Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

James Gray¹, Garrett Prestage², Fengyi Jin², Nittaya Phanuphak³, Ruth K Friedman⁴, Christopher K Fairley^{5

6}, Anthony Kelleher², David J Templeton^{2

7

8}, Iryna Zablotska-Manos^{9

10}, Jennifer Hoy¹¹, Anna McNulty^{12

13}, David Baker¹⁴, Graham Brown¹⁵, Andrew Grulich², Benjamin Bavinton²; Opposites Attract study group

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia. jgray@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
³ Institute of HIV Research and Innovation, Bangkok, Thailand.
⁴ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
⁵ Melbourne Sexual Health Centre, Melbourne, Australia.
⁶ Central Clinical School, Monash University, Melbourne, Australia.
⁷ Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, Australia.
⁸ Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁹ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁰ Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, Australia.
¹¹ Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia.
¹² Sydney Sexual Health Centre, Sydney and Sydney Eye Hospital, Sydney, Australia.
¹³ School of Population Health, UNSW Sydney, Sydney, Australia.
¹⁴ East Sydney Doctors, Sydney, Australia.
¹⁵ Centre for Social Impact, UNSW Sydney, Sydney, Australia.

PMID: 36917425
PMCID: PMC10386966
DOI: 10.1007/s10461-023-04030-2

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

James Gray et al. AIDS Behav. 2023 Sep.

. 2023 Sep;27(9):3098-3108.

doi: 10.1007/s10461-023-04030-2. Epub 2023 Mar 14.

Authors

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia. jgray@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
³ Institute of HIV Research and Innovation, Bangkok, Thailand.
⁴ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
⁵ Melbourne Sexual Health Centre, Melbourne, Australia.
⁶ Central Clinical School, Monash University, Melbourne, Australia.
⁷ Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, Australia.
⁸ Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁹ Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁰ Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, Australia.
¹¹ Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia.
¹² Sydney Sexual Health Centre, Sydney and Sydney Eye Hospital, Sydney, Australia.
¹³ School of Population Health, UNSW Sydney, Sydney, Australia.
¹⁴ East Sydney Doctors, Sydney, Australia.
¹⁵ Centre for Social Impact, UNSW Sydney, Sydney, Australia.

PMID: 36917425
PMCID: PMC10386966
DOI: 10.1007/s10461-023-04030-2

Abstract

Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

Keywords: Gay men; HIV prevention; Homosexual; Men who have sex with men; Risk reduction strategies; Serodiscordant couples; Sexual behavior.

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Conflict of interest statement

Not applicable.

References

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Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

Affiliations

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous