Relationship Definitions and Condom Use among Gay and Bisexual Men in Atlanta, Georgia

Introduction:  Men who have sex with men (MSM) account for a disproportionate burden of HIV incidence in the United States.  This paper examines how relationship definitions shape sexual risk-taking among MSM.

Methods:  In this qualitative longitudinal study in Atlanta, gay and bisexual men completed three web-based quantitative diaries to track experiences of anal and/or oral sex.  In each diary, men elaborated on up to three partners, explaining how they met the partner, how long they knew each other, the type of sex they had, condom use, and ranking of perceptions of HIV risk.  Participants also chose applicable statements to describe emotional relationship states.  Diaries were discussed in timeline-based interviews at the end of the study period.

Results: 25 men completed a total of 75 diaries.  The number of sex partners in each diary varied from 0-11.  77 partners were discussed in more depth; 43 of them were partners who were met online, 17 were committed relationships, 54 were anal sex partners, and 29 were partners with whom the participant had condomless anal sex.  We categorized partners into five groups: 1) Formal and committed monogamous relationships; 2) Formal and committed non-monogamous relationships; 3) Casual, non-monogamous, and uncommitted relationships; 4) Developing relationships where the status of formality and monogamy were not yet established; and 5) One-time sexual partners.  Decisions about condom use varied depending on the formality of the relationship and agreements regarding monogamy. 

Discussion:  These findings indicate that relationship definitions and agreements shape sexual decision-making and condom use among MSM.