Objective: To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions.
Method: Data from recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables.
Results: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection.
Conclusions: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.
PIP: Data from the Sydney Men and Sexual Health study were used to revisit negotiated safety. Recruitment for the study took place between November 1992 and February 1995 and involved 1037 homosexual men who were interviewed using a questionnaire. The focus was on 354 men who had been in a regular relationship for 6 months or more. Over 52% were engaged in professional occupations and their age ranged from 17 to 69 years. 181 men of the 354 reported being in a seronegative concordant regular relationship. 61.9% of these 181 had engaged in unprotected anal intercourse at least once, while 91% (165 men) had not engaged in unprotected sex outside their relationship. Of these 39.2% either had not engaged in sex outside their relationship at least in the 6 months prior to the interview, or they had not engaged in anal intercourse (34.9%), or they had engaged only in protected anal intercourse (27.1%). 82% (135) of those who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% (9) of those who had engaged in unprotected anal intercourse had an agreement. What distinguished the 165 men who did not engage in unprotected anal intercourse with a casual partner from the 16 men who did was also examined. Men who lived in gay areas of Sidney were more likely to engage in unprotected anal intercourse with casual partners than those who lived elsewhere (p = 0.06). Having a safety agreement was predictive of safer sex when compared with no agreement at all. The best agreement with regard to safe sex with casual partners was no anal sex. 74 (44.8%) of the 165 men who thought that anal intercourse was not important had not engaged in unprotected sex. Men who found condom use acceptable were more likely to avoid unprotected anal intercourse with their casual partners. The strategy of negotiated safety among men in HIV-seronegative regular relationships may promote safe sex.