Sexual Agreements in the Partnerships of Internet-Using Men Who Have Sex With Men

Among men who have sex with men (MSM), the majority of HIV transmission results from sex with a main partner, recent studies have shown. The authors noted that one factor likely to influence the risk of transmission is the type of agreements the couple has regarding sexual behavior both within the relationship and outside it.

In the current study, Facebook banner ads were used to recruit 732 MSM who use the Internet. The men completed an online questionnaire regarding demographic characteristics of the respondent, his main partner, their sexual behavior, whether they had a sexual agreement, "and the strength of investment in that agreement."

The association between sexual agreements (categorized as open, closed or none) and the predictive variables was assessed using the Pearson chi-square test. The sexual agreement investment scale (a composite score of 0 to 52) was used to assess respondents' investment in their sexual agreement.

Most respondents (91 percent) reported having some form of sexual agreement in place with their main partner. The presence and type of this agreement was strongly associated with many of the characteristics of the individual and the couple, including: the HIV status of the respondent; the length of time with the main partner; having unprotected anal intercourse with a man other than the main partner; and happiness in the relationship. The results indicated that increases in the strength of the respondents' investment in the sexual agreement were associated with newness of the relationship; happiness in the relationship; having a closed relationship; and decreases in risky sexual behavior.

"This study offers further evidence of the important role that sexual agreements play in male couples," the authors concluded. "The overwhelming prevalence of sexual agreements and their association with relationship happiness and risky sexual behaviors has important implications for future HIV prevention and control strategies, including the implementation of couples voluntary counseling and testing."

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