The Influence of Relationship Dynamics On Sexual Behavior with Outside Partners Among Gay Male Couples

HIV infection rates among gay men in the U.S. remain high, with primary partners identified as a leading source of transmission among gay male couples. To date, not enough attention has been paid to the influence that primary partners and relationship dynamics have on sexual behavior among gay men in relationships. For example, relationship status is often not examined when investigating influences on sexual risk behavior for HIV. In addition, few studies have examined relationship dynamics and HIV risk longitudinally. We aimed to longitudinally investigate relationship dynamics and psychosocial predictors of unprotected anal intercourse with outside partners of discordant or unknown HIV serostatus (UAIOUT), as this represents a potential pathway for HIV transmission. We recruited a sample of 566 ethnically diverse, HIV-concordant and HIV-discordant gay male couples in the San Francisco Bay area and interviewed them six times over three years. In addition to demographic information, the surveys explored numerous relationship dynamics as well as sexual behavior with outside partners in the past three months. We fit generalized linear mixed models with random intercepts for individuals nested within couples for the outcome UAIOUT using relationship dynamics as predictors while controlling for time and relationship length. At baseline, the median age of the men in the sample was 42 years and the median relationship length was 4 years. Analyses of the longitudinal data revealed similar results for men in both discordant and concordant primary relationships: men with higher levels of positive relationship dynamics at each wave (e.g., commitment, intimacy) were significantly less likely to engage in UAIOUT (p< 0.01) at that same time point. Further, stronger investment in their agreement about sex with outside partners at each wave was associated with significantly less UAIOUT (p < 0.01) at each time point. These results underscore the need to acknowledge the important influence of the relationship context on sexual risk behavior for HIV among gay couples. Dynamics present within a primary relationship have a significant impact on sexual risk behavior with sexual partners outside of the relationship. Further, such impact is not static over time: since relationship factors such as levels of commitment and satisfaction can and do change over time, they can in turn lead to changes in the patterns of sexual risk behavior. Therefore, to increase their relevance and effectiveness, HIV prevention interventions for gay men should factor in relationship dynamics and the primary partner’s influence.