by way of associating beliefs regarding UAI with protective behavior."

Three hundred twenty-four gay men ages 18-34 completed questionnaires assessing their sexual behavior and related cognitions. Of the participants who engaged in UAI with their steady partners, 55 percent did so within the first three months of the relationship, and 46 percent did not discuss UAI prior to it occurring.

Study authors found both the perception of UAI as a symbol of trust and belief that the partner desired UAI "were associated with less condom use but also with a higher likelihood that men established HIV-negative seroconcordance and made sexual agreements (i.e., practiced negotiated safety)." In addition, the perception that UAI is more gratifying was associated with risky UAI.

These findings suggest that interventions can highlight beliefs regarding trust and partner's desire for UAI as a way to promote negotiated safety. "In relationships where negotiated safety cannot be implemented," the authors concluded, "HIV prevention should regard the above beliefs, in particular the perception that UAI is more gratifying, as important barriers to safer sex." These findings, which indicate the early onset of risk in relationships, emphasized the narrow timeframe for preventing sexual risk before it occurs. Targeting single gay men for promoting safer sex in future steady partnerships could help, they concluded.

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