Sexual agreements (SAs)—guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship—are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.

性协议 (SA)——概述允许与主要关系之外的性伴侣进行何种性行为的指南——通常在同性男性关系中进行谈判，以降低他们感染艾滋病毒的风险。然而，艾滋病毒风险不仅是性行为的函数，还受到抗逆转录病毒疗法 (ART) 依从性等因素的影响。我们检查了血清不一致的男性夫妇中的 HIV 阳性伴侣是否有更好的关于 SA 的沟通并报告与其伴侣一致的 SA 有更大的机会坚持抗逆转录病毒疗法，不仅可以改善他们的健康，还可以降低将 HIV 传播给伴侣的风险. 我们分析了来自佐治亚州亚特兰大、马萨诸塞州波士顿和芝加哥的血清不一致男性夫妇的 135 名 HIV 阳性伴侣的纵向数据，IL 检查最佳 ART 依从性与两个自变量之间的关系：关于 SA 的沟通以及夫妻是否有不一致的 SA。与报告较低水平的那些人相比，报告有关 SA 的高水平沟通的 HIV 阳性男性伴侣对 ART 的最佳依从性的几率几乎是其三倍。与具有一致 SAs 的 HIV 阳性伴侣相比，与他们的男性伴侣具有不一致 SA 的 HIV 阳性伴侣对 ART 的最佳依从性的几率约为一半。我们的研究结果表明，将沟通技巧培训纳入二元级 HIV 干预措施以改善有关 HIV 的沟通可能为夫妻提供更多机会讨论降低 HIV 传播风险的方法。夫妻可以从帮助他们撰写 SA 的干预措施中受益。