A Little Thing Called Love: Condom Use in High-Risk Primary Heterosexual Relationships

The authors introduced the study by noting that condoms are less likely to be used in primary relationships than in other relationships. "An understanding of what women and men expect when entering into these relationships, as well as how they make decisions about condom use and other prevention behaviors, is essential to efforts to curb the spread of HIV," they wrote.

The subjects of the study -- 25 high-risk heterosexual couples, some of them HIV-serodiscordant, who were participants in a trial of the female condom in Hartford, Conn., in 2004-07 -- underwent qualitative in-depth interviews. The data were coded and analyzed in an iterative inductive and deductive process.

Condom nonuse was described by participants as a strategy to find and maintain a primary relationship, establish trust, and build intimacy. Although they recognized their risk of HIV and other STDs, many participants reported unprotected intercourse, "placing their love for their partner and other emotional needs over concerns about their health." Several couples relied on negotiated safety techniques to reduce their STD risk: These included using condoms until serostatus was known; sharing sexual or drug use history; disclosing HIV test results; and using condoms until the partners decided the relationship would be monogamous.

"HIV prevention approaches must recognize the importance of love and the needs that primary relationships satisfy if they are to be considered relevant by those at greatest risk," the authors concluded. "Negotiated safety and similar strategies may be an important risk reduction tool for heterosexuals, particularly those in HIV-affected relationships, but their potential effectiveness may vary."

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