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

了解与男性发生性关系的男性 (MSM) 中增加艾滋病毒风险的情况,需要考虑发生危险行为的背景。关系就是这样一种背景。这项研究调查了566对MSM夫妇在过去3个月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,65% 的样本与主要伴侣进行了UAI,包括近一半的不和谐夫妇。积极的关系因素,例如依恋和亲密关系,与主要伴侣发生UAI的可能性增加有关。同时,样本的22% 与外部伴侣进行了至少一次UAI发作,其中一半是外部伴侣不和谐或未知的HIV状态。较高水平的HIV特异性社会支持,平等和性协议投资与参与UAI的可能性降低显着相关。处于不和谐关系中的HIV阳性男性与不和谐或未知HIV状态的UAI作为其HIV阴性伴侣的可能性是UAI的两倍半。许多处于关系中的MSM,包括一些处于不和谐关系中的MSM,都与主要合作伙伴进行UAI。潜在的解释包括关系密切,关系长度和协议类型。此外,关系背景似乎对与主要和外部伴侣的UAI产生了不同的影响,这意味着可能需要为不同类型的夫妇量身定制预防信息。涉及MSM夫妇的预防工作必须考虑到关系特征,因为夫妇在更安全的性行为和艾滋病毒风险与亲密关系和愉悦之间取得平衡。

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