Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 41, Number 4, December 2009

A Little Thing Called Love: Condom Use in High-Risk Primary Heterosexual Relationships

By A. Michelle Corbett, Julia Dickson-Gómez, Helena Hilario and Margaret R. Weeks

CONTEXT: Condoms are less likely to be used in primary relationships than in other relationship types. An understanding of what women and men expect when entering into these relationships, as well as how they make decisions about condom use and other prevention behaviors, is essential to efforts to curb the spread of HIV.

METHODS: Qualitative in-depth interviews were conducted with 25 high-risk heterosexual couples, including HIV-serodiscordant couples, participating in a trial of the female condom in Hartford in 2004–2007. Data were codedand analyzed in an iterative inductive and deductive process.

RESULTS: Participants described nonuse of condoms as a strategy to find and maintain a primary relationship, establish trust and increase intimacy. Many had unprotected intercourse while recognizing their risk of HIV and other STDs, placing their love for their partner and other emotional needs over concerns about their health. Several couples reduced their STD risk by practicing negotiated safety (i.e., using condoms until their serostatus had been determined) or similar strategies, including sharing sexual or drug use history, disclosing HIV test results and using condoms until they decided that their relationship would be monogamous.

CONCLUSIONS: HIV prevention approaches must recognize the importance of love and the needs that primary relationships satisfy if they are to be considered relevant by those at greatest risk. Negotiated safety and similar strategies may be an important risk reduction tool for heterosexuals, particularly those in HIV-affected relationships, but their potential effectiveness may vary.

Perspectives on Sexual and Reproductive Health, 2009, 41(4):218-224




A. Michelle Corbett is program coordinator, and Julia Dickson–Gómez is associate professor, both at The Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee. Helena Hilario is research assistant, and Margaret R. Weeks is executive director, both at The Institute for Community Research, Hartford.