Gass Katherine, Hoff Colleen C, Stephenson Rob, Sullivan Patrick S
Department of Epidemiology, Emory University, Atlanta, GA, USA.
AIDS Care. 2012;24(10):1255-63. doi: 10.1080/09540121.2012.656571. Epub 2012 Mar 1.
Recent studies among men who have sex with men (MSM) have found that the majority of HIV transmission results from sex with a main partner. One factor likely to affect the risk of transmission is the type of agreements the couple has regarding sexual behaviour within and outside the relationship. This study recruited 732 Internet-using MSM through Facebook banner ads. Participants completed an online questionnaire regarding demographic characteristics of the respondent and their main partner, the sexual behaviour of the couple, the existence of a sexual agreement, and the strength of investment in that agreement. The Pearson chi-square test was used to assess the association between sexual agreements (categorized as open, closed, or none) and the predictive variables. Respondents' investment in their sexual agreement was measured using the sexual agreement investment scale (a composite score ranging from 0 to 52). Ninety-one percent of respondents had some form of sexual agreement in place with their main partner. The presence and type of sexual agreement was found to be strongly associated with many characteristics of the individual and couple, including the respondent's HIV status, length of time with the main partner, having unprotected anal intercourse with a man other than their main partner, and happiness in the relationship. Increases in the strength of respondents' investment in their sexual agreement were found to be associated with newness of the relationship, relationship happiness, having a closed relationship, and decreases in risky sexual behaviour. This study offers further evidence of the important role that sexual agreements play in male couples. The overwhelming prevalence of sexual agreements and their association with relationship happiness and risky sexual behaviours has important implications for future HIV prevention and control strategies, including the implementation of couples voluntary counseling and testing.
最近针对男男性行为者（MSM）的研究发现，大多数艾滋病毒传播是由与主要伴侣发生性行为导致的。一个可能影响传播风险的因素是伴侣双方对于关系内外性行为的约定类型。本研究通过脸书横幅广告招募了732名使用互联网的男男性行为者。参与者完成了一份在线问卷，内容涉及受访者及其主要伴侣的人口统计学特征、伴侣双方的性行为、性约定的存在情况以及对该约定的投入程度。使用Pearson卡方检验来评估性约定（分为开放式、封闭式或无约定）与预测变量之间的关联。受访者对其性约定的投入程度通过性约定投入量表来衡量（综合得分范围为0至52分）。91%的受访者与他们的主要伴侣有某种形式的性约定。研究发现，性约定的存在和类型与个人及伴侣的许多特征密切相关，包括受访者的艾滋病毒感染状况、与主要伴侣相处的时间长度、与主要伴侣之外的男性进行无保护肛交的情况以及关系中的幸福感。受访者对其性约定投入程度的增加与关系的新鲜感、关系幸福感、处于封闭式关系以及危险性行为的减少有关。本研究进一步证明了性约定在男同性恋伴侣中所起的重要作用。性约定的普遍存在及其与关系幸福感和危险性行为的关联对于未来的艾滋病毒预防和控制策略具有重要意义，包括实施伴侣自愿咨询和检测。
