A survey of American gay couples found that many have a ‘sexual agreement’, both to minimise HIV risks and to maintain the quality of their relationship. Around half the agreements simply clarified that sex was not permitted with other people, while other agreements concerned the relationship being ‘open’ to a lesser or greater extent.
But the survey found that partners do not always agree on whether they have an agreement, on whether it was explicitly discussed, on what sex is allowed with other people, or in what circumstances.
And the agreement had been broken by one or both partners in just under half the couples studied. Few men told their partner that they had broken the agreement.
Other research has suggested that many gay men acquire HIV from their primary partner. Few long-term couples use condoms together, so if a man acquires an infection from a casual partner he can easily pass it on to his primary partner.
Therefore HIV-prevention interventions which support men in strengthening their relationships, making better agreements and having clearer communication would be warranted. Projects which allow couples to test together are one possibility.
Also this month, research from Malawi has described gender inequalities which put married women at risk of HIV infection. This study also draws attention to HIV transmission occurring within long-term relationships and the lack of HIV prevention interventions addressing these issues.