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How Sexual Agreements Affect HIV Risk, Relationship Satisfaction

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Change Punitive Laws To Fight HIV

April 29, 2011

Punitive legal environments are seriously increasing peoples' risk of getting HIV the International HIV/AIDS Alliance is warning this World AIDS Day.

Discriminatory and punitive laws will be the focus for an audience of senior lawyers and diplomats at the first World AIDS Day Commonwealth lecture, chaired by Cherie Booth QC, in London on 30 November. The lecture will be given by Justice AP Shah who created shockwaves across the continent when he decriminalised homosexuality in Delhi, India.

"We see the problem that punitive laws and enforcement practices can cause for people who need quick and easy access to HIV treatment, care and prevention. Governments and the legal profession need to work more closely with the affected communities to address these laws and access legal services," said Alvaro Bermejo, Executive Director of International HIV/AIDS Alliance.

Women and girls, men who have sex with men, sex workers and injecting drug users as well as people who are living with HIV struggle to access the services they need because of environments where they feel judged or punished.

The World AIDS Day lecture is organised by the International HIV/AIDS Alliance and the Commonwealth HIV & AIDS Action Group and hosted by the Commonwealth Foundation.

Cherie Booth, QC commented, "The legal profession has an important role to play in providing an environment where people can come forward and be tested for HIV and cared for."

Justice AP Shah who is giving the lecture made history in India when he overturned Section 377 that criminalised consenting homosexual relationships in the capital Delhi.

"Indian society is very conservative but from the evidence presented I could see that without changing the legal framework to help men who have sex with men access good healthcare and HIV prevention services we would not successfully be able to deal with the epidemic in our country," said Justice Shah today.

HIV and AIDS is a major issue in many Commonwealth countries which have inherited outdated British laws. Over 60 per cent of people living with HIV live in Commonwealth countries.

"The Commonwealth Foundation is committed to doing all it can to help people access HIV prevention, treatment and care. This Commonwealth lecture on World AIDS Day will help more countries become familiar with the example of India, which has identified the benefits of starting to decriminalise homosexuality and abolish laws that drive HIV and AIDS underground," said Mark Collins, Director of the Commonwealth Foundation.


- World AIDS Day is an annual event and is on Wednesday 1 December 2010.

- 2.6 million people worldwide are infected with HIV every year.

- At least 20 African countries have introduced HIV specific offences since 2000.

- People living with HIV have been prosecuted for biting, spitting or scratching although the risk of HIV transmission is minimal.

Justice AP Shah

Born in Solapur, Western India, Justice Shah was formerly Chief Justice of the Delhi High Court, he has been described as 'one of the finest judges in the country' by his peers. He retired in February but during his distinguished career in the High Courts of Bombay, Madras and Delhi he ushered in reforms that mean he is hero-worshipped by the poor and disposed of India.

It is his ruling that overturned Section 377, a 150-year old British law banning gay sex between consenting adults that will be most remembered. His decision made news around the world.

He admits he hadn't expected to be the person that would legalise homosexual sex. "I didn't switch on TV channels till late in the evening because I was not sure about the reactions from various quarters. When I attended a workshop with some gay rights activists in 1997 I had categorically said to them that it would be very difficult for an Indian court to legalise homosexual sex. I didn't realise then that I would be deciding the issues one day."

Cherie Booth, QC

Booth is Cherie Blair's professional name. Called to the Bar in 1976, she became a Queens Counsel in 1995 and is a founder member of Matrix Chambers. She sits as a part-time judge and is also an accredited mediator.

As well as fighting for human rights in her professional career, Cherie Blair is an active campaigner on equality and human rights issues. She has spoken across the world on both issues and also on the need for improved work/life balance for both women and men.

International HIV/AIDS Alliance
Commonwealth HIV & AIDS Action Group
Commonwealth Foundation

How Sexual Agreements Affect HIV Risk, Relationship Satisfaction

April 02, 2011

A new study examining the relationship dynamics of gay male couples finds that couples make "sexual agreements" -- rules about whether sex with outside partners is allowed -- primarily because they want to strengthen and improve their relationship rather than for protection against HIV. Published in the journal AIDS Care, the study explores how sexual agreements affect both HIV risk and a relationship's satisfaction and quality, and contains insights for HIV prevention.

Gay couples' top reasons for establishing sexual agreements were to build trust in the relationship, promote honesty between partners and to protect the relationship, according to the study, led by Colleen Hoff, professor of sexuality studies at San Francisco State University.

"We found that gay couples are interested in building healthy, satisfying and loving relationships," Hoff said. "These desires, when nurtured, can lead to strong relationships. Yet the reality is that a broken sexual agreement, or one that isn't clear to either partner, can make both partners vulnerable to HIV."

Widespread among gay couples, sexual agreements can include conditions limiting when, where, how often and with whom outside sex is permitted and whether safe sex is practiced.

Hoff and colleagues surveyed 566 gay male couples in the San Francisco Bay Area and found that 99 percent had sexual agreements. Specifically, 45 percent had monogamous agreements, 47 percent had open agreements and 8 percent of couples had discrepant agreements where partners reported a different understanding of whether they have an open or monogamous agreement.

"Discrepant couples were particularly concerning in terms of HIV risk," Hoff said. "When there isn't consensus on what the agreement is, one partner could be involved in risky behavior outside of the relationship and the other partner may be unaware of the resulting risk of unprotected sex within the relationship."

The study suggests that knowing what motivates gay couples to make sexual agreements could help HIV prevention programs tailor their efforts to be relevant to the whole relationship. "HIV prevention needs to take a more holistic approach that goes beyond messages about safe sex," Hoff said. "Helping gay couples learn how to negotiate robust sexual agreements and how to disclose and deal with a break in an agreement could be an effective approach to HIV prevention."

Participants in the study responded to a series of statements assessing their satisfaction with their relationship and various relationship characteristics, such as trust and intimacy. The study found no significant difference in relationship satisfaction between men in open or discrepant relationships and those in monogamous relationships. For relationship characteristics, participants' responses did vary significantly depending on the type of sexual agreement they had (open, discrepant or monogamous). Men in monogamous relationships reported greater levels of intimacy with their partner, more trust, commitment and attachment toward their partner and greater equality in the relationship.

Funded by the National Institute of Mental Health, this study is part of a five-year longitudinal study following the relationship dynamics of 566 gay couples in the context of HIV prevention.
"Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus" was published in the July 2010 issue of the journal AIDS Care. In addition to Hoff, co-authors include Sean C. Beougher, Deepalika Chakravarty, Lynae A. Darbes and Torsten B. Neilands.
Colleen Hoff is professor of sexuality studies at San Francisco State University and director of the University's Center for Research on Gender and Sexuality.

Elaine Bible
San Francisco State University

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