Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia.
The Kirby Institute, UNSW Sydney, Sydney, Australia.
Arch Sex Behav. 2023 Feb;52(2):761-771. doi: 10.1007/s10508-022-02382-9. Epub 2022 Aug 8.
Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson's chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships.
关系协议对于处于伴侣关系中的男同性恋和双性恋者（GBM）预防 HIV 非常重要，HIV 流行早期的研究经常发现，协议规定了与随意伴侣保持一夫一妻制或使用安全套。有证据表明，HIV 暴露前预防（PrEP）已经改变了一些处于伴侣关系中的男性的性行为，例如允许与随意伴侣无保护措施的性行为，但对于使用 PrEP 的 GBM 之间的关系协议关注甚少。在本文中，我们分析了 2021 年非 HIV 阳性 GBM 在线调查（N=1185）的全国性、澳大利亚横断面数据。使用逻辑回归，我们确定了与处于伴侣关系中的 GBM 使用 PrEP 相关的人口统计学特征、性行为和关系协议类型。使用 Pearson's chi-squared 检验，我们探讨了处于伴侣关系中的 PrEP 用户与未处于伴侣关系中的 PrEP 用户报告的性行为是否相似。处于伴侣关系中的 GBM 使用 PrEP 与年龄较大、同性恋身份、非一夫一妻制关系、有明确（明确）的关系协议、主要 HIV 阴性伴侣使用 PrEP 或主要伴侣感染 HIV、报告最近无保护措施的随意性行为、报告过去一年中患有性传播感染以及至少认识另一位 PrEP 用户独立相关。我们发现，处于伴侣关系中的 PrEP 用户与未处于伴侣关系中的 PrEP 用户的性行为相似。有随意性行为且符合 PrEP 适用标准的处于伴侣关系中的 GBM 可能是 PrEP 的良好候选者。我们的研究结果表明，明确的关系协议对于 HIV 预防仍然很重要，并且支持处于伴侣关系中的 GBM 使用 PrEP。
