For gay couples, condom decision-making and condom use varies by race

SF State researchers present findings at XIX International AIDS Conference

SAN FRANCISCO, July 22, 2012 – Black gay couples tend to practice safe sex but don't talk about it, while white gay couples discuss safety but are less likely to use condoms, according to new findings presented at the 19th International AIDS Conference.

Gay men, particularly white and black men, account for the majority of new HIV cases in the United States. One source of HIV infection could be men's primary relationship partners. To explore this aspect of risk, San Francisco State University researchers studied how black, white and interracial male couples make decisions about using condoms.

In a National Institutes of Health-funded study of male couples in San Francisco and New York, the researchers found that black couples were more likely to use condoms regardless of HIV status. Black couples reported that practicing safe sex was the product of unspoken agreements where it was "just understood" that condom use was non-negotiable.

"Research has shown that some of the fastest growing HIV cases in the U.S. are among men in couple relationships and among black men. However, we studied black men with black partners and found that they are practicing safe sex," said Colleen Hoff, professor of sexuality studies at SF State. "This suggests that being in a relationship isn't a risk factor for black men. We need to keep searching for other factors that may explain the high incidence of HIV among this demographic."

Most white couples, regardless of HIV status, did not use condoms. Many white couples came to that decision by discussing the risks and benefits of unprotected sex with each other. Interracial couples (black and white partners) were divided between using condoms and not using condoms.

White and interracial couples that included partners with a different HIV status reported that a major factor in their decision not to use condoms was the health of the HIV positive partner. Many white and interracial couples believed that if the HIV positive partner has a low viral load and is taking HIV medication, the risk of HIV transmission is lower. The findings add to a growing body of evidence suggesting that some gay couples are abandoning condom use in response to beliefs about advances in HIV treatment and testing.

"When some individuals get tested and hear that they have a lower viral load, they might interpret that decreased risk as no risk and hence use no protection," Hoff said. "It's a calculated risk that they are taking."

Black, white and interracial couples who decided to use condoms all reported occasional, spontaneous breaks in their agreement when they had unprotected sex with each other, but their behavior after the incident differed by race. Black couples tended to discuss the situation, get tested for HIV and revert to condom use. White and interracial couples tended to continue having sex without condoms.

"We found that black and white gay men process the information they receive about HIV in different ways, and for black men using condoms is the default choice," said SF State researcher Chad Campbell. "The black gay men we surveyed were aware of the high rates of HIV among their demographic and were taking steps to ensure they don't become another statistic."

These latest findings come from San Francisco State University's "You and Me" study, led by Hoff, which explores the relationship dynamics between male partners in black, white and interracial couples.

The research will be presented in poster format at the XIX International AIDS Conference, taking place July 22 – 27 in Washington D.C. It will be presented by Chad Campbell, director of the "You and Me" study at San Francisco State University.

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Colleen Hoff is professor of sexuality studies at San Francisco State University and director of the University's Center for Research and Education on Gender and Sexuality.