Factors associated with HIV sexual risk behavior in male couples of mixed HIV status

R. Remien, G. Wagner, C. Dolezal, A. Carballo-Diéguez

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners. This study was conducted with 75 HIV serodiscordant ("mixed HIV status" ) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both memhers of the couple were included in all assessments. There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire lor sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk hehavior. The men in these relationships also used specific "harm reduction" strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV seropositive (HIV+) partner.