Management of the risk of HIV infection in male homosexual couples

Objectives: To study the ways of managing HIV risk within male homosexual s teady relationships (gay couples), including factors associated with consis tent condom use during anal sex with the steady partner. Method: An anonymous and standardized questionnaire completed by a convenie nce sample of homosexuals in Switzerland in 1997 (n = 1097). Information on the couple was provided by the 74% (n = 786) of male respondents who repor ted having a steady partner in the past 12 months. Data were analysed by co ntingency tables and logistic regression. Results: Different ways of managing HIV risk were reported: negotiated safe ty (both HIV negative, condoms abandoned) was chosen by one quarter of the couples, but the most frequent solution was reliance on condoms for anal se x, chosen by more than four in 10. Altogether 84% of couples exhibited safe management of HIV risk within their partnership. The 16% of couples showin g inadequate management of HIV risk within the couple mostly relied on ques tionable assumptions about past or present risks. A total of 74% of couples had spoken about managing HIV risk with possible casual partners. Reported behaviour with the steady partner and with casual partners was highly cons istent with claimed strategies chosen to manage HIV risk. Consistent condom use with the steady partner was mostly associated with variables character izing the relationship: initial 2 years of the relationship, discordant or unknown serological HIV status, non-exclusivity. Conclusion: Cay couples manage HIV risk in a variety of ways. Most strategi es provide adequate protection with casual partners, but leave gaps in prot ection between the steady partners themselves. (C) 2001 Lippincott Williams & Wilkins.