Marked changes in gay men’s relationship agreements and condom use in the PrEP era

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.

Scroll to Top

During the Canada Post strike announced September 25, 2025, the following measures will be undertaken to minimize service disruption to BC-CfE clients and providers.

  • The BC-CfE Laboratory has transitioned to private courier for delivery of outgoing reports and documents. Results required urgently can be faxed upon request. (Lab Contact Information: Phone 604-806-8775; FAX 604-806-9463)
  • The BC-CfE Drug Treatment Program (DTP) will fax outgoing forms and documents to the provider’s office. (DTP Contact Information: Phone 604-806-8515; FAX 604-806-9044)
  • St. Paul’s Hospital Ambulatory Pharmacy has transitioned to private courier for delivery of medications. We recommend requesting medication at least 2 weeks in advance in case of delivery delays, particularly to rural/remote parts of BC. (Contact Information: Phone 1-800-547-3622; FAX 604-806-8675)

During the Canada Post strike, we recommend that documents be faxed or couriered to our sites, versus utilization of regular mail service

The BC-CfE Laboratory is streamlining reporting processes for certain tests in order to simplify distribution and record-keeping, and to ensure completeness of results. Beginning September 2, 2025, results for the ‘Resistance Analysis of HIV-1 Protease and Reverse Transcriptase’ (Protease-RT) and ‘HIV-1 Integrase Resistance Genotype’ tests will be combined into a single ‘HIV-1 Resistance Genotype Report’.
For more details and example reports, please click on the button below