title: Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men.
abstract: OBJECTIVE
  To examine the prevalence of negotiated safety (NS) in a diverse sample of HIV-negative men who have sex with men (MSM), characteristics of MSM practicing NS, and adherence to NS.
  
  
  METHODS
  This was a cross-sectional survey of San Francisco MSM recruited from venues and community organizations. NS relationships were defined as those in which HIV-negative men were in seroconcordant primary relationships for >/=6 months, had unprotected anal intercourse (UA) together, and had rules prohibiting UA with others. Adherence to NS was determined from self-reported sexual behavior in the prior 3 months. Presence of an agreement with NS partners to disclose rule breaking was also determined.
  
  
  RESULTS
  Of 340 HIV-negative participants, 76 (22%) reported a current seroconcordant primary relationship for >/=6 months. Of these 76 men, 38 (50%) had NS relationships, 30 (39%) had no UA with primary partners, and 8 (11%) had UA with primary partners without rules prohibiting UA with others. In multivariate analysis, NS was more common than no UA with primary partners in younger men. Among 38 NS men, 29% violated their NS-defining rule in the prior 3 months, including 18% who reported UA with others, and 18% reported a sexually transmitted infection (STI) in the prior year. Only 61% of NS men adhered fully to rules and agreed to disclose rule breaking.
  
  
  CONCLUSIONS
  Although NS was commonly practiced among HIV-negative men in seroconcordant relationships, some men violated NS-defining rules, placing themselves and potentially their primary partners at risk for HIV infection. Prevention efforts regarding NS should emphasize the importance of agreement adherence, disclosure of rule breaking, and routine STI testing.
authors.affiliation: HIV Research Section, San Francisco Department of Public Health, San Francisco, CA, USA. robert.guzman@sfdph.org
authors.forename: Robert
authors.initials: R
authors.lastname: Guzman
authors.forename: Grant N
authors.initials: GN
authors.lastname: Colfax
authors.forename: Sarah
authors.initials: S
authors.lastname: Wheeler
authors.forename: Gordon
authors.initials: G
authors.lastname: Mansergh
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
authors.forename: Melissa
authors.initials: M
authors.lastname: Rader
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology / Q000635:transmission; D018023:HIV Seronegativity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D017008:Negotiating; D012309:Risk-Taking; D012449:Safety; D012495:San Francisco; D012725:Sexual Behavior