1. Relationship Definitions and their Impact on Sexual Decision-Making among Gay and Bisexual Men Ryan Freeland, Tamar Goldenberg, MPH, Rob Stephenson, MSc, PhD SexLab: The Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI Abstract Gay, bisexual, and other men who have sex with men (MSM) are disproportionately impacted by the burden of HIV. Research has examined male-male relationships to understand the transmission of HIV because main partnerships account for one-third to two-thirds of new HIV infections among MSM. However, most of this research has focused solely on formal relationships or on casual ones. We do not understand how relationship definitions influence sexual decision-making, especially within the context of individual and relationship characteristics. We analyze relationship patterns among gay and bisexual-identifying men through an in-depth interview and visual timeline to reveal how definitions of their relationships, individual factors (participant vs. partner), and relationship characteristics influence the sexual decision-making, especially the decision to engage in condomless anal intercourse, a primary risk factor for HIV transmission. Research Question How do relationship definitions influence sexual decision-making between male-male couples? Methods We conducted a qualitative study using in-depth interviews (IDIs) with gay and bisexual men aged ≥18 who lived in the Atlanta-metro area and reported recent condomless anal intercourse. During the IDIs, participants built a timeline, using stickers with predetermined labels to visually understand their dating and sexual histories, with participants discussing up to five past or current relationships. Verbatim transcripts were analyzed and thematically coded based on reoccurring concepts across transcripts. Participant information was extracted and analyzed for patterns between relationship definitions and sexual behavior. Discussion Results These findings identify how relationship definitions and factors like individual participant, individual partner, and relationship characteristics shape sexual decision-making for gay and bisexual men. The results demonstrate that certain factors impact the definitions of relationships, which tend to an increase the formality of the relationship definition, thus decreasing the usage of condoms during anal intercourse. An increased understanding of how relationship definitions, individual characteristics, and relationship characteristics influence sexual decision- making can add insight into HIV interventions that address condom use among gay and bisexual men. Study Sample WhiteBlackMultiple RacesTotal <253216 25-3455010 ≥354419 Total12112 The study consisted of 25 participants, who varied by age and race. Participants were allowed to discuss up to five past relationships, which resulted in 107 participant-partner relationships. Relationship Definition Sexual Decision- Making ? This original research was supported by funding from the University Research Committee at Emory University. Authors for correspondence: Ryan Freeland, rsfreela@umich.edu, Tamar Goldenberg, MPH, tamargol@umich.edu & Rob Stephenson, MSc, PhD, rbsteph@umich.edu RelationshipDefinitionReasons for Condomless Anal Intercourse Partner “ And then going to partner, partner I would define as somebody who you – you’ve known for quite a bit as well so that the – the timeframe comes into play; somebody who you may, you know, you have a good bit of sex with regarding, you know, like a sexual history transitioning over into husband, somebody who you plan to spend the rest of your life with. Somebody who you can share your most intimate, deepest thoughts with. I guess too I realize maybe some of those overlap with the – with each other” (Participant 103; White; 24 years) Transition into formal relationship Knowledge of each other Feelings towards each other Commitment/Monogamy HIV Sero-Concordance Status Friends With Benefits “More of obviously the friendship, do you have things in common, are there familiarities there? Same sense of humor, just good common friends. Little romantic interest but then the friends with benefits part kicks in when you’re both on the same page of wanting to be intimate, fool around, just don’t want to have the commitment, you enjoy being single with a little side kick, but the root of it is, the goal, more times than not doesn’t work out but it works out where it’s just a, the friendship first with the level of intimacy” (Participant 117; White; 32 years) Partner’s relationship definition Random encounter Convenience Semi-exclusivity Discussion between partners Boyfriend “A boyfriend to me is you’re dating regularly and stuff like that but you don’t have any kind of dependency. I don’t know that’s a hard and fast rule but generally if I’m going to move in with someone then I consider them more than just a boyfriend” (Participant 114; White; 44 years) “It just happened. I mean we were together for a long time, I mean, like 6 months to years and, and then all of a sudden it’s like he couldn’t, he just didn’t know. So he, and he just didn’t want to keep playing these games and stuff. ” (Participant 110; White; 40 years) Discussion of HIV status Partner’s relationship definition Feelings towards each other Partner’s decision Lustful relationship Hook Up ” Meaning we basically had sex. He was, I don’t feel like he was every committed. I felt like I was more committed to him than he was to me” (Participant 106; Black; 42 years) “ In these two hook ups and boos, mean like they were just, figuring out and, and dating at the same time. I’m not trying to lock myself down because I always try to lock myself down because I thought that’s the way to go” (Participant 115; White; 28 years) Random encounter Minimal commitment Immediate desire for sex No condom available