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Abstract
Among gay men, there is evidence to suggest that serious, committed male couples practice especially risky
sex. To understand the reasons why male couples might take such risks, 92 participants (46 long-term couples)
were asked to complete a survey in which they independently indicated their sexual practices, why they
engaged in them, and their attitudes toward relationships. Three sets of findings suggest a paradoxical
relationship between emotional intimacy and sexual risk: (1) love, trust, and commitment were used more
often to explain riskier than safer sex; (2) those more dependent upon their relationships and who desired a
stable and lasting relationship practiced riskier sex; and (3) requesting safer sex had negative connotations
(e.g., suspicion of extrarelationship sexual contacts). Of those who practiced safer sex (i.e., protected anal sex),
94% indicated that they did so because of their fear of AIDS. Implications of these findings for developing
HIV interventions for male couples are discussed.
Despite the enormous risks, there is evi- of their HIV status (Pinkerton & Abramson,
dence that many gay men fail to consistently 1993) or couples who are aware of their HIV
practice safer sex (Stall, Ekstrand, Pollack, sero-discordant (ie., where one partner is
McKusick, & Coates, 1990). One especially HIV positive and one partner is HIV nega-
risk-prone subgroup is the rarely studied tive) status are at considerable risk.
40% to 60% of gay men in long-term rela- However, even couples who believe that
tionships (Blumenfeld & Raymond, 1988; they are HIV negative and sero-concor-
Peplau, 1991).Ironically,although many gay dant are often still at risk for the following
men may seek committed relationships as a reasons. First, a partner may believe that
strategy to lower their risk of HIV (King, he is HIV negative when he is actually HIV
1993), members of male couples may actu- positive. For example, there is an HIV
ally be at higher risk for HIV (McKirnan et window period where antibodies to the vi-
al., 1991;Reiss & Leik, 1989) than single gay rus may not be detected (Lackritz et al.,
men if their partner is actually HIV positive. 1995). In addition, an individuals status
Certainly, those couples who practice un- may change from his last HIV test because
protected anal sex who are either unaware he engaged in risky behavior outside of the
primary relationship. In fact, the preva-
lence of extrarelationship sexual contacts
This work was supported by the California University-
wide AIDS Research Program (UARP). That pro- is high among male couples. Peplau and
gram provided pre-doctoral traineeships to the first Cochran (1988) found that 73% of gay men
and third authors under the supervision of the second in relationships had sex with someone
author, the Director of the University of Southern other than their primary partner at least
Californias UARP Traineeship program.
once during the course of the relationship.
Correspondence regarding this work should be ad-
dressed to Paul Robert Appleby, Department of Psy- Unfortunately, it is unclear how many of
chology, University of Southern California, Los Ange- these encounters involved unsafe sexual
les, CA 90089-1061. E-mail: appleby@rcf.usc.edu. practices. Even if only a small percentage
81
82 I? R. Appleby, L.C. Miller, and S. Rothspan
mens reasons for unprotected sex and the Upon placing their completed, anonymous
reasons gay men give for using condoms are surveys in envelopes to ensure confidential-
unclear. Therefore, one additional question ity, participants were thanked and paid $20
posed by the current research was the fol- per couple.
lowing: What are the prevalent reasons for
risky and safer sex for gay men in couples?
Materials
We expected that hedonic reasons and rea-
sons related to risk estimates, as suggested In addition to general demographics (e.g.,
by prior research, would generally surface age; HIV status; income; education; ethnic-
as reasons for risky sex for gay men. How- ity) participants responded to questions
ever, for gay couples, an additional set of about the following areas described below.
reasons-previously unexamined-were
apt to be critical: issues of love, trust, and Sexual behaviors and couple characteristics.
commitment. Because relationship reasons Men were asked to indicate the length of
for couples are apt to be as or more fre- the current relationship; whether or not
quently mentioned than any other reason, they had sex with someone other than their
examining this relatively understudied mo- partner during the current relationship
tivational pull-for male couples-was the (and whether condoms were used if they
focus of this research did so); whether their partner knew that
they had sex outside of the relationship;
and their own and their partners HIV
Method
status. Men were also asked to indicate the
types of sexual behaviors that they engaged
Participants
in with their partners (e.g., protected anal
Participants were 92 gay men (46 couples) sex; unprotected anal sex; unprotected oral
from Los Angeles County who met the fol- sex; protected oral sex; mutual masturba-
lowing criteria: (1) both members of a cou- tion).
ple participated, (2) members were in their
current, committed relationship a mini- Open-ended questions. First, the partici-
mum of 6 months, and (3) both members of pant specified the sexual behavior(s) he was
the couple were over 18. Ages ranged from currently engaging in with his partner (see
18 to 68 years old (mean and median = 32 above). The survey then directed the partici-
years). The majority of the sample was Cau- pant to a page of open-ended questions that
casian (74%), and, on the whole, the sample were appropriate given these sexual prac-
was well educated; over 54% of the men tices. This section assessed each participants
surveyed completed at least 2 years of col- explanations for and beliefs about his sexual
lege, and all but one of the participants behavior within the relationship. For exam-
completed high school or its equivalent. It ple, if a couple was engaging in protected
is also recognized that volunteer partici- sex, they would answer the following ques-
pants tend to be more educated, of higher tions: (1) Think back to the first time you
social class, more intelligent, more approval had protected sex with your partner. Please
motivated, and more sociable than nonvol- take us through the sequence of events that
unteers (Rosenthal & Rosnow, 1991). led you to have protected sex. Please de-
scribe what happened. (2) Please specify
the reasons why you and your partner de-
Procedure
cided to have protected sex. (3) Why have
Each member of eligible couples, recruited you and your partner continued to have pro-
via advertisements in gay print media and tected s;~? (4) What does having pro-
fliers distributed in the gay community, in- tected sex mean to you? What thoughts and
dividually and privately completed sepa- feelings come to mind? (59 What do you
rate surveys at the same time and location. think having protected sex says about your
Risking and loving 85
relationship? Finally, each participant was cluding the master coder) was .92. In those
asked to explain what it would mean to him cases where the codes assigned by the rat-
if his partner wanted to change sexual be- ers varied for a particular statement, the
havior (i.e.,change from protected to unpro- code of the master coder was used; this was
tected sex): (6) Imagine that your partner justified in that the average interrater
now wants to start having unprotected sex. kappa between any given rater and all oth-
What would this mean to you? A couple ers was highest for the master coder (.94).
engaging in unprotected sex would answer For later analyses,the reasons and mean-
the identical questions except that the word ings of sexual behavior given by participants
unprotected was substituted for the word in response to the open-ended questions
protected (and vice versa) in order to be were collapsed within couples. This was
consistent with the couples sexual behavior. done in light of the fact that members of a
Because some couples engaged in both pro- couple often did not discuss the same behav-
tected sex (e.g., anal sex) and unprotected iors. For example, if a couple had unpro-
sex (e.g.,oral sex), they answered two sets of tected oral sex and protected anal sex,some-
the above series of questions (i.e., one set of times one partner would discuss the reasons
questions about their protected sexual be- for having protected anal sex while the other
havior and one set of questions about their partner would discuss the reasons for having
unprotected sexual behavior). Note that unprotected oral sex. Partners did not give
couples were asked to explain both pro- inconsistent reports; rather, partners some-
tected and unprotected sexual behaviors. times simply chose to report on different as-
Demand characteristics were thereby pects of their joint behaviors. To get a more
minimized because couples were required complete description of a couples behavior
to explain both good behavior (i.e., pro- and to avoid the problem of dependency of
tected sex) as well as bad behavior (i.e., couple members responses, the couple (e.g.,
unprotected sex). Of course, couples may the responses of both partners combined)
still have underreported their risky sexual was treated as the unit of analysis. Assump-
behavior owing to social desirability. This is tions of parametric statistics, specifically
a general problem in this line of research. normal distributions of variables and equal
variances between groups, were not met un-
Coding of open-ended responses. less otherwise specified; nonparametric sta-
Open-ended responses were coded in the tistics were therefore used.
following way. First, two graduate students
went through the responses in search of re- Relationship Interdependency Scale. The
current themes or types of responses. A pre- questionnaire included several attitude
liminary list of categories was compiled. items. Respondents rated their degree of
During the first few weeks of coding, codes agreement with relationship attitude state-
were added and surveys already coded ments on a scale of from (1) strongly dis-
were recoded to account for the new cate- agree to (7) strongly agree. Five items
gories. During data analysis some of these tapped ones feelings of interdependency
categories with similar meanings were col- with ones relationship partner. This Rela-
lapsed. (See Table 1 for a list and descrip- tionship Interdependency Scale had ade-
tions of the categories analyzed in the pre- quate reliability ( a = .75). The five items
sent work.) Six undergraduate research comprising this scale were the following: (1)
assistants were recruited as raters to assess Id be very upset if my relationship ended;
interrater reliability for the coding of open- (2) I get a lot of things I need from my
ended responses. In addition, there was one relationship; (3) My partner provides me
master coder, a gay male graduate stu- with a great deal of emotional support; (4)
dent. Cohens kappas (Cohen, 1960) were In general, I depend a lot on my partner;
run to assess interrater reliability, and the and ( 5 ) I want a relationship that will last
mean kappa comparing all of the raters (in- for a lifetime.
86 f? R. Appleby, L.C. Miller, and S. Rothspan
tacts. Sixteen of the couples (35%) had one Three (43%) engaged in unprotected oral
partner who had sex outside of the relation- and anal sex (Risk Group 2).Two (29%) en-
ship. For the remaining 20 couples (43%) gaged in protected anal sex but unprotected
both partners had sex outside of the rela- oral sex (Risk Group 1). One couple (14%)
tionship at one time or another. Eighty-four engaged in unprotected oral sex but did not
percent of the participants whose partners engage in anal sex at all (Risk Group 0). The
had sex with someone else during the remaining sero-discordant couple was the
course of the relationship knew about it. It one couple from our entire sample that only
is not clear, however, when partners found engaged in mutual masturbation. Thus, the
out about these extrarelationship sexual couple that engaged in the safest sex in our
contacts and whether in the interim they sample was sero-discordant. However,
were placed at risk. No differences were taken as a group, sero-discordant couples
found in riskiness of sexual behavior or rea- were just as risky in their sexual behavior as
sons given for engaging in different sexual were sero-concordant couples.
behaviors as a function of extrarelationship
sexual contact status of the couple.
Reasons for riskier versus safer sex
Twenty-two participants were HIV posi-
tive (twenty-four percent); 64 were nega- A series of chi-square tests were performed
tive (seventy percent), and the remaining comparing the reasons couples gave for en-
six (seven percent) were unsure or did not gaging in risky sex (unprotected anal sex)
respond to the question. Six couples were versus reasons couples gave for engaging in
therefore classified as sero-unknown. Of safer sex (protected anal sex). Therefore,
the 40 couples where both members re- only couples who engaged in anal sex were
vealed their HIV status, 26 (sixty-five per- retained for these analyses. Sixteen couples
cent) of the couples were HIV negative, 7 were currently using condoms for anal sex
(eighteen percent) of the couples were and therefore only answered questions
sero-different, and 7 of the couples (eight- about protected sex behavior; 20 couples
een percent) were HIV positive. were not currently using condoms for anal
One couple (2%) did not engage in oral sex and therefore only answered questions
or anal sex, only mutual masturbation. All about unprotected sex behavior. These 36
of the remaining couples engaged in unpro- couples were retained for analyses; and
tected oral sex; all of these couples believed comparisons of reasons given for protected
that unprotected oral sex is safe or of negli- sex and reasons given for unprotected sex
gible risk. Seven couples (15%) engaged in were strictly between-couples (see Table 2).
unprotected oral sex only, and did not en- To keep the comparisons strictly between-
gage in anal sex at all (Risk Group 0). Six- couples, two couples that were inconsistent
teen couples (35%) engaged in unprotected in their current use of condoms for anal sex
oral sex but protected anal sex (Risk Group (i.e., they answered questions about both
1). The remaining 22 couples (48%) en- protected and unprotected anal sex) were
gaged in both unprotected oral and unpro- excluded from the analysis.
tected anal sex (Risk Group 2). No differences were found in reasons
given for protected versus unprotected anal
Sero-discordant couples. Contrary to the sex as a function of sero-status of the cou-
finding by Kippax, Crawford, Davis, Rod- ple. However, to be certain that sero-discor-
den, and Dowsett (1993) that unprotected dant couples were not influencing the re-
anal intercourse is more likely among sero- sults of the comparisons of reasons given
concordant couples, the seven sero-discor- for protected versus unprotected anal sex,
dant couples in our sample did not differ sig- comparisons were also made excluding the
nificantly from sero-concordant (i.e., both four sero-discordant couples who were in-
partners have the same HIV status) couples cluded in the reported comparisons and
in the riskiness of their sexual behavior. also excluding the five couples who were
88 &? R. Appleby, L.C. Miller, and S. Rothspan
Table 2. Percentage of couples using various reasons to explain less risky versus risky sex
Protected Anal Unprotected Anal Likelihood
Reason or Meaning Sex (Less Risky) Sex (Risky) Ratio
Reasons Relating to Main Hypotheses
Relationship reasons 38% 95 % 15.21**
Fear of AIDS 94 % 15% 25.52**
Other Reasons
Hedonic reasons 38 % 95% 15.21**
Reasons related to risk estimates 56% 90 ?Lo 5.55*
Part of sexual script 44 % 10% 5.55*
Maximizing mutual outcomes 38 % 5 Yo 6.36*
unsure of their sero status. All significant more willing to use condoms if health-care
differences remained significant (p < .05) messages eroticize condom use.
and in the same direction. Thus, even after Reasons related to risk estimates illus-
looking only at sero-concordant couples, trate areas where couples inaccurately esti-
the differences we found in our compari- mate the level of risk involved with certain
sons were identical. behaviors, thus creating safer sex myths.
In Table 2, we have organized these rea- Pulling out before ejaculation is one ex-
sons into two general groups paralleling the ample of a safer sex myth; such safer
unprotected behaviors need to be ad-
focus of the report. The first category in-
dressed in future research and in HIV edu-
cludes reasons that relate to the main hy-
cation. Note that pulling out is not unique
potheses of the current work. Briefly, as hy-
to gay men; it is also an ineffective strategy
pothesized, relationship reasons were more
some heterosexuals use to prevent preg-
frequently associated with unprotected
nancy. Another frequently mentioned
anal sex while fear of AIDS was more asso- myth, used to explain unprotected anal sex,
ciated with protected anal sex. The second is that we had unprotected sex before and
category includes reasons not directly re- once the damage is done, it is done. This
lated to our main hypotheses. We will dis- explanation indicates a lack of under-
cuss this latter set of findings first before standing of cumulative risk (Kingsley et
returning to the reasons related to relation- al., 1987). The notions of cumulative risk
ships and fear. and repeated exposure must be clarified in
Two categories of reasons were used current safer sex interventions as the mes-
more frequently for unprotected anal sex sage is apparently not understood by many.
than protected anal sex (see Table 2); they Testing HIV negative was also a fre-
included issues pertaining to immediate quently mentioned reason related to risk
pleasure-hedonic reasons (e.g., sensation estimates. Given window periods and ex-
concerns, got carried away etc.) and reasons trarelationship sexual contacts, HIV inter-
related to risk estimates (e.g., My partner ventions must ensure that couples who test
pulls out, Once the damage is done, it is HIV negative do not harbor a false sense of
done, and I felt safe with my partner). security based upon test results alone. An-
With respect to hedonic reasons, consistent other reason relevant to risk perception
with earlier work (Choi et al., 1994), con- was the presumption of monogamy in the
cern about sensation was a prevalent rea- relationship. Monogamy was offered as an
son for foregoing condom-use. These find- explanation for engaging in risky sex, but
ings justify the argument that men may be the reality is that most couples will have sex
Risking and loving 89
with someone other than their current part- more frequently associated with love, trust,
ner during the course of the relationship and commitment. In support of this, feelings
(Peplau & Cochran, 1988). Therefore, in- of love, trust, and commitment were associ-
tentions of monogamy alone are not a fool- ated with risky sexual behaviors more often
proof method of safer sex. than with safer sexual behaviors (see Table
Other overly optimistic perceptions 2). To gather converging evidence for the
about the role of knowledge about ones link between relationship variables and
partner can also lead to inaccurate risk as- sexual risk-taking, scores on the Relation-
sessment: Discussing sexual histories and ship Interdependency Scale were corre-
knowing each other for a while, both rele- lated with level of sexual risk taking (un-
vant reasons for unprotected anal sex, illus- protected anal sex = high and protected
trate the common misperception that anal sex = low). There was a significant
knowing ones partners can minimize correlation between sexual risk taking and
(HIV) risk (Valdiserri et al., 1988, p. 804). relationship interdependency (r = .35, p <
Most HIV education emphasizes, correctly, .Ol) for all participants engaging in anal sex.
that one can never know everything about Because participants belonged to cou-
another person,and that the safest approach ples, independence of responses could not
to take (if not abstinence) is to use condoms. be assumed. Therefore, we could not simply
Two other categories were used more fre- correlate the responses on these two vari-
quently for protected anal sex than for un- ables across the 72 men included in the
protected anal sex: part of sexual script and analysis. Instead, the responses of partners
maximizing mutual outcomes. Forty-four needed to be separated, to avoid the de-
percent of the couples who engaged in pro- pendence of response problem. To do so,
tected anal sex implied that this is just what one member of each couple was randomly
we do (part of sexual script). This finding assigned to Group 1and the correlation be-
suggests the value of counseling couples tween riskiness of sexual behavior and rela-
simply to initiate condom use; the more con- tionship interdependency was assessed for
doms are used, the more likely they may be these 36 men. The same set of analyses was
to become integrated into ones typical sex- performed for the other 36 men not assigned
ual script. In this way, safer sexual behaviors to Group 1 (i.e.,the Group 2 men).The sepa-
may become automatic and normative parts rate correlations between riskiness of sexual
of sex. In fact, Kelly et al. (1991) suggested behavior and relationship interdependency
that experience with safer sex may contrib- were thus as follows: group 1 ( r = .48,p <
ute to a pattern of safer sex maintenance. .01) andgroup2 ( r = .23,p = .19).These cor-
Maximizing mutual outcomes was also relations supported Hypothesis 2: Those
cited frequently as a reason for protected who desire a stable and lasting relationship
anal sex. I want to protect myself and my and who are dependent upon their partners
partner from HIV is an example of this (as measured by a closed-ended relationship
category. The use of this reasoning by cou- attitudes measure) will take greater sexual
ples currently engaging in protected sex sug- risks in the relationship.
gests that a successful safer sex message for These findings are ironic in that the posi-
couples may be one that focuses less on indi- tive ingredients of a successful relationship
vidual outcomes (protecting self) and more (i.e., love, trust, commitment, and relation-
on joint outcomes (protecting each other). ship interdependency) are also predictive
of behaviors that could lead to HIV infec-
tion. What might explain this apparent
Reasons and relationships:
paradox? One possibility, as Rempel et al.
Main hypotheses
(1985) point out, is that taking risks within
Trust, risk, and commitment: Interwoven a relationship is part of building trust and a
themes. Our first hypothesis was that in closer, deeper relationship. A second possi-
comparison to safer sex, riskier sex will be bility, as articulated by Pilkington et al.
90 l? R. Appleby, L.C. Miller, and S. Rothspan
(1994), is that as trust develops, concern 5.68, p < .05. The same result was found
about AIDS diminishes, and sex becomes when excluding sero-discordants (p < .05)
riskier. This might occur because trust in and when excluding sero-discordants and
ones partner may be overgeneralized sero-unknowns (p < .Ol).
such that the individual trusts the partner This presents a problem for HIV preven-
not to give him . . .AIDS (Pilkington et al., tion efforts. If love and trust for ones part-
1994, p. 209). A third possibility also sug- ner are associated with riskier sex and
gested by Pilkingtoa and her colleagues is negative connotations surround safer sex,
the notion of a halo effect. Those who feel the prevalent safer sex message of using a
positively (i.e., loving and trusting) about condom shows that you care about your
their partners may assume that their part- partner is likely to ring hollow with many
ners are good in general and in turn free gay men. The message assumes that caring
of disease. and love are associated with not taking
There is one additional reason why risk chances and playing it safe, but this was
may be associated with loving. Risk-taking not the meaning that most couples in the
itself may be arousing. In a romantic con- present study ascribed to safer sex.
text, that arousal may enhance romantic
feelings and the desire for sexual intimacy.
Fear of AIDS
Supporting this possibility, Dutton and
Aron (1974) found that men who inter- Hypothesis 4 stated that: Fear of AIDS will
acted with an attractive female researcher be the most frequently cited explanation for
on a scary suspension bridge-compared to engaging in safer sex. Hypothesis 4 was sup-
those on a safe bridge-were more likely to ported, for in the current work, fear of
have fantasies about love, kissing, and sex- AIDS was cited 94% of the time in refer-
ual intercourse as well as more likely to ence to protected anal sex. Even after ex-
telephone the researcher later to talk cluding both the sero-unknown couples and
about the study. The causal connections the sero-discordants, 91% of the couples
between sexual risk-taking, arousal, and ro- having protected anal sex cited fear of
mantic feelings should be investigated in AIDS as a reason for using condoms. After
future research. excluding sero-positive couples as well,
Looking at safer sex, it was not just 89% of the sero-negative couples cited fear
viewed less positively than risky sex; it had of AIDS as a reason for using condoms.
specific negative associations. For example, Most researchers have put sero-concordant
a hypothetical request from ones partner negative couples in a low risk category for
to switch to safer sex practices (Imagine HIV infection. However, these couples are
that your partner now wants to start having still afraid of contracting HIV from their
protected sex. What would this mean to primary relationship partner-even though
you?) raised the possibility of extrarela- both partners have tested negative for HIV.
tionship sexual contacts. This supported They are therefore likely to share our per-
Hypothesis 3 : Aproposed change from risk- ceptions regarding the risks of gay men in
ier to safer sex (i.e.,a suggestion to use con- couples we alluded to earlier. This finding is
doms) is apt to arouse suspicion of extrare- consistent with past research that has
lationship sexual contact. Put another way, a linked fear of AIDS to safer sexual prac-
move by ones partner to initiate safer sex tices (Gielen et al., 1994; Rhodes & Wolit-
may undermine ones trust in ones partner. ski, 1990). Thus, fear appeals cannot be dis-
Suspicion of extrarelationship sexual con- counted as an important tool for increasing
tacts was more frequently mentioned in re- safer sex behavior.
sponse to a hypothetical change to pro- However, one must be careful when us-
tected sex (less risky), 53%, than in ing fear to affect behavior change. If too
response to a hypothetical change to un- much fear is aroused it may cause anxiety
protected sex (risky), 13%, x2(1, N = 30) = and a subsequent denial of the message that
Risking and loving 91
triggered the discomfort (Chu, 1966). To be bers. Because this fear is paired with strate-
most effective, fear appeals should be gies to lower risk of HIV infection (i.e.,
paired with messages that promote feelings boosting feelings of self-efficacy),it should
of self-efficacy (Maddux & Rogers, 1983). be effective in reducing high-risk sexual be-
More specifically, individuals must believe havior. The fourth advantage of this ap-
that they are capable of responding in a proach is that it addresses a problem with
way to avoid the feared consequence (Tan- the restrictiveness of safer sex guidelines.
ner, Day, & Crask, 1989). To be effective, There is evidence to suggest that safer sex
HIV interventions for couples should pro- guidelines may have failed some men be-
vide individuals with a clearer set of strate- cause the task of maintaining the use of
gies, skills, and plans for coping with the condoms indefinitely is too difficult, and
real sexual risks of commitment (e.g., prob- they engage in slipups, or random acts of
ability of extrarelationship sexual contacts unprotected sex (Sadownick, 1995).
and window periods). An approach known Negotiated safety allows for the possibil-
as negotiated safety, which addresses ity of having unprotected sex within the
these concerns, therefore holds promise. context of a relationship that has a negoti-
ated safety agreement; this may discourage
some men from engaging in random acts of
Negotiated safety
unprotected sex outside of the relationship
Negotiated safety, an approach to HIV in- that may be more risky than unprotected
tervention widely used in Australia sex acts practiced within their primary rela-
(Sadownick, 1995), encourages individuals tionship. One pitfall with negotiated safety,
with the same sero-status to form couples. however, is the presumption of honesty.
Couples use condoms during the first sev- However, given the greater candidness of
eral months of the relationship, and re- the negotiated-safety approach, honesty
peated HIV testing is administered during might not only be the best policy but
this time. If both partners are negative after might be less associated with conflict and
this repeated testing, they can start having relationship cost.
unprotected sex if they promise each other
they will avoid anal sex outside of the rela-
Conclusion
tionship. If unsafe sex occurs outside of the
relationship, it is permitted as long as ones This study provides insight into how risky
partner is told immediately and the two and safer sex practices are viewed by men
resume condom use. Repeated testing can in male couples. Safer sex is motivated pri-
allow them to do away with condoms once marily by fear of AIDS. Risky sex is viewed
again later on. as a sign of love, trust, and commitment,
The first advantage of this approach is while moves to initiate safer sex are viewed
that it may increase couples feelings of with suspicion.
self-efficacy because it gives them a plan Risky and safer sex are therefore not
and a set of strategies for responding to merely isolated behaviors. They are actions
extrarelationship sexual contacts that mini- imbued with meaning, especially when per-
mizes each partners exposure to HIV. The formed within an enduring relationship.
second advantage to negotiated safety is Unfortunately, HIV interventions have
that it simultaneously acknowledges the de- largely focused on the mechanics of sex
sire of male couples to engage in unpro- (i.e., how to use condoms) and neglected
tected sex to express love, trust, and com- the relationship context within which sex
mitment, and provides a lower-risk model occurs. A failure to acknowledge that risky
for doing so. The third advantage of nego- sexual behaviors are closely tied to loving
tiated safety is that by keeping the topic of may have led to ineffective HIV interven-
HIV salient, fear of AIDS should also re- tions in the past. Interventions targeted at
main salient in the minds of couple mem- couples and singles (straight or gay) that
92 f? R. Appleby, L. C. Miller, and S. Rothspan
discuss relationship issues must be devel- association among love, trust, commitment,
oped so as to foster lower risk behavior in and sexual risk may not be such a paradox
the future. after all. Risk-taking, arousal, and romantic
The possibility that risk-taking may in- feelings may simply be intertwined parts of
crease romantic feelings and sexual desire the complex experience of love.
(Dutton & Aron, 1974) suggests that the
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