Shaver John, Freeland Ryan, Goldenberg Tamar, Stephenson Rob
1 Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA.
2 Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Am J Mens Health. 2018 Jul;12(4):655-665. doi: 10.1177/1557988317745759. Epub 2018 Jan 22.
Men who have sex with men (MSM) bear a disproportionate burden of HIV incidence in the United States. Previous study of sexual decision-making and HIV risk among MSM has not accounted for relationship dynamics. Further research must examine this connection between relationship dynamics and sexual decision-making, especially regarding condomless anal intercourse. This study analyzes data gathered from gay and bisexual men regarding their sexual partners and sexual decision-making over a 10-week period through personal relationship diaries (PRDs) and a follow-up in-depth interview (IDI). Through coding and extraction of relationship dynamics, key patterns of participants' sexual decision-making processes were examined based on relationship type, which was categorized by commitment, formality, and sexual agreement. Participants' sexual relationships can be divided into five categories: (a) Uncommitted, one time, (b) Uncommitted, ongoing, (c) Transitioning or unknown commitment, (d) Committed, nonmonogamous, and (e) Committed, monogamous. These five categories correspond to patterns in sexual decision making and consequent sexual risk-taking behaviors. Each of these influence HIV risk within male-male sexual encounters in a particular manner, and understanding these is important for appropriately tailored HIV prevention interventions for MSM. Recommendations are included for interventions seeking to address HIV risk across a wide variety of MSM sexual relationships.
在美国，男男性行为者（MSM）承受着不成比例的艾滋病病毒感染负担。此前关于男男性行为者的性决策和艾滋病病毒风险的研究并未考虑到关系动态。进一步的研究必须考察关系动态与性决策之间的这种联系，尤其是在无保护肛交方面。本研究通过个人关系日记（PRD）和后续深度访谈（IDI），分析了从男同性恋者和双性恋男性那里收集到的关于他们在10周内的性伴侣和性决策的数据。通过对关系动态进行编码和提取，根据关系类型（按承诺、形式和性协议进行分类）来考察参与者性决策过程的关键模式。参与者的性关系可分为五类：（a）无承诺、一次性，（b）无承诺、持续，（c）过渡性或承诺情况不明，（d）有承诺、非一夫一妻制，以及（e）有承诺、一夫一妻制。这五类对应于性决策模式以及随之而来的性冒险行为。每一类都以特定方式影响男男性接触中的艾滋病病毒风险，了解这些对于为男男性行为者量身定制适当的艾滋病病毒预防干预措施很重要。文中还为旨在应对各类男男性行为者性关系中的艾滋病病毒风险的干预措施提供了建议。
