This poster was presented at the 10th Annual Canadian Conference on HIV/AIDS Research in Toronto in June 2001.

Sexual behaviours of men in same-sex relationships:
Are monogamous men less at risk?

Mary Lou Miller, Steve Martindale, Jacqueline M. O'Connell, Arn J. Schilder, Terry Trussler, Michael Botnick, Keith Chan, Kevin J.P. Craib, Robert S. Hogg.

OBJECTIVES:

To compare sexual behaviours and socio-demographic characteristics of young gay and bisexual men in monogamous and non-monogamous same-sex relationships.

BACKGROUND:

Stable relationships have been advocated as a means of decreasing sexual risk for HIV infection. However, research has shown that although relationships are increasingly reported among MSM, monogamy is not. Being in a relationship may lead to a generalized "denial" of HIV risk.

METHODS:

Since May 1995, young gay and bisexual men aged 15 to 30 have been recruited into an ongoing prospective study of HIV incidence and risk behaviors in the Greater Vancouver region.

Information on relationship status, sexual behaviour and socio-demographic characteristics were collected from self-administered questionnaires.

Contingency table and non-parametric methods identified factors associated with being in a monogamous relationship or not. Multivariate logistic regression models identified independent predictors of relationship status. In multivariate models, all possible two-way interactions were examined.

RESULTS:

Out of 462 participants, 216 (46.8%) reported being in a same-sex relationship, or whom 83 (38.4%) described their relationship as monogamous.

In addition to being more likely to have had casual sex partners and to have had more casual partners in the past year, participants in non-monogamous relationships were more likely to have had unprotected anal insertive sex with casual partners in the past year. As shown in Table 1, they were also more likely to have been paid for sex, both in the past year and in their lifetimes.

Marginally significant trends observed among monogamous men suggest that they were more likely to have receptive anal sex with a regular partner, and to do so without condoms. As shown in Table 1, they were also less likely to have HIV (0% vs. 4.6%; p=0.084).

No significant socio-demographic differences were observed between the two groups. Men in non-monogamous relationships were of course far more likely to have had a casual sex partner in the past year. As shown in Table 2, the only other predictor of non-monogamy was having ever been paid for sex (OR: 2.6; 95% CI: 1.2-5.8).

LIMITATIONS:

As our questionnaire covers events transpiring in the previous year, we are unable to determine whether casual sex encounters among participants who report currently being in monogamous relationships occurred before or during their current relationship.

CONCLUSIONS:

We found evidence of "negotiated safety" being practised in our cohort, as men in monogamous relationships were marginally more likely than those in non-monogamous relationships to have unprotected anal sex with their regular partners.

Non-monogamous men are, of course, at risk for HIV through their sexual activities with casual partners, both paid and unpaid.

Men who report being in monogamous relationships may, however, have a false sense of security. The majority of the men in monogamous relationships practised unprotected anal sex with their regular partners, and as over a quarter of them also reported unprotected insertive anal sex with casual partners in the past year, some of these men may be unknowingly at risk for HIV within their primary relationships.

As such, HIV prevention efforts should take into account the complexities of negotiating terms of relationships.

REFERENCES:

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2. Hoff CC, McKusick L, Hilliard B, Ekstrand M, Coates TJ. Changes in gay relationships before the AIDS epidemic and now. Int Conf AIDS, 1992:D418 (abstract no. PoD 5186).

3. McKirnan D, Doll L, Harrison J, et al. Primary relationships confer risk for HIV exposure among gay men. Int Conf AIDS,1991:402 (abstract no. M.D.4049).

4. Siva C, Spink MJ, Veras MA, et al. Regular partnerships and perception of risk for HIV infection among men who have sex with men: an elusive notion. Int Conf AIDS, 1998:220 (abstract no. 14190).