Assessing sexual risk behaviour of young gay men in primary relationships: the incorporation of negotiated safety and negotiated safety compliance.

OBJECTIVES: To establish the actual rate of risky unprotected anal intercourse (UAI) among young gay men in steady relationships by correcting for negotiated safety (NS) and NS compliance. In addition, to examine whether the rate of UAI with steady partners, after correction for NS and NS compliance, is higher than the rate of UAI during sexual contacts with casual partners.
METHODS: A total of 435 young gay men completed questionnaires regarding relationship status, HIV status, NS agreements, and sexual behaviour with steady and casual partners in the preceding 6 months.
RESULTS: Twelve per cent of the participants in a relationship practised NS. The non-compliance rate with NS agreements reached 10%. The rate of UAI with steady partners stood at 54%. After correction for NS and NS compliance, the actual risky UAI rate with steady partners dropped to 39%. Chi square tests showed that even after correction for NS and NS compliance, the rates of UAI with steady partners remained significantly higher than the rates of UAI with casual partners.
CONCLUSION: It is imperative to correct the rates of UAI with steady partners for NS and NS compliance in order to estimate accurately the rates of risky UAI. The higher rates of risky UAI found with steady partners, even after correcting for NS, support the assumption that steady relationships provide a context that facilitates sexual risk-taking behaviour. We should therefore specifically target primary relationships as a source of risk for HIV transmission, and take into consideration non-compliance with NS agreements.