Unprotected sex eight times more common in serious relationships than casual ones, US gay youth study finds

Published: August 26, 2011

The strongest single predictor of not using condoms in anal sex in a group of young US gay men was that the relationship was regarded as ‘serious’, a study has found. Unprotected sex was eight times more likely in serious relationships than in casual encounters.

This study, conducted conducted by Northwestern University in Illinois, USA (Mustanski) reinforces previous findings that over two-thirds of HIV transmissions between US gay men happen between primary sex partners and only a third between casual partners (Sullivan).

In this study, the researchers comment, “there was almost no unprotected sex occurring in relationships classified as casual”. This suggests that HIV prevention strategies amongst US gay men may need to focus more on HIV risk and safer-sex negotiation within couples than on individual risk-taking decisions.

The study

The current study included 122 young men (aged 16-20) who had sex with men (MSM). Two-thirds classed themselves as gay and nearly a quarter bisexual while the remaining 11% used other categories (queer, questioning etc.) They were a subset of Project Q2, a longstanding longitudinal study of gay youth that has already uncovered high levels of mental ill-health and suicidal behaviour.

The group was recruited by means of ‘snowball sampling’ whereby a number of participants were initially identified by outreach and then encouraged to recruit others (and given $10 for each recruit). Participants were not recruited according to whether they had risky sex or not.

The researchers conducted three surveys of sexual partnerships, risk behaviour and other factors during the previous six months. These occurred at the start of the study and then six and twelve months later. Participants were paid $40 for each interview, and the retention rate was about 90%. Data was available for 117 participants who between them reported a total of 416 sexual partners (3.5 each on average).

The participants’ mean age was 18.5 years and 23% were under 18.

Half of the group described themselves as African-American, just under one in five as white, one in eight as Hispanic and one in nine as multiracial. Six per cent (seven individuals) reported knowing they had HIV; 81% had ever tested for it and 60% said they had taken a test in the last six months.

Only two participants reported knowingly having had sex with an HIV positive partner – this was so uncommon that whether status knowledge influenced safer-sex decisions could not be established.


Half (49%) of participants reported being in a serious relationship at the time of asking, defined as having “someone you feel committed to above all others”, and 80% reported having had at least one over the study period. Twelve per cent had had a female partner (serious or otherwise) during this time.

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