Sexual minority men continue to experience higher rates of HIV infection compared with other groups in the United States. Public health programs have increasingly promoted biomedical tools like PrEP, a medication that significantly reduces the risk of HIV when taken regularly. But decisions about prevention rarely happen in isolation. They often depend on communication, trust, and power dynamics between partners.
A Diverse National Study
Participants were recruited mainly through social media and mobile dating apps commonly used by sexual minority men, along with outreach in LGBTQ+ community spaces. Eligible participants were cisgender men aged 18 to 45 who were in relationships with other men and confirmed to be HIV-negative through home testing kits.
One important feature of the sample was the high rate of consensual non-monogamy. More than half of the participants reported having agreements with their partners that allowed sex with other people outside the relationship. These agreements turned out to play a major role in shaping HIV prevention behaviors.
When researchers examined the use of PrEP, they found that violence did not directly determine whether participants were taking the medication. PrEP use actually increased over the course of the study, regardless of exposure to violence. Overall use of the medication was relatively high, with more than 60 percent reporting they had used PrEP at some point and about 40 percent currently taking it at the start of the study.
The researchers also found that men experiencing persistent violence tended to test for HIV more often. This may reflect a greater awareness of potential risk within unstable or conflict-filled relationships.
The Impact of Non-Monogamous Agreements
These agreements may encourage open communication about sexual health and risk management. Couples who acknowledge the possibility of outside partners may be more proactive about protecting themselves and each other.
Why the Findings Matter
The study highlights that HIV prevention among sexual minority men is closely tied to relationship dynamics. Intimate partner violence does not necessarily stop people from using prevention tools like PrEP, but it can influence the environment in which those decisions are made. Lower partner support and higher stigma can quietly discourage prevention behaviors.
Encouraging open communication between partners about sexual agreements and prevention strategies may also strengthen both relationship health and HIV prevention efforts. As biomedical advances continue to expand prevention options, the study suggests that addressing relationship challenges remains an essential part of protecting public health.
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