A recent Australian study found that gay couples’ agreements regarding casual sex outside their relationships have changed markedly in the era of pre-exposure prophylaxis (PrEP). Nearly 40% of PrEP users in relationships had agreements that allowed for condomless sex with casual partners. Additionally, 34% of PrEP users engaged in condomless casual sex despite being in relationships with agreements prohibiting it, and 13% of men not taking PrEP also engaged in condomless sex outside of their relationship when there was no agreement allowing for this. This research by Dr James MacGibbon and colleagues at the University of New South Wales was published in AIDS and Behavior.
“Negotiated safety” between HIV-negative men in open long-term relationships is a common practice. This refers to mitigating the risk of HIV and other STIs by partners agreeing to only have condomless sex with each other but to use condoms when having sex outside the relationship. While controversial, negotiated safety has been found to be effective when practised consistently. In Australia, the number of relationships (where both partners were HIV negative) with negotiated safety agreements decreased from almost 40% in 2008 to 29% in 2017, according to behavioural surveillance data. This has coincided with the rise of biomedical prevention, including treatment as prevention (TasP, or Undetectable = Untransmittable, U=U) and PrEP. As men now have other tools than condoms at their disposal, this may impact how men negotiate, and adhere to, safety agreements within their relationships.