title: Health, trust, or "just understood": explicit and implicit condom decision-making processes among black, white, and interracial same-sex male couples.
abstract: Among gay and bisexual men, primary partners are a leading source of HIV infection. Trust, intimacy, and advancements in HIV treatment may impact same-sex male (SSM) couples' decisions to engage in unprotected anal intercourse (UAI). This qualitative study explored how Black, White and interracial couples discussed, and made decisions regarding condoms. Qualitative interviews were conducted with 48 SSM couples in the New York and San Francisco metropolitan areas. Stratified purposive sampling was used to include Black (n = 16), White (n = 17), and interracial (Black-White) (n = 15) couples. Twenty-six couples were concordant HIV-negative and 22 were HIV-discordant. Interviews were recorded, transcribed, coded, and analyzed using a grounded theory approach. Some couples described explicit processes, which involved active discussion, while others described implicit processes, where condom-use decisions occurred without any explicit discussion. These processes also differed by race and HIV status. Black couples tended to report condom-use as "just understood." White, HIV-discordant couples decided not to use condoms, with some identifying the HIV-positive partner's suppressed viral load and high CD4 count as deciding factors. After an unplanned episode of UAI, White, HIV-negative couples tended to discontinue condom use while Black HIV-negative couples decided to revert to using condoms. HIV prevention efforts focused on same-sex, male couples must consider the explicit/implicit nature of condom decision-making processes. Understanding differences in these processes and considering relationship dynamics, across race and HIV status, can promote the development of innovative couple-level, HIV prevention interventions.
authors.affiliation: Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street, Suite 523, San Francisco, CA, 94103, USA, ccamp79@sfsu.edu.
authors.forename: Chadwick K
authors.initials: CK
authors.lastname: Campbell
authors.forename: Anu Manchikanti
authors.initials: AM
authors.lastname: Gómez
authors.forename: Shari
authors.initials: S
authors.lastname: Dworkin
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Wilson
authors.forename: Kirk K
authors.initials: KK
authors.lastname: Grisham
authors.forename: Jaih
authors.initials: J
authors.lastname: McReynolds
authors.forename: Peter
authors.initials: P
authors.lastname: Vielehr
authors.forename: Colleen
authors.initials: C
authors.lastname: Hoff
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D001727:Bisexuality / Q000523:psychology; D017280:Condoms / Q000706:statistics & numerical data*; D003657:Decision Making; D015658:HIV Infections / Q000517:prevention & control; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009518:New York; D021841:Safe Sex; D012495:San Francisco; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology*; D012747:Sexual Partners; D035502:Trust; D044465:White People / Q000523:psychology
references.citation: AIDS Care. 2006 Feb;18(2):166-72
references.pmid: 16338775
references.citation: AIDS Care. 2003 Aug;15(4):513-24
references.pmid: 14509866
references.citation: J Black Psychol. 2004;30(1):78-105
references.pmid: 20041036
references.citation: Int J STD AIDS. 2001 Mar;12(3):164-70
references.pmid: 11231869
references.citation: AIDS. 2009 Jun 1;23(9):1153-62
references.pmid: 19417579
references.citation: Sex Health. 2012 Mar;9(1):1-3
references.pmid: 22348626
references.citation: AIDS. 2001 Jul 6;15(10):1303-8
references.pmid: 11426076
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Jan 1;14(1):72-8
references.pmid: 8989214
references.citation: J Sex Res. 2009 Sep-Oct;46(5):399-413
references.pmid: 19337934
references.citation: J Sex Res. 2005 Aug;42(3):185-91
references.pmid: 19817032
references.citation: Sex Health. 2012 Mar;9(1):96-102
references.pmid: 22348637
references.citation: AIDS Care. 2010 Jul;22(7):827-35
references.pmid: 20635246
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Nov 30;61(47):962-6
references.pmid: 23190569
references.citation: Am J Public Health. 2010 Mar;100(3):503-9
references.pmid: 20075328
references.citation: Focus. 2005 Feb;20(2):1-5
references.pmid: 15880839
references.citation: AIDS Behav. 2009 Aug;13(4):630-7
references.pmid: 19479369
references.citation: AIDS Educ Prev. 2004 Aug;16(4):304-14
references.pmid: 15342333
references.citation: Sex Transm Dis. 2002 Jan;29(1):38-43
references.pmid: 11773877
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S85-95
references.pmid: 20397961
references.citation: Am J Mens Health. 2009 Jun;3(2):150-64
references.pmid: 19477728
references.citation: Qual Health Res. 2009 Dec;19(12):1669-77
references.pmid: 19949217
references.citation: Am J Prev Med. 2007 Dec;33(6):479-85
references.pmid: 18022064
references.citation: AIDS Behav. 2004 Sep;8(3):321-31
references.pmid: 15475679
references.citation: AIDS Behav. 2009 Aug;13(4):645-51
references.pmid: 19199021
references.citation: Qual Health Res. 2010 Dec;20(12):1642-55
references.pmid: 20663940
references.citation: AIDS Behav. 2012 Jan;16(1):159-67
references.pmid: 21221756
references.citation: Arch Sex Behav. 2010 Jun;39(3):774-87
references.pmid: 18686027
references.citation: J Clin Psychol Med Settings. 1997 Dec;4(4):437-51
references.pmid: 12348422
references.citation: AIDS Behav. 2006 Nov;10(6):637-48
references.pmid: 16673158
references.citation: AIDS. 2005 Jan 28;19(2):179-84
references.pmid: 15668543
references.citation: AIDS. 2000 Apr 14;14(6):701-6
references.pmid: 10807193
references.citation: J Consult Clin Psychol. 2000 Oct;68(5):934-7
references.pmid: 11068981
references.citation: Cult Health Sex. 2008 Jun;10(5):513-27
references.pmid: 18568873
references.citation: J Acquir Immune Defic Syndr. 2004 Apr 15;35(5):526-36
references.pmid: 15021318
references.citation: J Acquir Immune Defic Syndr. 2010 Aug;54(5):548-55
references.pmid: 20512046
references.citation: AIDS. 1997 Feb;11(2):191-7
references.pmid: 9030366
references.citation: AIDS. 1999 Jul 30;13(11):1407-11
references.pmid: 10449295
references.citation: Am J Public Health. 2006 Jun;96(6):1007-19
references.pmid: 16670223
references.citation: AIDS. 2007 Oct 1;21(15):2083-91
references.pmid: 17885299
references.citation: AIDS Care. 2012;24(9):1071-7
references.pmid: 22292838
references.citation: Lancet. 2008 Jul 26;372(9635):314-20
references.pmid: 18657710
references.citation: AIDS Care. 2003 Dec;15(6):839-52
references.pmid: 14617505
references.citation: Cult Health Sex. 2011 Jan;13(1):73-87
references.pmid: 20960357
references.citation: AIDS. 2001 May 25;15(8):1025-35
references.pmid: 11399985