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Negotiating sexual safety in the era of biomedical HIV prevention: relationship dynamics among male couples using pre-exposure prophylaxis.

  • Malone, Jowanna1
  • Syvertsen, Jennifer L2
  • Johnson, Blake E3
  • Mimiaga, Matthew J4, 5, 6, 7
  • Mayer, Kenneth H7, 8
  • Bazzi, Angela R9
  • 1 a Harvard T.H. Chan School of Public Health , Boston , MA , USA.
  • 2 b Department of Anthropology , The Ohio State University , Columbus , OH , USA.
  • 3 c University of North Carolina School of Medicine , Chapel Hill , NC , USA.
  • 4 d Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health , Brown University , Providence , RI , USA.
  • 5 e Department of Psychiatry & Human Behavior, Alpert Medical School , Brown University , Providence , RI , USA.
  • 6 f Center for Health Equity Research , Brown University , Providence , RI , USA.
  • 7 g The Fenway Institute, Fenway Health , Boston , MA , USA.
  • 8 h Infectious Disease Division , Beth Israel Deaconess Medical Center and Harvard Medical School , Boston , MA , USA. , (Israel)
  • 9 i Department of Community Health Sciences , Boston University School of Public Health , Boston MA , USA.
Published Article
Culture, health & sexuality
Publication Date
Sep 05, 2017
DOI: 10.1080/13691058.2017.1368711
PMID: 28872441


Up to two-thirds of new cases of HIV transmission between gay, bisexual and other men who have sex with men in the USA are attributed to primary relationships. Understanding the relationship dynamics and sexual agreements of male-male couples can provide insight into HIV transmission patterns and prevention needs in this population. The daily use of antiretroviral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its negotiation and use within social and intimate relationship contexts remain understudied. We conducted semi-structured qualitative interviews with 20 male couples (n = 40 men) in which at least one partner was either using or in the process of initiating PrEP. Congruent with a theoretical focus on social theories of relationships and negotiated risk, couples were interviewed about relationship dynamics, trust, communication and sexual health practices, including their perception and use of PrEP. Overall, we found that couples showed heightened trust and communication when establishing open, sexual agreements and demonstrated high awareness of sexual risks and health practices in the context of PrEP use. This study demonstrates how understanding relationship dynamics can better inform HIV prevention and sexual health promotion efforts for male couples at risk of HIV.

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