AIDS, Effects on Relationships

HIV Prevention and Safer Sex

In order to minimize the risk of HIV infection and other sexually transmitted diseases, couples should use a latex condom during oral, anal, or vaginal sexual contact. Studies of diverse populations from around the world indicate that people in long-term and committed relationships, both heterosexual and homosexual, use condoms less frequently than more casual couples. This could be because married or cohabiting people generally do not perceive that they are at risk for HIV infection. Couples also may engage in unprotected sex because they view condoms as detrimental to their relationship or as implying that partners are not monogamous or cannot be trusted. Research suggests that relationship dynamics and qualities are important in safer sexual practices. Specifically, feeling intimate with a partner predicts sexual behavior; greater intimacy, closeness, and commitment all predict reduced likelihood of using condoms.

Interestingly, marriage is actually a risk factor for HIV infection, particularly for women. Research with heterosexual couples suggests that married couples use condoms less frequently than unmarried couples and especially to the extent that they perceive little HIV risk from partners. Moreover, in many cultures around the world, gender expectations and social norms do little to discourage infidelity in husbands and simultaneously make it more difficult for wives to demand safer sexual practices. Such cultural norms heighten the risk of HIV infection for both partners.

In some couples, one partner is HIV positive (HIV+) and one is HIV negative (HIV–, i.e., they [Page 76]are serodiscordant). In these couples, secondary prevention, or how to simultaneously prevent HIV transmission to the uninfected partner and minimize health risks to the HIV+ partner, is a central concern. Research suggests that couple serostatus is related to sexual behavior and intimate relating; unprotected sex is more likely in couples in which both partners are HIV+ (i.e., they are seroconcordant) than in couples in which only one partner is HIV+ (serodiscordant). Although PLWHA may be motivated to practice safer sex to protect their HIV- partners, relationship closeness seems to influence the likelihood that couples engage in unprotected sex. Even among serodiscordant couples, greater feelings of relationship closeness predict greater likelihood of engaging in unprotected sex, with this tendency more pronounced among women than men in heterosexual relationships. The more dependent or less powerful partner in a relationship (e.g., women in traditional heterosexual relationships) may be pressured to not use condoms or it may be impossible for them to insist on safer sexual practices even when they are motivated to do so.

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