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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Arch Sex Behav. Author manuscript; available in PMC 2010 June 1.
Published in final edited form as:
PMCID: PMC2855749
NIHMSID: NIHMS133623

Sexual Agreements among Gay Male Couples

Abstract

Many gay male couples make agreements about whether or not to permit sex with outside partners, yet little is known about the development and maintenance of these agreements, their impact on relationships, and whether they are an effective HIV prevention strategy. Using semi-structured, qualitative interviews, 39 gay male couples were asked about their sexual agreements and about other relationship dynamics that might affect their agreements. Analysis revealed a wide range of agreement types, all of which are presented along a continuum rather than as discrete categories. For couples with open agreements, most placed rules or conditions limiting when, where, how often, and with whom outside sex was permitted. Although motivations for having agreements varied, HIV prevention did not rank as a primary factor for any couple. Most couples had congruous agreements; however, a small number reported discrepancies which may increase HIV transmission risk. How couples handled breaks in their agreements also varied, depending on what condition was broken, whether it was disclosed, and the partner's reaction. Additional results include differences in agreement type and motivations for having an agreement based on couple serostatus. Overall, agreements benefited couples by providing boundaries for the relationship, supporting a non-heteronormative identity, and fulfilling the sexual needs of the couple. Future prevention efforts involving gay couples must address the range of agreement types and the meanings couples ascribe to them, in addition to tempering safety messages with the relationship issues that are important to and faced by gay couples.

Keywords: gay couples, sexual agreements, negotiation, HIV prevention

INTRODUCTION

In the 1970s and early 1980s, studies investigating gay men in relationships reported high rates of non-monogamy (Bell & Weinberg, 1978; Blumstein & Schwartz, 1983). In fact, some reported that, after the first year, few gay couples remained monogamous (Mattison & McWhirter, 1987). The majority of gay couples who had sex with outside partners had an “understanding” whereby sex outside the relationship was not considered cheating. Although many gay couples expected that one or both individuals in the relationship would have sex with outside partners, most did not support any emotional involvement with those partners for fear it would threaten the relationship (Blumstein & Schwartz, 1983).

Since the advent of the AIDS epidemic, “understandings” about sex with outside partners have become more complicated for gay couples. The consequences of what was once a casual understanding became increasingly risky, even life-threatening. Early prevention efforts did not address how gay couples might negotiate their “understandings” to effectively reduce HIV transmission risk. At the time, most efforts were directed at single gay men, thus prevention messages were individually-focused. These early messages were successful in substantially reducing sexual risk and HIV transmission among many gay men; however, as the epidemic has matured, needs have changed. Recent research has shown that gay men in relationships are more likely to have unprotected sex with each other than their single counterparts with their casual partners, particularly if they are involved in seroconcordant relationships (Hoff, Coates, Barrett, Collette, & Ekstrand, 1996; Hoff et al., 1997; Stall, Hays, Waldo, Ekstrand, & McFarland, 2000). While unprotected sex with a known seroconcordant primary partner may pose little immediate risk, if either partner engages in sex outside of the relationship, or if the couple is discordant, risk for one or both partners increases. This finding is supported by recent studies reporting high numbers of men who were infected with HIV by their main partners (Davidovich, de Wit, & Stroebe, 2000, 2004; Kippax et al., 2003).

In the early 1990s, researchers in Australia reported on a trend whereby concordant negative gay couples either agreed to be monogamous or, if sex with outside partners was allowed, to always use condoms for anal sex or avoid anal sex with outside partners altogether. The agreement facilitated the couples' desire to have unprotected sex with each other while reducing HIV transmission risk (Kippax, Crawford, Davis, Rodden, & Dowsett, 1993). “Negotiated safety,” as it was called, was hailed as a realistic and promising approach to HIV prevention. The Victorian AIDS Council and the Gay Men's Health Centre in Australia developed a prevention campaign consisting of 10 steps for gay couples to follow if they wanted to safely discontinue using condoms. The steps included the following and more: get tested; wait three months and get re-tested; promise to either use condoms for, or avoid anal sex with, outside partners; and agree that either partner can insist on using condoms again. Reaction to the campaign from some U.S. researchers was that sophisticated communication skills were required to maintain such an agreement and that most people did not possess those skills (Ekstrand, 1992). At the very least, the Australian campaign seemed premature given there was so little research available on the success of negotiated safety as an HIV prevention strategy. Although subsequent research has found that men who had negotiated safety agreements with their main partner were at less risk for HIV than those who did not (Kippax et al., 1997; Semple, Patterson, & Grant, 2000), additional research has shown that couples have difficulty adhering to the two main components of negotiated safety agreements: knowing the HIV status of their main partner and only having safe sex with outside partners (Elford, Bolding, Maguire, & Sherr, 1999). Couples who experience these difficulties may not benefit from the full protection negotiated safety agreements promise.

Many questions remain about the agreements gay couples make about sex with outside partners and whether those agreements are effective in preventing HIV. However, before their effectiveness can be rigorously evaluated, it is important first to understand how agreements function in relationships and what motivates gay couples to make them. The present study explored how agreements function in the context of gay male relationships, what motivates couples to make agreements about whether or not to allow sex with outside partners, and how couples manage those agreements when they are broken. Additionally, factors associated with couple serostatus and the impact it has on the agreement were addressed.

METHOD

Participants

Gay male couples were recruited from the San Francisco Bay Area over a three-month period from February to April 2002. Active (i.e., outreach by field research staff) and passive (i.e., postcards and fliers left in community venues such as AIDS service organizations and gay-identified bars and cafes) recruitment strategies were conducted in community settings. Recruitment material instructed those interested in participating to call a toll-free number for more information. The goal of recruitment was to produce a diverse sample in terms of race or ethnicity as well as HIV status in an effort to reflect the demographics of the San Francisco Bay Area. Field research staff reached out specifically to community-based agencies that served gay men of color and HIV-positive gay men.

Callers were screened over the phone and partners were screened individually for eligibility. Eligibility criteria required that participants had to: have been in their relationship for at least three months, have been at least18 years old, have knowledge of their own and their partner's serostatus, and have had no legal record of domestic violence. Couples were eligible to participate only after both partners were screened and found to have met the eligibility criteria.

In total, 39 couples were eligible and went on to participate in the semi-structured interviews. While the overall sample of participants was diverse in terms of race or ethnicity as well as HIV status, the largest proportion were either Caucasian or concordant negative. The sample included 18 Caucasian couples, 7 African-American, 3 Latino, and 1 Asian/Pacific Islander couple. Ten couples were interracial. In terms of couple serostatus, 17 were concordant negative, 10 were concordant positive, and 12 were discordant. The mean relationship length was seven years, while the range was three months to 27 years. The mean participant age was 39 years, while the range was 21 to 63 years (see Table I).

Table I
Couple Characteristics

Interview

After a research staff member screened both partners and determined the couple was eligible, they were scheduled for a 60–90 minute semi-structured interview. Partners were interviewed separately to allow for the candid discussion of their relationship, agreement, and any reported breaks. Interviews examined the following topics: relationship history, relationship strengths and weaknesses, partner roles, a natural history of any agreement made about whether or not to allow sex with outside partners, whether those agreements had been broken, relationship support, and future goals (see Appendix A, Interview Guide).

Interviewers were trained to guide the participants through the interview by posing questions in an open-ended, conversational tone, to probe for clarity when and where necessary, and to allow for emergent topics to arise. The training stressed the intent of each question in the guide so interviewers were not required to ask them in a particular order, giving the interviews a natural flow and participants the freedom to discuss other issues they felt were salient. Each partner was paid $40 for participating at the end of each interview.

Procedure

All interviews were audio tape recorded using cassette recorders and transcribed verbatim. The research staff member who conducted the interview was responsible for reviewing the accompanying transcript for accuracy (e.g., mistakes, misspellings, and omissions). Reviewed transcripts were grouped by couple and read by two research staff members. One served as primary reader, leading the preliminary analysis of the transcripts, while the other reader was secondary, giving feedback on that analysis. Throughout the process, different research staff members took the lead in analyzing transcripts. In the preliminary analysis, readers summarized each partner's transcript, identified main areas of interest, and then created a new document that summarized both partners as a couple and identified main areas of interest for the couple. Members of the study team discussed summaries at weekly meetings, at which point additions and corrections to the summaries could be made and any discrepancies between the two readers could be resolved. Themes that emerged from the summaries were used to identify and develop codes.

Codes were developed by research staff members and fell into the following categories: agreements concerning sexual activity within the relationship, agreements concerning sexual activity outside the relationship, sexual behaviors within the relationship, sexual behaviors outside the relationship, perceptions of risk, gay identity, protective factors (e.g., actions or beliefs regarding the protection of the relationship, the individual or partner, or sexual safety), relationship dynamics, and other (e.g., coded text that does not fall into any other category). Only the categories concerning sexual agreements and sexual behaviors with outside partners and relationship dynamics were utilized for the present analysis. Within those categories, approximately two dozen codes were applied to the data. Codes that focused on the agreement included the following: agreement type (including those that were monogamous, allowed sex with outside partners, and allowed threesomes), agreement motivation, maintenance of or commitment to the agreement, agreement acceptability, the explicitness or implicitness of the agreement, agreement change, broken agreements, disclosure of broken agreements, and agreement change. Codes that focused on sexual behavior with outside partners included sexual preferences, reported incidences of oral and anal sex, incidences of unprotected sex, and sex roles. Finally, codes that focused on relationship dynamics included satisfaction, honesty, trust, intimacy, couple serostatus, and motivation.

Once codes were identified, research staff members applied them to selected sections of the transcripts to verify code definition and application consistency among team members. When agreement was found among research staff, which in some cases required revising the definition of certain codes, the transcripts were coded. The coding process began by having two research staff members (coders) code the same transcript independently of one another. Afterwards, they met to compare their coded transcripts for discrepancies. Together with a third staff member, coders reconciled any discrepancies. This process was repeated until both coders demonstrated sufficiently consistent coding techniques (approximately the first 10 transcripts coded). All subsequent interviews were coded by one coder only, rather than both simultaneously, and all were verified by a third staff member (Frieze, 2008). Both coders, along with the third staff member, coded all 78 transcripts. Further analysis using Ethnograph (2001) version 5.08 was conducted by searching for specific codes and pairings of codes. Interview data were sorted two ways: by couple to conduct side-by-side comparisons of partners' responses and by couple serostatus for comparison among the three serostatus groups.

RESULTS

Agreement Negotiation

Agreement negotiation was highly organic process that was influenced by a wide range of issues, including the age of the individuals in the relationship, the length of the relationship, experiences in prior relationships, and individual levels of comfort talking about sensitive issues, such as sex. For example, several participants described how their prior experiences in monogamous relationships led them, for one reason or another, to open (or desire to open) their current relationship and allow sex with outside partners. Not everyone described the same pattern. Coming from the opposite direction, one participant described his prior experience in open relationships and expressed his desire to close his current relationship which was open. Agreement negotiation usually involved a mix of the following three scenarios: clarifying a current agreement (or expectation), opening a monogamous agreement, or renegotiating an agreement after it was broken. Clarifying a current agreement often happened at the beginning of the relationship, immediately after a break, or both. Opening a monogamous agreement usually took the form of gradually adding conditions that allowed one or both partners to have sex with outside partners. An example of one such condition was allowing threesomes (i.e., couples who reported having sex with outside partners together). Renegotiating a broken agreement typically involved making a previously implicit agreement more explicit, adding a new agreement to existing ones, creating an entirely new agreement because the broken was effectively annulled, or some combination thereof.

Agreement Types

Agreement types reported by participants fell along a continuum of more closed to more open, with considerable overlap. Thinking of agreements types as existing on a continuum, rather than in discrete categories, not only captures the individual meanings participants assigned to their agreements, but also the shifts that many couples reported experiencing over time. For example, some couples reported having an open relationship, but only for threesomes. Similarly, other couples reported having threesomes yet described their agreements using the vocabulary of a closed or monogamous relationship. One participant described it thusly: “Kind of the way that I like to talk about it is, kind of, open sexually and monogamous romantically” (31/White/HIV−).1 This kind of overlap was common; therefore, the following categories are not intended to be discrete or exclusive and should not be interpreted as such (see Table I).

Closed Agreements

Twelve couples (31%) described their agreement as closed or monogamous. For many of these couples, theirs was an agreement to be monogamous in the “classic sense.” That is, no sex with outside partners was allowed. It was not uncommon for these couples to associate feelings of love and commitment to their monogamous agreement when they described it. One participant stated, “We made a decision to only be with each other. And it's because we love each other and care about each other deeply” (32/API/HIV−). It is important to understand, however, that closed agreements did not necessarily foreclose outside sexual encounters. On the contrary, a few couples who reported closed or monogamous agreements allowed some form of sex with outside partners.

One particularly striking example of this was reported by a couple where one partner worked as a masseur. Both partners described their monogamous agreement as being explicitly understood. Similar to the couple above, the first partner tied their agreement to feelings of commitment, saying, “Basically, we talked about it and considered we were monogamous, and that's when we felt that we were a couple” (50/White/HIV−). Partner 2, the masseur, made it clear from the beginning of their relationship that his job had an erotic component to it whereby he sometimes masturbated his clients. He maintained that this did not affect their monogamous agreement because masturbating his clients was part of his job and, as such, did not constitute outside sex or a break in the agreement. He described his thought process on the issue:

Like when the massage is happening, if I'm just massaging the person and the person is receiving the pleasure, that's fine. But if the pleasure starts to extend over to me, like if I start to get sexually involved personally with the client, then that's different altogether. But as long as I'm pleasuring the client, then that's fine `cause I'm not getting personally involved in it myself. (47/API/HIV−)

This couple demonstrates that even an agreement as seemingly straightforward as monogamy has a relative meaning that each couple defines for themselves.

As a construct, closed or monogamous agreements continued to hold currency for many couples, even for those who were not necessarily exclusive sexually. Several couples who permitted outside sex in one form or another used the vocabulary of monogamy when discussing their agreements. For example, one partner involved in an open relationship described his agreement as, among other things, “fairly monogamous” (46/Latino/HIV+). Similarly, another partner in a relationship where sex with a third person was occasionally allowed said that he still considered himself and his relationship “monogamous in lots of ways” (54/White/HIV+). For this participant, being monogamous in nearly every other aspect of his relationship (e.g., being emotionally faithful and only allowing threesomes every once in a while) overrode his desire to label is relationship as anything but monogamous. Even though these couples allowed some degree of outside sex, the idea and label of monogamy remained an important fixture in their relationships and agreements.

Open Agreements

Twenty-five couples (64%) described agreements that, to varying degrees, allowed sex with outside partners. Most of those couples described agreements that were neither completely closed nor completely open, testifying to the overlap and fluidity of the different types of agreements reported by participants. What distinguished them, however, were the conditions couples placed on whether or not sex with outside partners was allowed and how those conditions limited sexual behavior. Two conditions emerged most frequently: opening up the relationship for threesomes and separating physical from emotional intimacy with outside sex partners.

Several couples described agreements that allowed threesomes. For most of these couples, sex with a third person was something they only did together and many of them made a point of qualifying it. One couple reported explicit rules to this effect. One participant said of his agreements regarding threesomes:

So one rule is that we will do it together…. We both should agree on the person we would like to be with us. And then safe sex, we have very safe sex. We are more into jerking off, touching the body, licking the body, but not sucking or rimming and things like that. Sometimes we kiss the person. We like to kiss, but that's the most we do. And we let the person know that we are a couple, we are together, and we have our rules. That's so the person who joins us knows what's going on. (34/Latino/HIV−)

For this couple, involving a third person was not a casual sexual act or something they took lightly. They had clear conditions or rules, including agreeing on who the third person would be and the types of sexual behaviors that they would do together, that limited sex with outside partners. No other outside sex was allowed for this couple.

Many other couples reported agreements that addressed the importance of separating physical from emotional intimacy with outside partners. Couples with this condition prioritized their relationship together by forbidding emotional connections with outside partners. One partner summarized his agreement thusly, “[T]he way that I like to talk about it is open sexually and monogamous romantically. So, no candlelight dinners with other people and that, but if you want to screw around that's totally fine” (31/White/HIV−). For another couple, allowing outside sex on the condition that they separated physical from emotional intimacy was an integral part of how they accepted sex as a natural part of their adult lives.

[W]e're sexual beings, that's who and what we are. And there are differences between sex and intimacy, making love. It can be two different things. So within the relationship it's understood that if one happens then that's all it would be. (34/Latino/HIV+)

His partner made similar comments, stating, “[I]f I feel comfortable sharing my body with someone, it doesn't mean I would share an emotional connection with them. Just sharing my body is a sexual thing” (33/Latino/HIV−). For these participants, sex with outside partners was only a physical, sexual expression, and because of their agreement to separate that from emotional intimacy their partners were not threatened by it.

Other conditions that limited sex with outside partners emerged less frequently, such as the request one participant made to his partner that they not have sex with friends or past lovers. He said, “The only agreements we really have are that we're not going to have sex with our friends and that we're not going to have sex with our exes. We don't want to” (29/White/HIV−). The condition of separating physical from emotional intimacy with outside sex partners was central to how these participants reconciled their desire for sex with outside partners with their need or desire for a meaningful connection to and relationship with their primary partners.

Unlike the majority of couples with agreements that allowed sex with outside partners and who placed conditions that limited outside sex in some way, a small number of couples did not report any conditions that would limit sex with outside partners. Importantly, however, this should not suggest that their agreements were condition-less. The conditions reported by these couples instead focused on the requirement that there be honesty, respect, or discretion around having sex with outside partners. Outside that, these couples placed no other conditions on the sex they had with outside partners, and these arrangements seemed to work for these couples. One participant said, “Really, we say just be discreet about it. We both know… we both know each other has sex with other people and we've tried to put limitations on it before, which have always led to frustrations” (31/White/HIV+). Borrowing from a familiar phrase for their own uses, some of these couples described their agreements as `don't ask, don't tell.' One participant emphasized that although he might not want to know the details surrounding his partner's outside sexual encounters, if he did ask, he wanted his partner to be honest and forthcoming. He said, “I don't ask, I don't. But if I ask, tell me the truth” (58/Black/HIV−).

For some couples with open agreements, discretion meant they did not want to know or talk about outside sex. One participant was succinct: “I am a big proponent that honesty's highly overrated as a virtue” (42/White/HIV+). However, not all couples with open agreements felt this way. Two participants reported discussing the sex they had outside their relationship with their partners. One described the discussions as a type of “feedback loop” (38/White/HIV−) where he and his partner could check in and talk about what happened outside their relationship. The other said he enjoyed hearing about the sex his partner had outside the relationship and that hearing about it turned him on. He said, “At this point, we talk about everything just because there's a whole voyeuristic aspect to the whole thing. Like the whole story is kind of hot” (29/White/HIV−). For those couples who chose to discuss outside sexual encounters, communication and honesty were central parts of their agreements and provided an additional level of security and intimacy.

Discrepant Agreements

Two couples (5%) had partners that reported discrepant agreements. Discrepant agreements occurred when both partners reported agreements that were different enough so that there was little to no overlap in what their reported agreement was and what sexual behavior it allowed. For example, in one couple, Partner 1 said that sex with outside partners was not allowed, although if his partner wanted to open the relationship, he was amenable to discussing the possibility. He said, “Right now it's monogamous. If we want to [have sex with outside partners] it's open for discussion” (38/White/HIV+). Meanwhile, his partner clearly stated that although they used to be monogamous, they currently allowed sex outside the relationship and that they had a `don't ask, don't tell' policy. Interestingly, both partners not only described discrepant agreements about whether or not they allowed sex with outside partners, they also described different attitudes towards discussing outside partners: one was open to the idea, while the other wished to avoid it. Thus, discrepancies sometimes appeared in multiple aspects of the same agreement.

Parity

Alongside understanding the types of agreements reported by participants was the issue of whether there was parity in those agreements. Parity was defined as both partners understanding their agreement in the same way and behaving accordingly. During the analysis, parity was examined alongside the issue of whether agreements were understood implicitly or explicitly. This was done to gain a more nuanced view of how participants understood their agreements and to see what effect parity and explicitness had on the agreement and the relationship more broadly.

Overall, 28 couples (72%) reported explicit agreements about sex outside the relationship. Explicit agreements were defined as verbal conversations between partners about whether or not to allow sex with outside partners and how to handle it if it was allowed. Five couples (13%) reported having implicit agreements. Implicit agreements were defined as mutual understandings between partners about whether or not to allow sex with outside partners that may not have been articulated directly. For the remaining six couples (15%), it was unclear how explicit (or implicit) their agreements were (see Table I).

After examining both parity and explicitness, it became clear that parity was linked with feelings of equity towards the agreement and the relationship more generally and that couples did not necessarily associate beneficial feelings towards their relationship with whether or not their agreement was explicitly understood. In this regard, parity may be more important to the relationship, and to adhering to the agreement, than simply having an agreement that is explicit. In other words, how couples understood their agreements and how they behaved relative to them was just as important, if not more so, as having articulated the agreement and its boundaries explicitly.

The following couple illustrates this point well. Both partners reported having a monogamous agreement and described it as being implicitly understood. Partner 1 said, “That's something I guess we never really discuss, like an agreement about…sex with other people. That's never really happened. [Sex is] something we've always kept within ourselves and we've never really been outside of that” (29/Black/HIV+). Both partners' comments demonstrated parity regarding what the agreement was and what expectations went along with it. Partner 2 joked, “Oh, having sex with other people, no. No, no sex with other people. I said no. He will kill me and I will kill him” (25/Black/HIV+). Neither partner reported breaking the agreement or suspecting the other partner of breaking it. Later in the interview, however, Partner 1 added that if he had ongoing suspicions, he would reconsider whether the relationship was right for him. He said, “I would just have to deal with it the best way I could. If it would continue, if it was something that was consistent and I knew about it, then I guess I would have to end the relationship.” Despite their implicit agreement, both partners approached their relationship with the same set of expectations and Partner 1 was prepared to reevaluate whether his relationship was right for him if those implicit expectations were not being met.

Several couples, similar to the one above, did not report having explicit agreements or explicit conversations about their agreements. These couples approached their agreements from the point of view that they could work even without being explicitly articulated. In this vein, one participant said that he felt the more explicit his agreement was the more mechanical it became. Yet, as the above couple shows, having an implicit agreement did not negatively impact the way they understood their agreement or their reported level of satisfaction and adherence.

While parity was not necessarily problematic for many couples, non-parity presented potential for miscommunication and distrust. One such couple reported having a monogamous agreement; however, whereas one partner said it was explicitly understood, the other partner said it was an assumption that his partner made of their relationship. Partner 2 commented:

There's an assumed agreement that we are in a committed relationship…. Yeah, a committed and monogamous relationship. And it's interesting that he didn't ask me exactly what I thought about it. I didn't have a way to express my own feelings about it. (44/Latino/HIV−)

Partner 2 went on to explain that he found it difficult to remain monogamous because he was not always interested in having sex with his partner, which led him to seek sex with outside partners. He said, “When our sexual connection is not strong, I tend to want to have another partner or…even a one-night stand. Just having sex with someone, even if very brief, I tend to want it or to desire it.” He explained that he felt guilty about seeking outside sex behind his partner's back and that he would like to talk to him about it, but he said that he could not approach his partner because his partner would not listen and was verbally abusive. Here, communication difficulties have contributed to discrepancies and a misunderstanding of the agreement, sexual behavior that falls outside of the agreement, and increased HIV transmission risk.

In sum, the agreement types reported by couples covered a wide range of sexual behaviors, some of which permitted sex with outside partners and some of which did not. On the surface, sexual agreements seemed relatively straightforward. However, once examined in the context of the everyday lives of the couples, agreements quickly grew in depth and complexity. Monogamous agreements sometimes permitted sex with outside partners in some form and open agreements often had conditions that limited sex outside the relationship in some manner. Finally, parity, where both partners reported understanding their agreement in the same way, may have been more important when considering agreement satisfaction and adherence than simply the explicitness of the agreement.

Motivations for Having an Agreement

Couples were motivated to have agreements for a variety of reasons, such as trusting and loving each other and giving their relationships structure and meaning. Importantly, however, findings showed that couples were not primarily motivated to have agreements in an effort to reduce HIV transmission risk. When HIV prevention was discussed in the context of agreements, many couples simply assumed safe sex without defining what that meant in terms of each partner's sexual behavior. Rather, most couples discussed their agreements in the context of their relationships. For example, trusting that one's partner would adhere to an agreement brought some couples closer together. Concordant negative couples were particularly motivated to have agreements such as being monogamous, or being “safe” with outside partners, so they could have sex with each other without using condoms. Trusting one's partner (either to be monogamous or to adhere to the agreement to be safe with outside partners) was a primary factor supporting the relationship for concordant negative couples. These couples were acutely aware that, if trust (i.e., the agreement) was broken, both partners could be exposed to HIV or other sexually transmitted diseases (STDs). The relationship itself would also likely be negatively impacted. Many, like the following couple, reported feeling good that their relationship had such a deep level of trust. Partner 1 said:

And your level of trust with this person that is so strong. And you're putting so much on the line: You're putting your health, your life, on the line that there's a real sense of strength that comes to the relationship for doing it, when you do something like that. (29/White/HIV−)

Partner 2 made similar comments, saying:

So like I say, it elevated it to a new level of trust because obviously we have to trust one another. If we're going to be sexually active outside of the relationship, we have to trust each other not to be bringing STIs into the relationship, or HIV, or endangering one another in any way. (36/White/HIV−)

For this couple, and others like them, trust was not a source of anxiety or suspicion. Instead, they drew from their trust of one another a source of strength and pride in their relationship.

For some couples in monogamous relationships, trust was heightened by an additional agreement, or clause, to tell each other–no matter what–if either partner broke the agreement by having sex with an outside partner. We found that some couples who were fully committed to monogamy and who had no intention of breaking their agreement insisted that, if a break ever happened, they would tell their partner, no matter how difficult. This clause may have provided an additional level of trust in the relationship because no couple who had it reported a break in their monogamous agreement.

Relationship Structure

Couples were also motivated to have agreements because they provided structure to the relationship (i.e., a boundary or framework that helped define the relationship). At a time when same-sex relationships are not acknowledged legally or approved of socially, and most gay couples lack role models for their relationships regardless of whether they are closed or open, many of the couples sought and found structure for their relationships in their agreements. Participants reported that having an agreement helped them know where they stood with their partners and made them feel more secure in their relationships. Discussing the condition that he and his partner would separate physical from emotional intimacy when having sex with outside partners, one participant said that his agreement made him feel secure because he knew his relationship was not in jeopardy. He said, “Security. Yeah, security and knowing that if he meets someone, and has sex with him, that I don't need to be threatened” (49/White/HIV−). Another participant voiced similar sentiments about his agreement, stating, “If anything, that's really the agreement: I always have to know that I'm the priority” (32/White/HIV+).

Sexual Satisfaction

Some couples were motivated by the sexual benefits to having an agreement. For example, one couple felt their agreement brought them closer together sexually because it helped facilitate their need for sexual satisfaction. Others reported that their open agreements made sex between them more intimate because it was an expression of both physical and emotional intimacy. Still others were titillated by the thought of their partner having sex with someone else. Many couples who engaged in threesomes explained that bringing in an outsider added vigor and excitement to their sexual relationship. One participant with such an agreement said:

I think it's nice because, of course, we all have fantasies and, in the relationship, it works very well…. And when you go out to places. and have a chance to do something like that, we can enjoy other things, we can enjoy physically other pleasures, but we don't have any guilty feelings. (34/Latino/HIV−)

Relationship Satisfaction

Some couples were motivated by the fact that their agreement to allow sex with outside partners, for example, kept them from feeling trapped in or stifled by their relationship. One partner with an open agreement said:

The benefit is that, I mean, I don't feel trappe...I have desires to do things with other men that are strong and very animalistic sometimes and I enjoy that aspect of my life and I like to act on it and not have to feel guilty or not feel like I'm repressing something that I feel like I would just naturally be willing to do. And it's working for us. (29/White/HIV−)

Others felt good that their relationship was unique and that they avoided replicating more traditionally heterosexual models of sexual relationships which they felt did not fit their lifestyle. One participant said:

I wouldn't want to be in a monogamous-sexually monogamous-relationship. The idea of, kind of, the heterosexual trip of getting married and pledging sexual allegiance to one person for the rest of your life and never having sex with anyone else for the rest of your life...it definitely sends chills up my spine. (31/White/HIV−)

For these couples, creating agreements that were meaningful to and supportive of their lifestyles and sexual needs increased their feelings of satisfaction with their relationship as well as with their partners.

Broken Agreements

It was not uncommon for couples to report that their agreements about sex with outside partners had been broken. During the interviews, reports of broken agreements came in one of two forms: either the participant reported that he himself broke the agreement or the participant reported that his partner broke the agreement. Sometimes those reports aligned so that both partners reported the same break. Other times, one partner reported a break while the other partner did not, although this did not necessarily mean that the break was not disclosed. All reports, whether or not they were acknowledged by both partners, were counted as broken agreements. In total, there were 25 reports of broken agreements. Three couples reported two breaks each, thus a total of 22 couples (56%) reported broken agreements (see Table I).

Given the wide range and variability of agreement types, it logically follows that the context in which agreements were broken was also varied. Reports of broken agreements ranged from a partner having kissed someone in a bar to a partner having had anonymous oral sex in a public environment to a partner becoming overly attached to an outside partner. Types of breaks fell into two categories: emotional and structural. As with agreement type, neither category was discrete and, based on the participants' reported experiences of broken agreements, there was a reasonable amount of overlap. For example, most broken agreements were met with some emotional response. The main difference between the two was that emotional breaks were characterized by the reaction to the break (e.g., a participant reported his partner's infidelity and was upset because he felt betrayed and because he felt the larger agreement had been broken), whereas structural breaks were characterized by breaks to the conditions placed around agreements that allowed sex with outside partners (e.g., a participant reported that he brought an outside partner home when he was not supposed to). As such, structural breaks mostly affected couples whose agreements allowed sex with outside partners and, because the larger agreement was still intact (i.e., the agreement to allow sex with outside partners had not been broken), they were not usually characterized by an emotional reaction. Each break was bound together by a unique set of circumstances, including the type of agreement that was broken, how it was broken, and the personal reactions to the break.

Emotional Breaks

Some participants reported breaks in their agreements that created emotional distance between themselves and their partners. Emotional breaks often constituted a violation of trust, intimacy, or commitment. In some cases, this distance threatened the longevity of the relationship, particularly if breaks were ongoing. For example, one participant reported that his partner frequently sought outside sex. Although they had open agreement without conditions that would have limited sex with outside partners, the participant expressed feeling uncomfortable with the frequency that his partner looked elsewhere for outside sexual contact.

[O]ur agreements are not being held. Like, he's breaking the agreement [by] going out so often. He doesn't really agree to, well, he does agree to it and then he still goes out three and four days a week and I think it's pulling us apart. I don't know how much longer we'll be together. I always have a feeling he's seeing somebody else, although he denies it. (55/White/HIV+)

Emotional breaks were experienced by couples reporting all agreement types. As the above quotation demonstrates, even couples with few formalized agreements can and do experience a break that carries significant emotional impact.

Structural Breaks

For couples who allowed sex with outside partners, structural breaks specifically affected the conditions those couples placed on the sex they had with outside partners. Examples include the condition to separate physical from emotional intimacy with outside partners or to not have ex-boyfriends as outside partners. Structural breaks violated those conditions and, as a result, not only threatened the relationship; they also threatened feelings of trust, commitment, and security because the conditions, as part of the broader agreement, protected couples from emotional injuries, such as jealousy and dishonesty. For example, an agreement, such as don't ask, don't tell, allows a couple to have outside sex while protecting them from knowing details that might upset partners and, in turn, threaten the stability of the relationship. One participant who had an agreement with his partner not to bring outside sex partners back to their apartment admitted to breaking the agreement several times, not all of which he told his partner about. He said, “I've had people at the apartment, which…would be a breach of it right there. You know, I'm only human. I slip up sometimes, so I guess, yeah, there was a breach of the agreement” (37/White/HIV−).

Not all participants reported that structural breaks caused emotional problems in their relationships. One participant waxed philosophical about a recent structural break for which his partner was responsible. The participant reported having an open relationship with the condition that he and his partner not become emotionally attached to outside partners. His partner, however, once found himself in a situation where he grew emotionally attached to an outside sex partner. When the outside partner canceled the dates his partner had set up for them, it hurt his partner's feelings. He said of the situation:

The guy backed out, saying he was too sick, his mother was in town and he couldn't leave her, blah, blah, blah…. So it made him feel kind of bad…because he got too involved with the guy. I mean, I didn't tell him I told you so, or nothing like that, but he knew what he did was kind of stupid…. So, you know, he kind of broke that rule, but that's, I mean, that's a rule for our relationship, but it's also sort of a rule of self-protection, like your emotions, so you don't feel, so you don't get hurt. (45/White/HIV−)

Whereas a break such as this might have created emotional tumult for some couples, this participant was able to handle it by reframing the break as a structural concern. That is, the condition was violated but not the participant's emotional feelings towards his partner or his feelings towards his relationship. As a result, he was able to better deal with his partner and the break itself.

Disclosure of Broken Agreements

Disclosure was central to the issue of broken agreements because, whether or not partners chose to disclose, agreement breaks significantly impacted the relationship and the sexual health of each partner. Of the 25 reports of broken agreements, 21 (84%) were disclosed. Despite the fear of angering their partner, most participants who disclosed the broken agreement felt the resulting discussion made both the relationship and the agreement stronger. For example, one participant described how he broke his agreement to be monogamous and how disclosing the break led him and his partner to reconsider their agreement and to open their closed relationship. The break occurred early in the relationship, technically before he and his partner had agreed to be monogamous. At the time, his partner insisted on no sex outside the relationship, yet no formal agreements were made. Later in their relationship, while out shopping one evening, he stopped off at an adult bookstore where he had anonymous sex with another man inside a video booth. When he emerged from the store, his partner was waiting outside. His partner had driven by and recognized his car. He said, “Oh, it was horrible. I was so embarrassed and he was so hurt and I was so ashamed” (42/White/HIV+). In working through the second break, the participant had the opportunity to explain to his partner that being monogamous was not working for him. After breaking his agreement to be monogamous twice, he suggested they open their relationship and, with time, they did. Reflecting back on the experience, he commented:

I broke the agreement and it had horrible consequences. But even then, I just thought, You know what? This isn't going to work for me this way. And that's what I was trying to say…. I've come to this realization that a relationship works because it works, not because it's like we've just seen [it in] a book or in a movie. And I think [my partner] is still hunkering after that, but little by little he's realizing that what we have in some way is way better, I hope.

Although there was emotional turmoil when he disclosed the break to his partner, he felt they came out of it for the better, in part because he was able to express what he truly wanted in his relationship, which gave them an agreement that worked rather than one that was socially prescribed.

Not all participants who reported disclosing broken agreements experienced emotional fallout as a result. Some reported not feeling threatened by breaks because they felt that sex was a necessary physical release. Consistent with open agreements that have conditions separating physical from emotional intimacy, many couples viewed sex as a normal urge or physical need, like exercise. As a result of this view, the relationship was in a better position to withstand breaks because couples accepted how one might get caught “in the moment” and have outside sex or engage in sexual behaviors that are not part of the agreement. One participant explained how towards the beginning of his relationship he was only monogamous “in theory” because he and his partner had not yet come to an agreement about whether or not to allow sex with outside partners. As a result, he continued seeing, and having sex with, an outside partner during the first several months of his relationship. When his partner later confronted him about it, he said they were able to talk openly and honestly about it. He said:

I mean, it wasn't something to worry about. Yeah, to be really worried about because that's normal. I mean, I know that we are young and we like other people and we are horny almost all the time, or at least I am, so we have to deal with that. We have to face it…and that didn't change our view of our relationship. (26/Latino/HIV−)

This couple took a pragmatic approach when they dealt with this break in their (expected) agreement. They were able to factor in their sexual needs as well as their need for a more concrete agreement when they discussed the break.

Some participants reported a delay in disclosure–in some instances, it was as long as several months–which was problematic when the truth finally came forward. Delays in disclosure frequently resulted in mistrust, suspicion, and, on the behalf of the partner in the dark, anger at being kept from the truth. Commenting on his partner's recurring infidelity and reticence about disclosing it, one participant said:

So, okay, say we're supposed to be monogamous and each time [he's] like, Well, I'm never going to do that again or whatever. And I'm like, Are you sure about that `cause you've done it already a few times. How can you say that you're not going to do it again? So I suppose the agreement is that we're not going to do it again, but like I don't believe that really. (34/White/HIV−)

He later added that the distance created by his partner's reticence and unwillingness to be forthcoming about the truth made their sex less satisfying and made him feel less safe.

Only four reports of broken agreements (16%) were not disclosed. Undisclosed broken agreements presented complicated challenges for the relationship and for HIV prevention. Although many initially refrained from disclosing broken agreements because they did not want to hurt their partner, those who did not disclosure formed a wedge in the relationship, which left the partner who did not disclose feeling guilty and isolated. For some, those feelings created an ongoing distance in the relationship that was unresolved. With regard to HIV prevention, non-disclosure may increase HIV transmission risk, adding additional guilt and distance to the relationship. One HIV-positive participant suspected that his HIV-negative partner had unsafe sex with outside partners, thus breaking their agreement to be safe when having outside sex. He said:

I recently know that [my partner] has been having unsafe sex…but I'm not quite sure how to bridge that. I've said a couple of times, whatever you're doing, I hope you're doing it safe. And a couple of times in the past year he said, `Well, I'm going to get my HIV test, I know, but [I'll] be okay. And I was like, if you aren't, I'll be really sad and I'll be here for you, but I don't feel as I once did that if you're HIV-positive then it's my fault. (42/White/HIV+)

Although disclosing a broken agreement was oftentimes difficult, analysis indicated that those participants who disclosed were better off in that they ended up with clearer, more satisfying agreements. Some even reported feeling closer as a couple. As demonstrated above, disclosure often led to increased communication about and renegotiation of the agreement. In most cases, disclosing broken agreements and the renegotiation process that followed allowed parity to grow between partners and gave couples the opportunity to discuss their needs and expectations more explicitly and openly.

DISCUSSION

Agreements about whether or not to allow sex with outside partners are complex. The spectrum of agreement types couples may adopt is broad and in many cases there is substantial overlap in the ways couples conceptualize their agreements as well as what behaviors they allow. Overlap in agreement type, however, should not be mistaken for a shared sense of how those agreements operate within relationships or how they are labeled or understood by couples. For example, an agreement allowing sex with a third person could be labeled as monogamy by one couple or as polyamory (i.e., an open relationship) by another. Thus, it becomes critical to understand the range of perceptions that may be attached to labels such as monogamy so that HIV prevention messages do not overlook those who perceive similar behaviors differently.

Couples who report discrepant agreements present unique challenges to HIV prevention, as it is unclear exactly why partners may give different responses when asked whether or not, and to what degree, they allow sex with outside partners. It is also unclear what effect those discrepancies have on sexual behavior and HIV risk. Discrepancies may be the result of an agreement in transition. That is, neither partner may fully understand what his agreement is because it, or some aspect of it, is being negotiated (or re-negotiated). Discrepancies could also be the result of the lack or absence of an agreement, which might be of particular importance where couples just beginning their relationships are concerned. However, more troublingly, discrepancies may be the result of dissatisfaction with the agreement or the relationship or communication difficulties between partners, which may increase HIV risk (Davidovich, de Wit, & Stroebe, 2006; Prestage et al., 2006).

Motivations for having agreements about outside sex were also varied and HIV transmission and prevention were revealed to be a distant second in terms of the concerns couples vetted when they formed their agreements. When HIV did emerge as a concern, most participants agreed that being safe with outside partners was important for their own and their partners' health and safety. These concerns around HIV, however, were almost exclusively discussed when participants were asked about safer sex practices. HIV rarely appeared in the participants' discussions of their agreements and when it did, it was usually in the context of a reported benefit to having an agreement (e.g., some participants felt that a benefit to being monogamous was the ability to avoid HIV). Thus, HIV appeared most often as an afterthought, rather than an issue that was considered during the negotiation of that agreement.

When safer sex was discussed, what constituted “safe” sex with outside partners was, more often than not, rarely discussed in any detail. Furthermore, “safe” sex was frequently assumed or expected by most couples, but not agreed upon. On one hand, the fact that participants with agreements allowing sex with outside partners expected their partners to be safe suggests that taking precautions was the norm and therefore not worthwhile belaboring. On the other hand, the lack of detail to those agreements is worrisome given that it was not uncommon for partners to have discrepant definitions of “safe” and to act accordingly.

Most couples were motivated to have agreements because it benefited their relationship. For example, trusting one's partner to be monogamous or to be safe with outside sex partners deepened the emotional bonds couples shared. Agreements also provided boundaries, which supported couples in their knowledge of where they stood with each other. Those boundaries dealt not only with the couple relative to outside partners, they also extended into agreements about safety, supporting the idea that relationship dynamics are an important component of agreements (Davidovich, de Wit, & Stroebe, 2006). Finally, agreements helped couples prioritize different aspects of their relationship.

Broken agreements were relatively common and affected just over half (56%) of the couples who participated. This number comes in significantly above similar studies (Davidovich, de Wit, & Stroebe, 2000; Prestage et al., 2006) and may be due to the fact that both partners were interviewed and, as such, broken agreements were more likely to be reported. Disclosing broken agreements supported relationships by airing secrets and minimizing distance between partners. The process of renegotiating broken agreements gave participants the opportunity to revisit their needs and desires with their partners and gave couples an additional opportunity at making a clearer, more explicit agreement. However, consistent with other studies, there were several instances reported where partners were not informed of a broken agreement (Kippax et al., 2003; Prestage et al., 2006; Prestage et al., 2008). Those who did not disclose broken agreements reported emotional distance from their partner and, to a lesser extent, concern over their own and their partner's health.

There were noteworthy differences in agreements with regard to couple serostatus. Concordant negative couples were motivated to make agreements that allowed them to have unprotected sex with each other. For most couples, this translated into having a monogamous agreement or requiring that outside sex was safe. Additionally, several concordant negative couples emphasized getting tested for HIV together, as testing represented a crucial step in the development of their relationship and agreements. Trust featured prominently among negative couples: trust that they would remain monogamous and trust that sex outside the relationship was safe. Trust has been associated with a higher likelihood of making negotiated safety agreements among gay men in steady relationships in the Netherlands. In that study, those who were more likely to perceive trust as a symbol of unprotected anal sex were also more likely to have agreements (Davidovich, de Wit, & Stroebe, 2004). Still, a few monogamous, concordant negative couples reported breaking their agreement and not disclosing it. Given that these couples have unprotected sex together, undisclosed broken agreements within this group may be particularly dangerous. This was the case among participants in a longitudinal study in Sydney, Australia. Men who recently seroconverted as a result of having unprotected sex with their main partner reported that they had trusted that their partner was indeed HIV-negative and monogamous. Finding out they had been betrayed in addition to becoming infected with HIV was devastating (Kippax et al., 2003).

Concordant positive couples were more likely to have vague agreements with regard to specific sexual behaviors than concordant negative or discordant couples. In general, positive couples showed a great deal of concern for each others' health and many vocalized their anxieties about HIV re-infection or super-infection and co-infection with other STDs.

Discordant couples reported the most articulate and detailed agreements, including the specific sexual behaviors they could engage in with each other and with outside partners. Discordant couples were also the most explicit about safety. Discussions of safety were camped in two separate but related concerns: keeping the HIV-negative partner negative and the HIV-positive partner healthy and free of other STDs. That discordant couples were more explicit about safety than concordant negative and concordant positive couples seems logical given that one partner was HIV-positive and one was HIV-negative. Several behavioral and epidemiological studies, however, report that most discordant couples occasionally engage in unprotected sex together and that having a known HIV-positive main partner is a predictor of seroconversion for HIV-negative individuals (Davidovich, de Wit, & Stroebe, 2000; Remien, Carballo-Dieguez, & Wagner, 1995). So, although discordant couples took care in establishing rules to keep sex safe, they may fall short in their ability to adhere to these rules consistently. It could also be that some couples employ strategic positioning strategies where, for example, the HIV-negative partner is insertive during anal sex (Van de Ven et al., 2002). Additional research is needed to examine the specific sex behaviors discordant couples engage in and the understandings they have with regard to risk.

LIMITATIONS

Although the present study offers novel information about the agreements gay couples make about outside sex, it should be noted that it is not without its limitations. Beginning with the sampling method, all participants were self-selected. As such, this may have produced a sample of couples who were more confident in their relationships and were therefore more willing to openly discuss sensitive issues such as sexuality. Additionally, all participants were residents of the San Francisco Bay Area. Taken together, these issues may have led to a bias in the results which could limit their generalizability. One apparent example of potential bias is that all discordant couples reported agreements allowing sex with outside partners. It is unclear how representative this was for the majority of discordant couples. Perhaps most importantly, the present study did not contain couples who ended their relationships after an agreement was broken. As a result, data on agreement breaks and agreement renegotiation may favor those participants who, for one reason or another, possess the skills and motivation to work through reported breaks.

Additional limitations stem from the design and implementation of the interview guide (see Appendix A, Interview Guide). Although questions about partner roles and cultural background were asked, the responses were not sufficient enough to warrant in-depth examination of their impact on relationships. Questions on age, level of education, and income disparities were not included; therefore their impact on the participants' relationships is unknown. As such, the present study cannot comment on whether or not these issues generated power struggles, nor can it comment on any potential adverse effect of those struggles on the participants' agreements about sex outside the relationship. Future studies need to examine more closely power dynamics and their affects on relationships and agreement negotiation.

The present study illustrates the complexity of sexual agreements among gay couples and how intimately linked they are to relationship issues. In many cases, the agreement is so intimately linked to the relationship that the agreement defines or becomes the relationship. Taken as a whole, the findings from the present study suggest a new direction for research on gay couples and for HIV prevention with gay couples. Future studies for gay couples should focus on the complex interplay between agreements and relationship dynamics. Additional research should examine agreement negotiation, disclosing broken agreements, anticipating change in agreements, and how agreements are sustained over time. Future HIV prevention efforts should temper safety messages with the relationship issues that are important to and faced by gay couples.

ACKNOWLEDGMENTS

The authors thank the NIMH for providing financial support for this research. This study was supported by NIMH grant MH65141. Special thanks are extended to research staff members Efren Bose, Lynae Darbes, Joey Downey, Raven Mahosadha, Byron Mason, Anne Richards, Edwin Ramos-Soto and to the participants for their time and effort discussing their relationships.

APPENDIX A: INTERVIEW GUIDE

Relationship History

  1. Tell me a little about your relationship.
    1. How did you meet?
    2. What attracted you to each other?
    3. How long have you been together?
    4. Do you live together?
    5. When did you know you were a couple?
  2. What would you say are the strengths of your relationship?
  3. What are the weaknesses in your relationship?
  4. What kinds of activities do you do together? What do you like or dislike about them?
  5. What kinds of activities do you do alone? What do you like or dislike about them?
  6. When do you feel closest to your partner?
  7. When do you feel most distant from your partner?
  8. What keeps you together?
    1. Do you find it difficult to maintain your relationship?
    2. What do you get out of your relationship?
    3. What does the relationship add to your life?

Personal Dispositions

  1. Describe three characteristics you like about yourself.
  2. Describe three characteristics you dislike about yourself.
  3. How do you see your role in the relationship you have with your partner? (Note: Probes are for questions 3–6 in this section)
    1. How do you feel about that?
    2. What do you attribute to the roles you have each taken?
    3. Have the roles changed over time? Why?
    4. If one emerges as more powerful, what tells you he is more powerful?
    5. (Note: If the participant has trouble with the word “role,” ask…) If a neighbor was observing you and your partner, how would that person describe you?
  4. How does your partner see your role?
  5. How do you see your partner's role in the relationship?
  6. How does your partner see his role?
  7. How do your roles play out sexually?
  8. Name three characteristics about your partner that you like. (Note: If not already discussed.)
  9. Name three characteristics about your partner that you dislike. (Note: If not already discussed.)

Sexual Agreements

  1. Many couples have agreements about sex within or outside their relationship. Some of these agreements are clear and discussed with partners, but many are assumed or unspoken. Tell me about any agreements you and your partner have about sex with outside partners.
    1. How was the agreement made?
    2. What is the agreement?
    3. How long have you had the agreement?
    4. How has the agreement changed over time?
    5. How explicit is the agreement?
    6. How easy or hard is it for you to keep the agreement?
    7. What are strategies for changing or maintaining the agreement?
    8. What is the benefit to having (or not having) an agreement about sex?
    9. How comfortable are you with the agreement?
    10. How do drugs or alcohol impact your agreement?
    11. Do you see yourselves having an/this agreement in the future?
    12. How are safer sex practices part of the agreement?
    13. If seroconversion happened within the relationship, how did it happen?
  2. Tell me about a time when the sex agreement you and your partner had about outside partners was broken.
  3. Now tell me about any agreements you and your partner have about sex with each other.
    1. How was the agreement made?
    2. How long have you had the agreement?
    3. How has the agreement changed over time?
    4. How explicit is the agreement?
    5. How easy or hard is it for you to keep the agreement?
    6. What are strategies for changing or maintaining the agreement?
    7. What is the benefit to having (or not having) an agreement about sex?
    8. How comfortable are you with the agreement?
    9. Do you see yourselves having an/this agreement in the future?
  4. Tell me about a time when the agreement about sex with your partner was broken.
  5. How do you think your agreement(s) (or absence of agreement(s)) impacts your relationship?
  6. How common do you think agreements about sex are among gay men in relationships?

Norms

  1. Tell me about people you and your partner socialize with.
    1. Do you have many friends who are in relationships?
    2. Are they gay? Straight? Male or female?
  2. How supported is your relationship by friends, family, community? (Note: Participant is to define “community” for himself.)
  3. Do you and your partner feel party of a community? How does that impact your relationship?
  4. Do you and your partner feel a part of any community? How does that impact your relationship?
  5. How does your cultural or family background impact your relationship?
    1. Does it deepen the relationship or cause friction?
    2. Does it match with your partner's background? How do you deal with differences?

Goals

  1. What are your relationship goals for the future?
    1. What are your short-term goals and long-term goals?
    2. (Note: If there are no goals, ask…) Why don't you have any goals?
    3. Do you have individual goals?

Closure

  1. Is there anything else about your relationship I should know?

Footnotes

1The text in parentheses refers to the participant's age, race, and HIV status, respectively.

REFERENCES

  • Bell AP, Weinberg MS. Homosexualities: A study of diversity among men and women. Simon and Shuster; New York: 1978.
  • Blumstein P, Schwartz P. American couples: Money, work, sex. Morrow; New York: 1983.
  • Davidovich U, de Wit JB, Stroebe W. Assessing sexual risk behaviour of young gay men in primary relationships: The incorporation of negotiated safety and negotiated safety compliance. AIDS. 2000;14:701–706. [PubMed]
  • Davidovich U, de Wit J, Stroebe W. Behavioral and cognitive barriers to safer sex between men in steady relationships: Implications for prevention strategies. AIDS Education and Prevention. 2004;36:304–314. [PubMed]
  • Davidovich U, de Wit J, Stroebe W. Relationship characteristics and risk of HIV infection: Rusbalt's investment model and sexual risk behavior of gay men in steady relationships. Journal of Applied Social Psychology. 2006;37:22–40.
  • Ekstrand M. Safer sex maintenance among gay men: Are we making any progress? AIDS. 1992;6:875–877. [PubMed]
  • Elford J, Bolding G, Maguire M, Sherr L. Sexual risk behaviour among gay men in a relationship. AIDS. 1999;13:1407–1411. [PubMed]
  • Ethnograph. Version 5.08. Qualis Research Associates; Colorado Springs, CO: 2001. Computer software.
  • Frieze IH. Publishing qualitative research in Sex Roles. Sex Roles. 2008;58:1–2.
  • Hoff CC, Coates TJ, Barrett DC, Collette L, Ekstrand M. Differences between gay men in primary relationships and single men: implications for prevention. AIDS Education and Prevention. 1996;8:546–559. [PubMed]
  • Hoff CC, Kegeles SM, Acree M, Stall R, Paul J, Ekstrand M, et al. Looking for men in all the wrong places…: HIV prevention small-group programs do not reach high risk gay men. AIDS. 1997;11:829–830. [PubMed]
  • Kippax S, Crawford J, Davis M, Rodden P, Dowsett G. Sustaining safe sex: A longitudinal study of a sample of homosexual men. AIDS. 1993;7:257–263. [PubMed]
  • Kippax S, Noble J, Prestage G, Crawford JM, Campbell D, Baxter D, et al. Sexual negotiation in the AIDS era: Negotiated safety revisited. AIDS. 1997;11:191–197. [PubMed]
  • Kippax S, Slavin S, Ellard J, Hendry O, Richters J, Grulich A, et al. Seroconversion in context. AIDS Care. 2003;15:839–852. [PubMed]
  • Mattison AM, McWhirter DP. Stage discrepancy in male couples. Journal of Homosexuality. 1987;14:89–99. [PubMed]
  • Prestage G, Jin F, Zablotski I, Grulich A, Imrie J, Kaldor J, Honnor G, Kippax S. Trends in agreements between regular partners among gay men in Sydney, Melbourne and Brisbane, Australia. AIDS Behavior. 2008;12:513–520. [PubMed]
  • Prestage G, Mao L, McGuigan D, Kippax S, Kaldor J, Grulich AE. HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care. 2006;18:166–172. [PubMed]
  • Remien R, Carballo-Dieguez A, Wagner G. Intimacy and sexual risk behaviour in serodiscordant male couples. AIDS Care. 1995;7:429–438. [PubMed]
  • Semple SJ, Patterson TL, Grant I. The sexual negotiation behavior of HIV-positive gay and bisexual men. Journal of Consulting and Clinical Psychology. 2000;68:934–937. [PubMed]
  • Stall R, Hays R, Waldo C, Ekstrand M, McFarland W. The Gay '90's: A review of research in the 1990s on sexual behavior and HIV risk among men who have sex with men. AIDS. 2000;14(suppl. 3):S1–S14. [PubMed]
  • Van de Ven P, Kippax S, Crawford J, Rawstorne P, Prestage G, Grulich A, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002;14:471–480. [PubMed]