Sex,Drugs, and Love Among the Middle Aged: A Case Study of a Serodiscordant Heterosexual Couple Coping with HIV

ABSTRACT

HIV infection attributable to injection is growing, as is the incidence among heterosexual persons. Some of the people affected are over 50, and we can anticipate a growing number of older people with substance use and HIV as primary concerns. Therefore, we need to know more about the intersections of age, addictions, and HIV. This article uses narrative analysis to examine a research interview with an African-American woman and her African-American HIV-infected male partner in order to gain insight about how a middle-aged serodiscordant drug-affected couple might struggle and succeed in the face of HIV. Implications for social work, policy and research are provided.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.