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Management of the risk of HIV infection in male homosexual couples

Moreau-Gruet, Florence; Jeannin, André; Dubois-Arber, Françoise; Spencer, Brenda

Epidemiology & Social

Objectives: To study the ways of managing HIV risk within male homosexual steady relationships (gay couples), including factors associated with consistent condom use during anal sex with the steady partner.

Method: An anonymous and standardized questionnaire completed by a convenience sample of homosexuals in Switzerland in 1997 (n = 1097). Information on the couple was provided by the 74% (n = 786) of male respondents who reported having a steady partner in the past 12 months. Data were analysed by contingency tables and logistic regression.

Results: Different ways of managing HIV risk were reported: negotiated safety (both HIV negative, condoms abandoned) was chosen by one quarter of the couples, but the most frequent solution was reliance on condoms for anal sex, chosen by more than four in 10. Altogether 84% of couples exhibited safe management of HIV risk within their partnership. The 16% of couples showing inadequate management of HIV risk within the couple mostly relied on questionable 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 consistent with claimed strategies chosen to manage HIV risk. Consistent condom use with the steady partner was mostly associated with variables characterizing the relationship: initial 2 years of the relationship, discordant or unknown serological HIV status, non-exclusivity.

Conclusion: Gay couples manage HIV risk in a variety of ways. Most strategies provide adequate protection with casual partners, but leave gaps in protection between the steady partners themselves.

From the University Institute of Social and Preventive Medicine, Lausanne, Switzerland.

Correspondence and requests for reprints to: Florence Moreau-Gruet, Institut Universitaire de Médecine, Sociale et Préventive, Rue du Bugnon 17, CH-1005 Lausanne, Switzerland. E-mail:

Received: 7 March 2000;

Revised: 18 September 2000;

Accepted: 29 September 2000.

Sponsorship: This research was funded by the Swiss Federal Office of Public Health as part of the ongoing evaluation of the AIDS prevention strategy in Switzerland, contract number 316.95.5755 A-B-C.

© 2001 Lippincott Williams & Wilkins, Inc.