Beougher Sean C, Chakravarty Deepalika, Garcia Carla C, Darbes Lynae A, Neilands Torsten B, Hoff Colleen C
Center for Research on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA.
AIDS Care. 2012;24(9):1071-7. doi: 10.1080/09540121.2011.648603. Epub 2012 Jan 31.
As HIV research and prevention efforts increasingly target gay men in relationships, situational factors such as couple serostatus and agreements about sex become central to examinations of risk. Discordant gay couples are of particular interest because the risk of HIV infection is seemingly near-at-hand. Yet, little is known about their sexual behaviors, agreements about sex, and safer sex efforts. The present study utilized longitudinal semi-structured, qualitative interviews to explore these issues among 12 discordant couples. Findings show that nearly every couple had agreements about reducing the likelihood of HIV transmission from one partner to the other. Negotiating these agreements involved establishing a level of acceptable risk, determining condom use, and employing other risk-reduction techniques, such as seropositioning and withdrawal. For half of the couples, these agreements did not involve using condoms; only two couples reported consistent condom use. Despite forgoing condoms, however, none reported seroconversion over the course of data collection. Additional issues are raised where long-term HIV prevention is concerned. Future prevention efforts with discordant couples should work with, rather than fight against, the couple's decision to use condoms and endeavor to complement and accentuate their other safer sex efforts.
随着艾滋病病毒（HIV）研究和预防工作越来越多地将目标对准处于恋爱关系中的男同性恋者，诸如伴侣血清学状态及性方面的约定等情境因素，成为了风险评估的核心内容。血清学不一致的男同性恋伴侣尤其值得关注，因为HIV感染风险似乎近在眼前。然而，对于他们的性行为、性方面的约定以及安全性行为举措，人们却知之甚少。本研究采用纵向半结构化定性访谈，对12对血清学不一致的伴侣之间的这些问题展开了探究。研究结果显示，几乎每对伴侣都就降低一方将HIV传染给另一方的可能性达成了约定。协商这些约定涉及确定可接受的风险水平、决定是否使用避孕套以及采用其他降低风险的技巧，例如血清学体位法和体外射精。对于半数伴侣而言，这些约定并不涉及使用避孕套；只有两对伴侣报告称始终坚持使用避孕套。然而，尽管未使用避孕套，但在数据收集期间，没有一对报告血清转化情况。在长期HIV预防方面还引发了其他问题。未来针对血清学不一致伴侣的预防工作，应该顺应而非对抗伴侣使用避孕套的决定，并努力补充和强化他们的其他安全性行为举措。
