Concordance in Perceptions of Health Protective Sexual Communication and Safer Sex Behavior within Young Heterosexual Couples at Increased Risk of HIV

Background: Safer sexual behavior in couples, including condom use and mutual monogamy, requires communication and cooperation. Some studies have demonstrated a strong, positive relationship between communication about safer sex and condom use; however, other studies have found no relationship between the two.  The relationship between communication and mutual monogamy has not been explored.  

Objectives: This study assessed 1) couple concordance on perceptions of communication about sexual risk and health protective behaviors, including condom use, mutual monogamy, and testing for HIV and other STDs; and 2) the associations between communication and protective behaviors.

Methods: Data are from a baseline survey completed individually but concurrently by both members of 434 heterosexual couples recruited for an HIV prevention intervention study. Percentage agreement and kappa statistic were used to assess within-couple concordance and logistic regression models were used to test for associations between concordance in perceptions of communication and health protective behaviors.

Results: Overall, concurrence within couples was low on health protective communication items. In 61% of couples, both partners agreed they had discussed feelings about using condoms (kappa=.08).  Concurrence on HIV and other STD testing was higher; however, higher kappas were driven in part by negative agreement, for example, in 37% of couples both partners agreed that the male partner had not been tested for an STD other than HIV (kappa=.46). Eight couples (2%) reported they used condoms consistently and 139 (32%) reported mutual monogamy. In multivariate analysis, couple concordance in perceptions of communication was positively associated with mutual monogamy.

Conclusions: The majority of couples in this sample did not practice effective STD prevention. Misperceptions about partner communication were common. Couples with greater communication were more likely to be mutually monogamous.

Implications for Programs, Policy, and/or Research: Strategies to improve partner communication among couples are needed to improve STD prevention in young adults.