Understanding situations that increase HIV risk among men who have sex with men (MSM) requires consideration of the context in which risky behaviors occur. Relationships are one such context. This study examines the presence and predictors of unprotected anal intercourse (UAI) in the past 3 months among 566 MSM couples. A majority of couples allowed sex with outside partners. Overall, 65% of the sample engaged in UAI with primary partner, including nearly half of discordant couples. Positive relationship factors, such as attachment and intimacy, were associated with an increased likelihood of UAI with primary partner. Meanwhile, 22% of the sample engaged in at least one episode of UAI with an outside partner, half of whom were discordant or unknown HIV status outside partners. Higher levels of HIV-specific social support, equality, and sexual agreement investment were significantly associated with a decreased likelihood of engaging in UAI with a discordant or unknown HIV status outside partner. HIV-positive men in discordant relationships had two and one half times the odds of having UAI with a discordant or unknown HIV status outside partner as their HIV-negative partners. Many MSM in relationships, including some in serodiscordant ones, engage in UAI with primary partners. Potential explanations include relationship closeness, relationship length, and agreement type. In addition, relationship context appears to have a differential impact upon UAI with primary and outside partners, implying that prevention messages may need to be tailored for different types of couples. Prevention efforts involving MSM couples must take into account relationship characteristics as couples balance safer sex and HIV risk with intimacy and pleasure.

译文

:要了解与男性发生性关系(MSM)的男性中增加HIV风险的情况,需要考虑发生危险行为的背景。关系就是这样一种背景。这项研究检查了过去3个月中566对MSM夫妇中无保护的肛门性交(UAI)的存在和预测因素。大多数夫妇允许与外部伴侣发生性关系。总体而言,有65%的样本是与主要伴侣进行UAI的,其中包括近一半的不和谐夫妻。积极的关系因素,例如依恋和亲密感,与主要伴侣进行UAI的可能性增加有关。同时,有22%的样本与外部伴侣进行了至少一次UAI发作,其中一半是外部伴侣的不和谐或未知的HIV状况。特定于艾滋病毒的社会支持,平等和性协议投资的增加,与在伴侣外部或艾滋病毒状况不明或未知的情况下参与UAI的可能性大大降低有关。处于不和谐关系中的HIV阳性男性患UAI且其伴侣之外的HIV状况处于不和谐或未知状态的几率是其HIV阴性伴侣的两倍半。许多关系中的MSM,包括一些血清异常的人,都与主要合作伙伴一起参与UAI。可能的解释包括关系亲密性,关系长度和协议类型。此外,关系背景似乎对与主要和外部合作伙伴的UAI有不同的影响,这意味着可能需要针对不同类型的夫妻量身定制预防信息。涉及MSM夫妇的预防工作必须考虑到夫妻之间的关系特征,因为夫妇要在安全的性行为和HIV风险与亲密和愉悦之间取得平衡。

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