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Rationalizing risk: sexual behavior of gay male couples

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Rationalizing risk: sexual behavior of gay male couples

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Content RATIONALIZING RISK:
SEXUAL BEHAVIOR OF GAY MALE COUPLES
by
Paul Robert Appleby
A Thesis Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(Psychology)
December 1995
Copyright 1995 Paul Robert Appleby
UNIVERSITY O F SO U TH ER N CALIFORNIA
t h e g r a d u a t e s c h o o l
UNIVERSITY PARK
LO S A NGELES. C A LIFOR N IA SOOOT
This thesis, written by
Paul Robert Appleby
under the direction of ha, s Thesis Com m ittee,
and approved by ail its members, has been p re
sented to and accepted by the D ean of The
Graduate School, in partial fulfillment of the
requirements for the degree of
Master of Arts
Dtm*
Date... Noveanber 7 ; .1995
THESIVCOMMITTEE
Acknowledgements
This work was supported by the California Universitywide
AIDS Research Program. I would like to express my gratitude
to Larry Grossman whose emotional support helped me through
this project; Sadina Rothspan, my colleague and friend; Dr.
Lynn Carol Miller, my committee chair whose patience and
expertise guided me through this thesis; Dr. Stephen J. Read,
who was always helpful in answering my questions about this
project; and Dr. Gerald C. Davison, my outside committee
member, who offered his valuable time to evaluate the current
work.
Ill
Table of Contents
Page
Acknowledgements
ii
List of Tables
iv
Abstract
V
Introduction
1
Method
5
Results
13
Discussion
24
References 36
iv
List of Tables
Page
Table 1 39
Table 2 42
Table 3 44
Table 4 46
Table 5 47
Table 6 48
V
Abstract
Although men who are part of gay couples may engage in
particularly risky sexual practices, little is known about
why they do so. To address this question, gay men who were
part of a long-term couple independently filled out a series
of open-ended questions which addressed the reasons they
engaged in either risky sex or safer sex; in addition,
couples answered a closed-ended relationship attitude scale.
Three sets of findings suggest a paradoxical relationship
between emotional intimacy and sexual risk: (1) Relationship
reasons (e.g., "shows love, trust, and commitment") were used
more often to justify risky sex than safer sex. (2) Safer
sex had negative connotations for the relationship such that
a partner's hypothetical request to switch to safer sex
practices was met with suspicion of infidelity. (3) Couples
with more positive beliefs about relationships practiced
riskier sex. If risk is indicative of closeness as these
results suggest, why do some couples practice safer sex? Of
those couples who engaged in protected sex, 95% did so
because of "fear of AIDS." Thus, despite their pitfalls,
fear appeals may play an important role in HIV prevention.
Implications of these findings for developing HIV
interventions for gay couples and others are discussed.
1
Despite the enormous risks, many gay men fail to
consistently practice safer sex (Stall, Ekstrand, Pollack,
McKusick, f i t Coates, 1990). One of the most understudied
subgroups of gay men are the estimated 40% of gay men
involved in long-term relationships (Blumenfeld f i t Raymond,
1988). One might think that gay men in long-term
relationships are at lower risk for HIV infection than single
gay men. Consistent with this notion, there is evidence that
many gay men seek committed relationships as a strategy to
lower their risk of HIV infection (King, 1993).
Paradoxically, however, gay men in relationships may be at
higher risk for HIV infection than single gay men for four
main reasons. First, gay men in relationships are among the
most likely to engage in the riskiest forms of unprotected
sex (Coxon, Coxon, Weatherburn, Hunt, Hickson, Davies, f i t
McManus 1993; King, 1993) . Second is the issue of
infidelity; Peplau and Cochran (1988) found that 73% of gay
men in relationships had sex with someone other than their
partner at least once during the course of the relationship.
Third, gay couples may halt safer sexual practices when it is
unsafe to do so, for HIV antibody tests can produce false
negative test results (Saah, Farzadegan, Fox, Nishanian,
Rinaldo, Phair, Fahey, Lee, & Polk, 1987) , Fourth,
incubation periods of the virus are variable (Munoz, Kirby,
He, Margolick, Visscher, Rinaldo, Kaslow f i t Phair, 1995) which
may allow one partner to be asymptomatic and to unwittingly
2
infect his partner. It is a paradox that those gay men who
have developed trusting, committed relationships may be
putting themselves at the greatest risk for HIV. The very
qualities that are emphasized as necessary to produce a good
relationship (i.e., trust and commitment) may prove deadly.
Trust, Risk, and Commitment: Deadly Trio?
Trust and risk may be surprisingly interwoven themes in
intimate relationships. On the one hand, one popular message
in current safer sex interventions is the following: "Using a
condom shows that you care about your partner." But there is
a problem with this message; it assumes that caring and love
are associated with not taking chances and "playing it safe."
However, as Rempel, Holmes, and Zanna (1985) point out,
taking risks within a relationship is part of building trust
and a closer, deeper relationship. One component of building
trust in a relationship is taking risks. The risks they were
describing were "intimate disclosure, reliance on another's
promises, sacrificing present rewards for future gains and so
on ..." (p. 96); they did not entail the possibility of
contracting a fatal disease.
However, the ultimate risk in a gay male relationship
today is having risky sex. Risk is best conceptualized on a
continuum from abstinence and mutual masturbation (at the low
risk end) to unprotected anal sex (at the high risk end) with
gradations of risk in between (e.g., protected oral sex;
protected anal sex; unprotected oral sex). Although Rempel,
Holmes, and Zanna (1985) did not conceptualize risky sex as
one of the risks which might be taken to build trust and
subsequently closeness in a relationship, risky sexual
behaviors may very well symbolize evidence of trust, love,
and commitment in gay couples. Safer sex, in turn, might be
viewed negatively or as a barrier to a close relationship.
In light of these arguments, three sets of hypotheses were
derived; the first set addressed reasons given for engaging
in safer versus riskier sex. The second set involved the
meanings ascribed to hypothetical changes to safer versus
riskier sex, and the third involved the correlations of
relationship attitudes with riskiness of sexual behavior.
Riskv Versus Safer Sex
As suggested above, risky sexual behavior may be viewed
by couples as a symbol of love, trust, and, commitment (i.e.
relationship reasons), therefore:
Hypothesis 1: In comparison to safer sex, riskier sex
will be more frequently associated with love, trust, and
commitment.
Although other rationales may be given for engaging in
risky sex, relationship reasons should be the primary
rationale offered for engaging in risky sex, therefore:
Hypothesis 2: Relationship reasons will be the most
frequently cited of all rationales for engaging in risky sex
What motivates safer sex behavior in couples? There is
evidence that fear of AIDS may promote safer sex practices
4
(Rhodes & Wolitski, 1990), and that many of those who engage
in safer sex practices are motivated by fear of AIDS (Gielen,
Faden, O' Campo, Kass, & Anderson, 1994). Although other
rationales may be used for engaging in safer sex, it seems
reasonable that the primary motivation for engaging in safer
sex might be fear of AIDS, and that engaging in safer sex
should not require much in the way of a defense other than a
desire to avoid HIV infection, therefore:
Hypothesis 3: Fear of AIDS will be the most frequently
cited justification for engaging in safer sex.
Hypothesis 4: Fear of AIDS will be used with regard to
safer sex more frequently than with regard to risky sex.
Hypothesis 5: A smaller number of rationales will be
generated for safer sex than for riskier sex.
Hypothetical Change to Riskv Versus Safer Sex
If having risky sex is viewed as a symbol of trust, a
partner's request to have safer sex should be viewed as a
sign of a lack of trust, therefore:
Hypothesis 6: A proposed change from riskier to safer
sex is apt to arouse suspicion of infidelity.
Healthy Relationship Dependence and Stability
Because past research has shown that risky sexual
behavior and feelings of love are associated (Burns, 1993;
Pollack, Ekstrand, Stall, & . Coates, 1990) , it seems likely
that those individuals who are most dependent upon their
relationship or more apt to view their relationship as stable
5
might be especially likely to take sexual risks in the
relationship -- to demonstrate their love and commitment,
therefore:
Hypothesis 7: Those who have a healthy dependence on
their relationship and view their relationship as stable (as
measured by a closed-ended relationship attitudes measure)
will take greater risks sexually within the relationship.
Method
Partigjpanta
Participants were 92 gay men (46 couples) from Los
Angeles County who had been in "committed" relationships for
at least six months; participants were recruited by
advertisements in gay print media and fliers distributed in
businesses catering to the gay community. A telephone number
was listed in the advertisements and fliers, and participants
called the number and left a message on an answering machine
set up for the purpose of the study. When calls were
returned, potential participants were reminded of the
criteria for inclusion in the study (originally listed in the
advertisements and fliers) which were the following; (1) both
members of a couple were required to participate, (2) members
must have been in that relationship a minimum of six months,
and (3) both members of the couple had to be over 18.
Potential participants were also informed that the study
would ask questions about their sexual behavior and that the
purpose of the study was to assess attitudes of gay couples
6
towards their relationship in general and safer sex practices
in particular. They were also assured that survey responses
would remain anonymous and confidential, and were reminded
that they would be paid $20.00 per couple to complete the
surveys. Couples were given the option of coming to the
university, meeting at a specified location such as a
restaurant or coffee house, or having the researcher come to
their home to administer the survey. Most couples {67%)
chose to be surveyed at home; 17% were surveyed at a
specified location other than the University or home, and the
remaining 15% drove to the University of Southern California
to fill out the survey.
Ages ranged from 18 to 68 years old (mean and median =
32 years). The majority of the sample was Caucasian (74%),
and, on the whole, the sample was fairly well educated; over
54% of the men surveyed completed at least 2 years of
college, and all but one of the participants completed high
school or its equivalent.
The average length of the relationships was 43 months.
However, the majority of the men did not maintain an
exclusive sexual relationship with their partner; 62% of the
sample reported having had sexual relations with someone
other than their current partner during their relationship.
Eighty-four percent of the participants whose partners had
sex with someone else during the course of the relationship
knew about it. Only 30% of those who had sex outside of the
7
relationship consistently used condoms. Ten of the couples
(21%) were completely monogamous - both partners reported
being faithful. Sixteen of the couples (35%) had one partner
who had sex outside of the relationship. For the remaining
20 couples (43%) both partners had sex outside of the
relationship at one time or another.
Twenty-two participants were HIV positive (24%); 64 were
negative (70%), and the remaining six (7%) were unsure or did
not respond to the question. Of the 3 9 couples where both
members revealed their HIV status, 26 (67%) of the couples
were HIV negative, six (15%) of the couples were
sero-different, and seven of the couples (18%) were HIV
positive.
Protected sex refers, unless otherwise indicated, to the
use of condoms. One couple (2%) did not engage in oral or
anal sex, only mutual masturbation. All of the remaining
couples engaged in unprotected oral sex; all of these couples
believed that unprotected oral sex is safe or of negligible
risk. Seven couples (15%) engaged in unprotected oral sex
only, and did not engage in anal sex at all (Risk Group 0).
Sixteen couples (38%) engaged in unprotected oral sex but
protected anal sex (Risk Group 1). The remaining 22 couples
(48%) engaged in both unprotected oral and unprotected anal
sex (Risk Group 2).
8
Materials
Participants completed an anonymous survey which
assessed the couples' sexual behavior as described above.
Open-ended questions probed for the reasons why the
participants engaged in given sexual behaviors. In addition
to demographic questions, participants were asked to respond
to a series of questions assessing attitudes toward one's
current relationship and relationships in general.
Part 1 - Open-Ended Questions. After the participant
categorized his sexual behavior into one of the categories
described above, the survey directed the participant to a
page of open-ended questions that were appropriate given the
participant's reported sexual behavior. This section
assessed the participant's justifications for and beliefs
about his sexual behavior within the relationship. To
address this, the participant responded to open-ended
questions which asked the participant 1) to recount the first
time he engaged (with his partner) in the sexual behavior
that he currently practices with his partner 2) to answer
why they either engaged in protected or unprotected sex on
that occasion and on subsequent occasions, 3) to describe
what that behavior signifies to him and says about the
relationship, and 4) to explain what it would mean to him if
his partner wanted to change sexual behavior (i.e., change
from unprotected to protected sex or from protected to
unprotected sex). The following are examples of the
9
questions used in the current set of analyses. "Think back
to the first time you had (un)protected sex with your
partner. Please take us through the sequence of events that
led you to have {un)protected sex. Please describe what
happened." "Please specify the reasons why you and your
partner decided to have (un)protected sex." "Why have you
and your partner continued to have (un)protected sex?" "What
does having (un)protected sex mean to you? What thoughts and
feelings come to mind?" "What do you think having
(un)protected sex says about your relationship?" "Imagine
that your partner now wants to start having (un)protected
sex. What would this mean to you?" Couples that engaged in,
for example, unprotected oral sex and protected anal sex
would answer questions about both protected anal sex and
unprotected oral sex.
Coding of Open-Ended Responses. Open-ended
responses were coded in the following way. First, the
researcher went through the responses in search of recurrent
themes or types of responses. A preliminary list of
categories was compiled. During the first few weeks of
coding, codes were added and surveys already coded were
recoded to account for the new categories. During data
analysis some of these categories with similar meanings were
collapsed. (Twenty-one categories of responses were assessed
in the final data analysis.) The researcher then went
through the responses and divided them into statements
10
sufficiently small that they would correspond to single
categories; these statements were then numbered. The order
of the surveys across the 92 men was randomized with couple
identification codes removed. This was to avoid the
possibility that raters would code responses of known couple
members similarly.
Six female, heterosexual undergraduate research
assistants were recruited as raters in order to assess
interrater reliability for the coding of open-ended
responses. In addition, there was one gay male reference or
"master coder." Raters were given a list of 25 final codes
(only those codes that were used by 20% or more of the
couples were used in the final set of analyses, and they are
described in Table 1; their frequencies are recorded in Table
2), coding sheets, and copies of the open-ended question
pages from the surveys; they were blind to the hypotheses of
the study and did not view any of the demographic or other
closed-ended questions from the participants' surveys.
Cohen’s Kappas (Cohen, 1960) were run to assess interrater
reliability, and the mean Kappa comparing all of the raters
(including the master coder - the code assigned by the gay
male coder) was .9152. The Kappas ranged from a low of .8550
and a high of .9782. Interrater reliability was thus quite
high. In those cases where the codes assigned by the raters
varied for a particular statement, the code of the master
coder was used; this was justified in that the average
11
interrater reliability of the master coder was the highest of
the raters ( .94166) .
Part 2 - Closed-Ended Relationship Questions.
Participants responded to two closed-ended scales assessing
relationship attitudes. Only one of the scales was analyzed
for the purposes of this paper, and it consisted of a series
of 12 questions regarding participants’ attitudes toward
their present relationship, attitudes toward gay
relationships in general, and degree of financial dependence
on the relationship. Respondents rated their degree of
agreement with relationship attitude statements on a scale of
from (1) strongly disagree to (7) strongly agree.
Factor Analysis of Relationship Attitudes Scale.
Because the twelve questions were hypothesized to be tapping
into three dimensions which were expected to be partially
correlated (attitudes toward current relationship, attitudes
toward gay relationships in general, and degree of dependence
upon the relationship), an oblique solution that forced a
three-factor solution was employed. This solution yielded a
conceptually coherent first factor of six items that
accounted for 23% of the variance in responses. These items
(see Table 3) were together labeled the "Healthy Relationship
Dependence and Stability Scale," because an individual's
agreement with these items would characterize him as
depending on his partner and endorsing that relationships in
general should be stable and lasting (e.g.,"I'd be very upset
12
if my relationship ended." "In general, I depend a lot on my
partner.") These items had an alpha reliability of .7345.
Because the distribution of scores on this scale was
significantly positively skewed, a "reflex and logarithmic
transformation" was used as recommended by Tabachnick and
Fidell (1983); this remedied the problem. This transformed
scale was used in later conparisons. Factor 2 contained
three items that assessed the participant's attitude about
the stability of gay relationships in general (See Table 3).
Factor 2 accounted for 15% of the variance in responses; it
had a low alpha reliability (.5953), and it was therefore
dropped from further analyses. Factor 3, which assessed
financial and negative dependency on the relationship,
accounted for 13% of the variance in responses; it had an
even lower alpha reliability (.2898), and thus it too was
dropped from further analyses.
Procedure
As aforementioned, couples were recruited together to
corrplete the surveys. As each member of the couple completed
a separate survey, they were not allowed to converse.
Participants were assured that their responses would remain
anonymous and confidential. Upon completing them,
participants placed their surveys into envelopes and were
paid. The survey took, on average, between 20 and 40 minutes
to complete.
13
Results
Overview. The results section is divided into three
main sections. The first section examines differences in
reasons given for safer sex behaviors versus reasons given
for riskier sexual behaviors. This first section is
subsequently divided into smaller sub-sections addressing
specific behavioral comparisons. The second section details
differences in the meanings ascribed to a partner's
hypothetical request to change from protected to unprotected
sex versus the meanings ascribed to a partner's hypothetical
request to change from unprotected to protected sex. The
third section examines sexual behavior as a function of
healthy relationship dependence and stability.
Riskv Versus Safer Sex. The open-ended questions probed
for the reasons why couples engage in particular sexual
behaviors, what such behaviors mean to them, and what they
believe those behaviors say about their relationships.
Answers were coded as described above. The reasons and
meanings of sexual behavior given by participants in response
to the open-ended questions were collapsed within couples.
This was done in light of the fact that members of a couple
often did not discuss the same behaviors. For example, if a
couple had unprotected oral sex and protected anal sex,
sometimes one partner would discuss the reasons for having
protected anal sex while the other partner would talk about
the reasons for having unprotected oral sex. To get a
14
complete description of a couple's behavior, it was therefore
necessary to combine the answers of each member of a couple
and treat the couple as a single unit in order to make
meaningful comparisons between couples. Assumptions of
parametric statistics, specifically normal distributions of
variables and equal variances between groups were not met
unless otherwise specified; non-parametric statistics were
therefore used.
To address our hypotheses, a series of comparisons were
made such that couples 1 reasons given for a riskier sexual
behavior were compared with couples 1 reasons given for a
safer (or less risky) sexual behavior. Comparisons were
therefore made between unprotected oral sex (less risky) and
unprotected anal sex (risky), protected anal sex (less risky)
and unprotected oral sex (riskier), and protected anal (less
risky) and unprotected anal sex (risky).
Chi-square tests were performed comparing the reasons
and meanings given for different sexual behaviors as a
function of couple risk group (Risk Group 0 - unprotected
oral sex, no anal sex; Risk Group 1 - unprotected oral sex,
protected anal sex; and Risk Group 2 - unprotected anal sex).
As will become clear when the behavioral comparisons are
subsequently examined, couples needed to clearly fit into one
of these risk groups in order for the behavioral comparisons
between couples to be meaningful. Three couples were not
retained for analysis, because they did not fit within one of
15
the three risk groups. One couple, as mentioned earlier,
only engaged in mutual masturbation, and therefore did not
fit in with the other members of Risk Group 0 who all engaged
in unprotected oral sex. The other two excluded couples
sometimes engaged in protected anal sex and sometimes engaged
in unprotected anal sex; they were therefore not clearly
members of Risk Group 1 or Risk Group 2. Therefore, 43
couples remained for analysis; seven in Risk Group 0 (16%),
16 in Risk Group 1 (37%), and 20 in Risk Group 2 (47%) .
Although comparisons of reasons given for sexual behavior as
a function of sero-status of the couple and fidelity status
of the couple are not reported here, sero-status and fidelity
were found to be unrelated to the risk group status of the
couple.
Unprotected Oral Sex Versus Unprotected Anal Sex.
Reasons for having unprotected sex were compared as a
function of Risk Group (See Table 4). Couples in Risk Groups
0 and 1 were collapsed into one group, because unprotected
sex for them meant having unprotected oral sex. They were
compared with couples in Risk Group 2 who had unprotected
anal sex. Therefore, couples reasons for and meanings
ascribed to having unprotected oral sex (less risky) were
compared with couples' reasons and meanings for having
unprotected anal sex (risky). Four couples who engaged in
unprotected oral sex did not answer questions regarding that
behavior; as a result, 19 couples remained in the unprotected
16
oral sex group and 20 couples were in the unprotected anal
sex group.
As predicted by Hypothesis 1, those having unprotected
anal sex (risky) were more likely to cite love, trust, and
commitment (relationship reasons) as a justification or
meaning for their behavior than were those having unprotected
oral sex (less risky) x2^> M ~ 39) = 5.06847, p = .02436.
Couples having unprotected anal sex (risky) were also
more likely to cite Reason 6 (monogamy) as a reason for their
sexual behavior than were couples having unprotected oral sex
(less risky) x2(i* ^ = 39) = 7.70457, p = .00551. Were those
who cited monogamy as a justification for unprotected oral or
anal sex in the open-ended questions actually monogamous? In
a closed-ended question answered after the open-ended
questions, participants were asked if they had ever had sex
outside of the relationship during the course of the
relationship, and, if so, did their partner know about it.
Surprisingly, 14 of the 28 people (50%) who cited monogamy as
a rationalization for having unprotected sex in the
open-ended section actually reported having sex outside of
the relationship when asked in the closed-ended question. Of
course, the people who cited monogamy in the open-ended
questions and had sex outside of the relationship could have
meant that currently they are being monogamous in their
relationship, but of these 14 people who had sex outside of
17
the relationship while claiming monogamy on the open-ended
questions, four had partners who did not know about the
infidelity. In one reported case, an HIV negative, faithful
partner was potentially exposed to HIV by his partner who was
having unprotected sex outside of the relationship and lying
about it.
Unprotected Oral Sex Versus Protected Anal Sex
(Within Couples Comparisons). Another way to ascertain if
gay couples give different reasons when they engage in risky
versus less risky sex, is to compare within couple responses
to behaviors that differ in risk level. As mentioned
earlier, 16 couples engaged in protected anal sex but
unprotected oral sex. Four of these couples answered
open-ended questions relating either to the protected anal
sex or the unprotected oral sex, but did not answer questions
about both behaviors; 12 of the couples answered questions
regarding both protected anal and unprotected oral sex, and
these 12 couples were retained for the following analyses.
Of interest were the differences in reasons given for having
unprotected oral sex (risky) on the one hand but protected
anal sex (less risky) on the other hand (see Table 5).
As predicted by Hypothesis 1 relationship reasons (love,
trust, and commitment) were cited more frequently in defense
of unprotected oral sex (the more risky behavior) than for
protected anal sex (the less risky behavior) x2d< M = 24) =
4.33182, e = .03741.
18
As predicted by Hypothesis 4, fear of AIDS was used more
frequently in reference to protected anal sex (less risky)
than unprotected oral sex (more risky) U = 24) =
15 .406675, p = .00009.
The following other reasons were offered for protected
anal sex (less risky) significantly more frequently than
unprotected oral sex (risky): Reason 11 (means taking care of
self and partner) x2 (1< LI - 24) = 8.26288, p = .00405; Reason
13 (We had only been together a short while < 1 month) x2 (1 - N
=24) = 4.58893, p = .03218; Reason 16 (One or both partners
is/are HIV+) x2 <1 - LI = 24) = 4.58893, p = .03218; and Reason
19 (Sexual Script) J C 2(1, N = 24) = 3.80738, p = .05. All of
the following additional reasons or meanings were offered
significantly more frequently for unprotected oral sex
(risky) than protected anal sex (less risky): Reason 7 (Oral
Sex is Safe), x2(l, M = 24) = 6.51147, p = .01072; Reason 15
(We only have unprotected sex sort of) x2(l, U = 24) =
6.35060, p = .01173; and Reason 2 (Sensation Concerns) x2 (1 > LI
= 24) = 3.80738, p = .05.
Protected Anal Sex Versus Unprotected Anal Sex.
Frequencies of different reasons given for having protected
anal sex and reasons for having unprotected anal sex were
compared using chi-square comparisons. Couples who had
protected anal sex were compared with couples who had
unprotected anal sex. As mentioned earlier, couples who
19
switched on and off in using protection for anal sex were
removed from the sample (two couples). (See Table 6)
In support of Hypothesis 1, unprotected anal sex (risky)
was defended with relationship reasons (love, trust, and
commitment) more frequently than protected anal sex (less
risky) x2 < 1 - = 36) - 15.20524, p = .00010
In support of Hypothesis 4, couples who engaged in
protected anal sex (less risky) were more likely to report
fear of AIDS as a justification for their behavior than were
couples who engaged in unprotected anal sex (risky) x2d< H -
36) = 25.5169, p = .00000.
Couples who engaged in protected anal sex (less risky)
were more likely to report the following reasons for their
sexual behavior than were couples who engaged in unprotected
anal sex (risky): means taking care of self and partner
(Reason 11) x2{l< H = 36) = 6.35683, p = .01169; and our
sexual behavior is just what we do (Reason 19) x2 (1< N = 36) =
5.5 5476, p = .01843. Those engaging in unprotected anal sex
(risky) reported the following reasons more frequently than
did couples having protected anal sex (less risky): sensation
concerns (Reason 2) x2 (1 < M = 36) = 12.69015, p =.00037; one
or both partner(s) is(are) HIV negative (Reason 4) x2 (1 - M =
36) = 6.04649, p = .01393; discussed sexual histories (Reason
5) X2<1, U - 36) = 4.75965, p = .02913; monogamy (Reason 6)
X2 ( l , M = 36) = 23.67932, p = .00000; convenience reasons
20
(Reason 9) x2 (1, £J = 36) = 7.47730, £ = .00625; relationship
length greater than one month (Reason 10), x2d< fcl = 36) =
4.75965, £ = .02913; we only kind of have unprotected sex
(Reason 15) x2 (1 > N = 36) = 5.09981 , £ = .02393; recognizes
risk (Reason 17) X2 (1« N = 36) = 6.53897, p = .01055. Taking
care of self and partner and relationship reasons were each
cited 38% of the time as a justification for protected anal
sex. Were those who cited "means taking care of self and
partner" the same couples as those who cited relationship
reasons? For the most part they were not. Of the nine
couples who cited one or the other of these reasons for
engaging in protected anal sex only three cited both reasons.
Total Number of Responses for Risky Versus Safer
Sex. Hypothesis 2 was supported; relationship reasons were
the most frequently cited rationale for engaging in riskier
sex. Eighty-two percent of couples engaging in unprotected
sex cited relationship reasons as a rationale for doing so.
Hypothesis 3 was also supported; fear of AIDS was the most
frequently cited reason for engaging in safer sex. Ninety-
five percent of couples engaging in protected sex cited fear
of AIDS as a rationale for doing so.
To test Hypothesis 5 that having riskier sex would be
justified with a greater number of responses than safer sex,
a series of three comparisons were made: 1) the mean number
of rationales for unprotected oral sex (less risky) was
compared with the mean number of responses for unprotected
21
anal sex (risky); 2) the mean number of rationales for
protected anal sex (less risky) was compared with the mean
number of responses for unprotected oral sex (riskier); 3)
the mean number of rationales for protected anal sex (less
risky) was compared with the mean number of responses for
unprotected anal sex (risky). The groups used in the
following comparisons were the same as those used in the
previously described comparisons made as a function of risk
group. Assumptions of parametric statistics were met so t-
tests were used to compare these groups. A two-tail
independent t-test showed that the mean number of
justifications couples gave for unprotected anal sex (risky)
(H = 19.75, = 6.568) was greater than the mean number of
justifications couples gave for unprotected oral sex (less
risky) (£J = 10.9474, = 5.421) , £(37) = 4.57, p = .000.
A two-tail independent t-test indicated that the mean number
of justifications couples gave for unprotected anal sex
(risky) (U = 19.75, £I> = 6.568) was greater than the mean
number of justifications couples gave for protected anal sex
(less risky) (£J = 8.875, ££> = 4.530) , £(34) = 5.63, p =
.000. A two-tail paired t-test indicated that the mean
number of justifications couples gave for unprotected oral
sex (risky) (tJ = 9.1667, = 4.648) was no greater than the
mean number of justifications couples gave for protected anal
sex (less risky) (U = 8.1667, = 4.914), £(11) = .46, p =
22
.652. Thus, Hypothesis 5 was supported by two out of three
of the comparisons.
Comparisons of Responses to Hypothetical Change to
Protected Sex Versus Hypothetical Change to Unprotected Sex.
Couples were asked "Imagine that your partner now wants to
start having protected sex. What would this mean to you?"
and/or "Imagine that your partner now wants to start having
unprotected sex. What would this mean to you?" Responses to
a hypothetical change to unprotected sex (riskier sex) were
compared with responses to a hypothetical change to protected
sex (less risky sex). Hypothetical unprotected sex referred
to unprotected anal sex since all couples used in the
analysis were already having unprotected oral sex.
Hypothetical protected sex included protected oral sex,
protected anal sex, and mutual masturbation depending on the
type of behavior the couple was currently engaging in. The
reason that these protected sex behaviors were collapsed into
one category was that the question was essentially asking
"suppose your partner now wants to be less risky sexually"
(change to protected sex) the lowering of risk is the
essence of the question rather than the specific behavior.
Fifteen of the couples responded to both questions (i.e., a
hypothetical change to protected sex and a hypothetical
change to unprotected sex), because they engaged in mixed
behaviors such as having unprotected oral sex and protected
anal sex. Three couples responded only to questions about
23
hypothetical unprotected sex, and 2 5 of the couples answered
only the hypothetical protected sex question. In order to
keep comparisons as strictly within or between couples and to
maximize the number of couples that could be used for this
comparison, the fifteen couples that answered both questions
were retained for analysis. Therefore, the comparison of
meanings ascribed to a hypothetical change to protected
(safer) sex versus a hypothetical change to unprotected
(riskier) sex was a within-subjects (couples) comparison.
The following provided support for Hypothesis 6 that a
hypothetical change to protected sex would arouse suspicion
of infidelity more often than a hypothetical change to
unprotected sex would arouse such suspicion. Suspicion of
infidelity was more likely in response to a hypothetical
change to protected sex (less risky), 33%, than in response
to a hypothetical change to unprotected sex (risky), 7%, x~(l,
H = 30) = 3.58082, p = .058.
Healthy Relationship Dependence and Stability Scale. In
support of Hypothesis 7, the healthy relationship dependence
and stability scale correlated significantly with riskiness
of sexual behavior (defined as low risk - not engaging in
unprotected anal sex, and high risk - engaging in unprotected
anal sex) (p = .3346, p = .006) for all participants.
Because participants belonged to couples, the issue of
dependency of responses was recognized; therefore, couples
were split randomly into two groups. Separate correlations
24
for each group were then run between riskiness of sexual
behavior and relationship stability: group 1 (p = .3797, p =
.029) and group 2 (p = .2937, p = .097).
Discussion
All seven hypotheses were supported. In summary, the
following was found: 1) In comparison to safer sex, riskier
sex was more frequently associated with love, trust, and
commitment. 2) Relationship reasons were the most frequently
cited of all rationales for engaging in risky sex. 3) Fear
of AIDS was the most frequently cited justification for
engaging in safer sex. 4) Fear of AIDS was mentioned more
frequently regarding safer sex than regarding risky sex.
{Note: Although other rationalizations were also used by
couples, fear of AIDS and relationship reasons were by far
the most frequently cited; therefore, because they were the
most important reasons to the subjects, they will be the
focus of the following discussion.) 5) A smaller number of
rationales was generated for safer sex than for riskier sex.
6) A proposed change from riskier to safer sex aroused
suspicion of infidelity. 7) Those who had a healthy
dependence on their relationship and viewed their
relationship as stable (as measured by a closed-ended
relationship attitudes measure) took greater risks sexually
within the relationship.
25
Trust, Risk, and Commitment: Deadly Trio?
Feelings of love, trust, and commitment were
consistently found to be associated with risky sexual
behaviors. This is a cruel irony in that the positive
ingredients of a successful relationship on the one hand
(i.e., love, trust, and commitment) are also predictive of
behaviors which may lead to death on the other hand. Why
might this paradox exist? One possibility, as Rempel,
Holmes, and Zanna (1985) point out, is that taking risks
within a relationship is part of building trust and a closer,
deeper relationship. The ultimate risk in a gay male
relationship today is having risky sex. Although Rempel and
his colleagues did not conceptualize risky sex as one of the
risks which might be taken to build trust and subsequently
closeness in a relationship, risky sexual behaviors may very
well symbolize evidence of trust, love, and commitment in gay
couples. This argument suggests that taking risks leads to
trust, love, and commitment, but a second possibility, as
articulated by Pilkington, Kern, and Indest (1994), is that
as trust develops, concern about AIDS diminishes and sex
becomes riskier. This might occur because trust in one's
partner "... may be overgeneralized such that the
individual trusts the partner not to give him . . . AIDS."
(Pilkington et al., 1994, p. 209). A third possibility also
suggested by Pilkington and her colleagues is the notion of a
halo effect. Those who feel positively (i.e., loving and
26
trusting) about their partners may assume that their partners
are "good" in general and in turn free of disease.
Not only did the notion of having safer sex fail to
bring forth positive relationship feelings, a request from
one's partner to switch to safer sex practices had negative
connotations such as the possibility that infidelity had
occurred. Put another way, a move by one's partner to
initiate safer sex may undermine one's trust in one's
partner. This presents a problem for HIV prevention efforts.
If love and trust for one's partner are associated with
riskier sex and negative connotations surround safer sex, the
popular safer sex message of "using a condom shows that you
care about your partner" is likely to ring hollow with many
gay men. The message assumes that caring and love are
associated with not taking chances and "playing it safe," but
this was not the meaning that couples in the present study
ascribed to safer sex. Perhaps, however, the message that
"using a condom shows that you care about your partner" is
not the same as "using a condom shows love, trust, and
commitment."
This possibility is addressed through closer examination
of the rationales given for unprotected anal sex (risky)
versus protected anal sex (safer). Note that over a third of
the couples engaging in protected anal sex cited relationship
reasons (love, trust, and commitment) as reasons for using
condoms; in addition, an identical percentage of the couples
27
who engaged in protected anal sex said "it means taking care
of self and partner." Were couples who used relationship
reasons the same couples that cited taking care of self and
partner? For the most part, they were not! This suggests
that "taking care of self and partner" is not the same
rationale as loving, trusting, and being committed to one's
partner. The safer sex message of "using a condom shows that
you care about your partner" may be more equivalent to
"taking care of self and partner." Therefore, the current
safer sex message might be effective for some in promoting
safer sex behavior (i.e., the 38% of couples using condoms
who cited taking care of self and partner). However, this
message is not as universal as the belief that having risky
sex shows love, trust, and commitment which was cited by 95%
of the couples having unprotected anal sex.
How can HIV interventions incorporate these findings to
yield a more effective HIV prevention program? Interventions
might emphasize that with feelings of love, trust, and
commitment come responsibilities, and that the most important
responsibility is keeping oneself and one's partner HIV
negative. Many couples may respond that they have been
tested for HIV, but they must be informed that HIV antibody
tests can produce false negative test results (Saah,
Farzadegan, Fox, Nishanian, Rinaldo, Phair, Fahey, Lee, &
Polk, 1987), and incubation periods of the virus are variable
(Munoz, Kirby, He, Margolick, Visscher, Rinaldo, Kaslow &
28
Phair, 1995) which may allow one partner to be asymptomatic
and to unwittingly infect his partner. The high incidence of
infidelity of men in gay relationships, ranging for 62%
(current work) to 73% (Peplau and Cochran, 1988), must also
be emphasized in interventions. Of course, the appeal to
protect yourself and your partner will not be successful if
individuals do not have a clear conception of what they are
protecting themselves from (i.e., the terrible consequences
of HIV). Such an understanding of the horror of AIDS is
necessary to foster a fear of AIDS. Fear of AIDS, in turn,
may be necessary, if not sufficient, to motivate safer sex
behavior.
Fear of AIDS
Past research has indicated that fear of AIDS may
promote safer sex practices (Rhodes & Wolitski, 1990), and
that many of those who engage in safer sex practices are
motivated by fear of AIDS (Gielen, Faden, O ’ Campo, Kass, &
Anderson, 1994). In the present study, fear of AIDS was cited
95% of the time in reference to protected sex but only 13% of
the time in reference to unprotected sex. Fear of AIDS,
therefore, rather consistently predicted safer sex behavior
in this sample. Fear appeals might therefore be expected to
be successful in promoting safer sex behavior.
However, one must be careful when using fear to affect
behavior change. The level of fear that is instilled is
important, because if too much fear is aroused it may cause
29
anxiety and a subsequent denial of the message which caused
the discomfort (Chu, 1966). To be most effective, fear
appeals should be paired with messages that promote feelings
of self-efficacy (Maddux & Rogers, 1983). Put another way,
individuals must believe that they are capable of responding
in a way to avoid the feared consequence. Tanner, Day, and
Crask (1989) found that safer sex brochures which contained
fear appeals paired with high self-efficacy information were
more effective than brochures containing fear appeals with
little self-efficacy information. An HIV intervention that
provides individuals with a mental model for how to reduce
their risk of HIV infection (i.e., instills high self-
efficacy) in light of the aforementioned obstacles to
lowering risk of HIV (e.g., infidelity and imprecise HIV
antibody testing), would be expected to be effective. An
approach known as "negotiated safety" may therefore hold
promise.
Negotiated Safstv
Negotiated safety, an approach to HIV intervention
widely used in Australia (Sadownick, 1995), encourages
individuals with the same sero-status to form couples.
Couples use condoms during the first several months of the
relationship, and repeated HIV testing is administered during
this time. If both partners are negative after this repeated
testing, they can start having unprotected sex if they
promise each other they will avoid anal sex outside of the
30
relationship. If unsafe sex occurs outside of the
relationship, it is okay as long as one's partner is told
immediately and the two resume condom use. Repeated testing
can allow them to do away with condoms once again later on.
This approach is promising for three reasons. First, it
may increase couples' feelings of self-efficacy because it
gives them a plan for how to deal with infidelity.
Negotiated safety recognizes that infidelity is particularly
common for gay male couples, and it teaches gay couples an
approach for dealing with such a situation that minimizes the
risk of exposing either partner to HIV. Other interventions
have stressed monogamy and not given couples a system for
dealing with infidelity. As a result, some gay men, although
fearful of AIDS, may have felt that there was nothing they
could do about the unknown risk of HIV from their partner.
Instead, they may have chosen to engage in denial about the
risks because the cognitive dissonance was too overwhelming.
Such denial may have manifested itself in gay male couples in
their practice of very risky sex, for gay men in
relationships are the most likely to engage in the riskiest
forms of unprotected sex (Coxon, Coxon, Weatherburn, Hunt,
Hickson, Davies, & McManus 1993; King, 1993). The second
advantage to "negotiated safety" is that it recognizes the
need of gay couples to engage in unprotected sex to express
love, trust, and commitment, and provides a lower-risk model
for gay men to do so. That is, a series of HIV tests over a
31
six month period should reveal HIV positivity, and if both
partners test negative and do not have unsafe sex outside of
the relationship they should be relatively safe with respect
to HIV. The third advantage of "negotiated safety" is that
by keeping the topic of HIV salient, fear of AIDS should also
remain salient in the couples' minds. Since this fear is
paired with strategies to lower risk of HIV infection (i.e.,
boosting feelings of self-efficacy), it should be effective
in reducing high-risk sexual behavior.
Of course, this approach assumes that the couples will
be honest with one another, and the present study indicates
that 12% of men who had sex outside of the relationship had
not informed their partners. However, if safer sex education
targeted towards gay male couples discusses the reality of
infidelity, recognizes the need for gay men to have
unprotected sex to express love and intimacy, and puts forth
a model for how to deal with these conflicting goals, it
might very well succeed in keeping partners honest with one
another, sexually satisfied in the relationship, and safer
with regard to HIV infection.
Conclusion
In the current study, only 21% of couples were
completely monogamous (i.e., both partners reported being
faithful); only 30% of those who had sex outside of the
relationship consistently used condoms, and 16% of partners
who had sex outside of the relationship had not informed
32
their partners about their infidelity. In light of these
statistics, the fact that HIV testing is inexact, and the
fact that incubation periods for HIV are variable, couples
who can maintain safer sex practices indefinitely should be
encouraged to do so. However, there is evidence that safer
sex guidelines have failed some men because the task of
maintaining the use of condoms indefinitely is too difficult
and they engage in "slip-ups" or random acts of unprotected
sex {Sadownick, 1995). Educating men that unprotected sex is
a possibility in a relationship {i.e., in a "negotiated
safety" situation), may discourage some men from engaging in
random acts of unprotected sex outside of the relationship
that may be more risky than unprotected sex acts practiced
within their primary relationship.
Another unresolved issue is the risk of unprotected oral
sex. Some believe that unprotected oral sex is not a major
concern in the transmission of AIDS {e.g., Rosser, 1991)
while others (Samuel, Mohr, Speed, & Winkelstein, 1992)
suggest that although the risk is small (i.e., a per partner
infectivity of oral receptive intercourse of around 1%),
information about the risk should be incorporated into HIV
education materials. All but one couple in the current study
engaged in unprotected oral sex, and the general belief among
couples was that unprotected oral sex is not risky. The
issue of unprotected oral sex is complicated. On the one
hand, if it poses a significant risk, it should be
33
discouraged. On the other hand, if all forms of unprotected
sex are discouraged, some individuals may find such
guidelines so restrictive that they give up and decide to
forego all condom use. In such a scenario, unprotected anal
sex, which is definitely very risky, might increase.
No matter what form of safer sex education is used, the
horror of AIDS must be emphasized, because, as
aforementioned, fear of AIDS was the most consistent
motivator for using condoms that was found in this study.
There is evidence that in younger gay men, rates of protected
sex may be down and resultant HIV sero-conversion may be on
the rise because this group is not familiar enough with AIDS
(Boxall, 1995). Because of the long incubation period, young
gay men do not know men in their peer group with AIDS and a
fear of AIDS has not yet been created; this may be a strong
reason why they engage in high risk sexual behavior. HIV
education must stress the possibility of AIDS infection at
all ages, and particularly stress this and the unnerving
details of the disease to young gay men who are less familiar
with the disease. This may be the only way to instill the
fear of AIDS that seems necessary to promote safer sex.
This study provides insight into how risky and safer sex
practices are viewed by men in gay male couples. Safer sex
is motivated primarily by fear of AIDS. Risky sex is viewed
as a sign of love, trust, and commitment, while moves to
initiate safer sex are viewed with suspicion. One may
34
conceptualize these meanings associated with safer and risky
sexual behaviors in terms of goals. For example, engaging in
risky sex might satisfy the emotional goal of showing love
for one’s partner. Goals associated with different sexual
behaviors may often be in conflict (Miller, Bettencourt,
DeBro, & Hoffman, 1993) . For example, one may have the goal
of avoiding HIV infection which should lead to engaging only
in safer sex practices. However, at the same time, one may
have the goal of showing one's partner trust, love, and
commitment by engaging in risky sex. How might such
conflicting goals be addressed in HIV interventions? At
first thought, the task seems insurmountable. There are
countless individual differences in goals associated with and
meanings ascribed to different sexual behaviors. How can an
HIV intervention program meet the individualized needs of
everyone? One possible solution is the use of innovative
technologies such as interactive video. With interactive
video, messages that are customized to the computer user can
be generated based upon the computer user1s responses to
questions and/or situations. For example, the computer might
generate questions about the meanings the user ascribes to
different sexual behaviors and the goals that different
sexual behaviors satisfy for the computer user. A customized
HIV intervention could then be delivered based upon the
responses given.
35
Although the current work provides useful insights,
further research into the meanings and goals ascribed to
sexual behavior by gay men (both singles and couples) and
others must be conducted. Through an understanding of the
intricate web of conflicting goals and meanings that
individuals ascribe to different sexual behaviors, new and
innovative interventions may be designed to affect behavior
change and curb the spread of HIV.
36
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39
Table 1
Reasons biven ror ana neanrnas nscrioea co sexuar uenavior
General Description
of Reason or Meaning
Given for Sexual
Behavior
Examples of
Statements
Reason or Meaning
1) Fear of AIDS
2) Sensation Concerns
3) Relationship Reasons
4) One or both tested HIV
negative
5)Discussed sexual
histories
6) Monogamy
7) Oral sex is safe
9) Convenience Reasons
10) Been together for a
while > 1 month
"I'm afraid of getting AIDS."
"(Un)protected sex more
pleasurable, feels better."
“Shows love/trust/commitment."
"We tested negative so we have
(un)protected sex."
"We discussed our sexual
histories and decided it was
best to use protection."
"Neither one of us slept around
much so we did not use
protection."
“Monogamy is. our safer sex."
"Oral sex without a condom is
not risky."
"We got carried away in the heat
of passion."
"We had been dating for over a
month, so we felt that the time
had come to do away with
condoms." "We had known each
other for a while but still felt
we should use condoms."
11) Means taking care of "Using condoms shows that we
self and partner. look out for each other's
health."
40
Table 1 (Continued)
General Description Examples of Reason or Meaning
of Reason or Meaning Statements
Given for Sexual
Behavior
13) We had been together
less than one month.
14) I felt safe/low risk.
(Excludes reasons 7, 10,
i 13)
15) We only have
unprotected sex kind of
16) One or both HIV+
17) Recognizes riskiness
of sexual behavior.
"We had been out on a few dates,
and I felt I knew him well
enough to not use protection."
"We had known each other for
only a short time, and felt it
was best to use protection."
"I just felt safe with my
partner so we did not use
protection." "I felt safer
using protection.”
"We have unprotected oral or
anal sex, but itty partner does
not ejaculate inside of me."
"My partner is HIV+, and I am
not so we use protection." "We
are both HIV+ so we do not use
protection."
"I know what we do is risky,
but I choose to take the risk."
18) Communication about
sex.
"We talked about sex." "We set
our boundaries in advance."
19) Part of sexual script
or schema.
22) Does not fit any of
the specified codes.
23) I would wonder why/
be suspicious.
24) Fidelity issues.
"That's just what we do." "Using
condoms is automatic."
Any statement that was given
less than three times.
"I would be curious as to why."
"I would think that maybe
something was wrong."
"I would think that maybe my
partner had cheated on me." "I
would think that maybe my partner
suspects me of cheating."
41
Table 1 (Continued)
General Description
of Reason or Meaning
Given for Sexual
Behavior
Examples of Reason or Meaning
Statements
25) Alcohol or drugs
involved.
"We had too much to drink and
had (un)protected sex."
Note. Except for codes 6, 23, & 24, all codes refer to
protected or unprotected sex depending upon the context.
Code 6 was only used in defense of unprotected sex. Codes 2 3
and 24 were used in response to the hypothetical questions.
42
Table 2
Frequencies of Reasons Given for Having Unprotected Sex
Versus Protected Sex.
Reason or Meaning Protected Unprotected
I) Fear of AIDS 95% 13%
2} Sensation Concerns 5% 51%
3) Relationship Reasons 32% 82%
4) One or both HIV- 11% 51%
5) Discussed Sexual Histories 5% 31%
6) Monogamy - 49%
7) Oral Sex is Safe 11% 41%
9) Convenience Reasons 21% 62%
10) Been together > 1 month 11% 28%
II) Means taking care of self 3 7% 5%
and partner
13) Been together < 1 month 21% 15%
14) Felt safe/ low risk 37% 69%
15) Have unprotected sex kind of 5% 28%
16) One or both HIV+ 26% 8%
17) Recognizes risk of behavior 16% 51%
18) Communication about sex 26% 28%
19) Part of Sexual Script 37% 8%
22) Does not fit any specified 68% 62%
codes
23) Would wonder why/be suspicious 35% 6%
43
Table 2 (Continued)
Reason or Meaning Protected Unprotected
24) Fidelity concerns 55% 6%
25) Alcohol or Drugs involved 11% 21%
Note. Statistical comparisons were not made between frequency
of reasons given for protected sex in general versus
unprotected sex in general. There were two reasons for this.
1) Protected sex included both protected anal sex and mutual
masturbation and unprotected sex included both unprotected
oral and unprotected anal sex. In order to make more precise
comparisons of behavior, comparisons of frequency of reasons
were made between specific behaviors such as between
protected anal sex versus unprotected anal sex. 2) Not every
couple engaged in every behavior, and some couples engaged in
more than one behavior. In order for comparisons of
frequencies of rationales to be either strictly between
couples or within couples, comparisons had to be made of
specific unprotected and protected sex behaviors.
44
Table 3
Factor Analysis of Relationship Items
Item Factor 1:
Healthy
Relationship
Dependence
and
Stability
Factor 2:
Stability
of Gay
Relationships
Factor 3:
Negative
and
Financial
Dependency
1) I'd be very
upset if my
relat ionship
ended.
. 82116
2) I get a lot
of things I need
from my
relationship.
. 75199
3) My partner
provides me with
a great deal of
emotional support.
.71341 - .3748
4) In general, I
depend a lot on my
partner.
. 66823
5) I want a
relationship that
will last a
lifetime.
. 53179 .49591
6) I believe that
a good relationship
should be monogamous.
.36645
7) in general, I . 87598
think it is
difficult for gay
men to maintain
a long-term committed
relationship.
45
Table 3 (Continued)
I tern Factor 1:
Healthy
Relationship
Dependence
and
Stability
Factor 2:
Stability
of Gay
Relationships
Factor 3:
Negative
and
Financial
Dependency
8) It is rare for gay
men to maintain long
term committed
relationships.
.66783
9) I have f ound i t
difficult to
maintain long-term
committed
relationships with
other men.
. 62812
10) My partner gets
angry if I try to
have my way.
.71340
11) I depend on my
partner to pay the
bills.
. 52408
12) I usually let
my partner have his
way.
.42142
46
Table 4
Riskv Versus Riskv Sex
Reason or Meaning Unprotected Oral
Sex (Less Risky)
Unprotected Anal
Sex (Risky)
Relationship Reasons
(3)
68%d 95%b
Monogamy (6) 26%^ 7 0%b
Oral Sex is Safe (7) 63 %a
20%b
One or both partners
HIV+ (16)
0%a 15%b
Mote. Differently lettered percentages across sexual behavior
are significantly different from one another (x2, £2 < .05)
47
Table 5
Within-Couple Comparisons of Rationales: Percentages for Less
Riskv versus Riskier Sex
Reason or Meaning Protected Anal
Sex (Less Risky)
Unprotected Oral
Sex (Riskier)
Fear of AIDS (1)
Sensation Concerns (2)
Relationship
Reasons (3)
Oral Sex is Safe (7)
Means Taking Care of
Self and Partner (11)
Were only together a
short while < 1
month (13)
Only have unprotected
sex kind of (15)
One or both partners
is/are HIV+ (16)
Part of sexual
script (19)
92%d
8%d
25%d
17%a
42%a
25%a
0%a
25%a
42%a
17 %b
42%t>
67%b
67%b
0%b
0%b
33%b
0%b
8%b
Note. Differently lettered percentages across sexual behavior
are significantly different from one another (x2,D S -05)
48
Table 6
t'ercentaae or LOUDies usincr various Reasons co txoiain Less
Riskv Versus Riskv Sex
Reason or Meaning Protected
Sex (Less
Anal
Risky >
Unprotected Anal
Sex (Risky)
Fear of AIDS (1} 94%a 15%b
Sensation Concerns {2) 6%a 60%b
Relationship
Reasons (3)
38%a 95%b
One or both tested
HIV negative (4)
13%a 50%b
Discussed sexual
histories (5)
6%a 35%b
Monogamy (6) 0%a 70%b
Convenience reasons (9) 2 5 %a
7 0%b
Been together for
a while > 1 month (10)
6%a 3 5%b
Means Taking Care of
Self and Partner (11)
38%a 5%b
Only have unprotected
sex kind of (15)
0%a 20%b
Recognizes riskiness of
sexual behavior (17)
19%a 60%b
Part of sexual
script (19)
44%a 10%b
Mote. Differently lettered percentages across sexual behavior
are significantly different from one another (x2, p < -05) .
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Asset Metadata

Creator Appleby, Paul Robert (author)

Core Title Rationalizing risk: sexual behavior of gay male couples

School Graduate School

Degree Master of Arts

Degree Program Psychology

Degree Conferral Date 1995-12

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health sciences, rehabilitation and therapy,OAI-PMH Harvest,psychology, social

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Miller, Lynn Carol (committee chair), Davison, Gerald C. (committee member), Read, Stephen J. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-7252

Unique identifier UC11357465

Identifier 1378395.pdf (filename),usctheses-c18-7252 (legacy record id)

Legacy Identifier 1378395-0.pdf

Dmrecord 7252

Document Type Thesis

Rights Appleby, Paul Robert

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA