Introduction

Sexual minority men (i.e., gay, bisexual, and other men who have sex with men) continue to experience high HIV incidence in the USA, despite significant declines in other priority populations, consistently accounting for approximately 70% of new HIV cases (CDC, 2018). HIV incidence remains especially high among adolescent sexual minority men, particularly among those aged 13–24 years who make up approximately one-fifth of new infections (CDC, 2019). Modeling work has demonstrated that between one- to two-thirds of new HIV infections among sexual minority men are attributed to primary partners (Goodreau et al., 2012; Sullivan et al., 2009), and among adolescent men this may be as high as 84% (Sullivan et al., 2009). The high rates of HIV transmission between primary partners have been attributed to couples engaging in more frequent condomless anal sex (CAS) with primary partners compared with casual sex partners (Goodreau et al., 2012; Sullivan et al., 2009) and are often shaped by perceptions of trust and desires for intimacy within relationships (Blais, 2006; Golub et al., 2012; Greene et al., 2014). As a result, a large body of research has focused on the relationship context of HIV transmission among sexual minority men, including adolescent and young adult sexual minority men, to understand how relationship characteristics contribute to both HIV transmission and engagement in HIV prevention (Gomez et al., 2012; Hoff & Beougher, 2010; Hoff et al., 2010; Mitchell, 2014b; Mitchell et al., 2012a, 2012b, 2020; Rios-Spicer et al., 2019; Sharma et al., 2019, 2020; Stephenson et al., 2017a, 2017b).

A growing body of literature has focused on sexual agreements—the explicit discussion that couples make about sex that may be allowed outside of their relationship (Hoff et al., 2009)—as a critical relationship factor that is linked to HIV transmission/acquisition and engagement in HIV prevention (Gamarel & Golub, 2020; Hoff et al., 2009; Mitchell, 2014b; Rios-Spicer et al., 2019). In a comprehensive review of the literature on sexual agreements, Rios-Spicer et al. (2019) found that between 50 and 99% of participants had established sexual agreements with their primary partners; however, most of these studies focused on adult sexual minority men. In a study with adolescent and emerging adult sexual minority men—considered to be those aged 18–29 years—fewer participants (34.6%) had established sexual agreements (Feinstein et al., 2018).

To date, most published studies on sexual agreements have focused on adults, with the exception of a few primarily quantitative studies conducted with emerging adult populations ages 18–29 (Rios-Spicer et al., 2019). For example, Feinstein et al. (2018) found that adolescent and emerging adult sexual minority men ages 18–29 who reported with monogamous agreements were more likely to report CAS within their primary relationships compared to those who reported a more casual or non-monogamous relationship. On the other hand, Cuervo and Whyte (2015) found that adolescent and emerging adult sexual minority men ages 18–29 who were in monogamous relationships were less likely to report CAS compared to those who reported unrestricted sexual agreement. In one mixed-methods study, Greene et al. (2014) identified perceptions of monogamy as a potential reason for engaging in CAS among adolescent and emerging adult sexual minority men ages 18–25.

Notably, there have been a few studies focused on sexual agreements among adolescent sexual minority men ages 15–18 who may be experiencing their first romantic and sexual relationships. In one quantitative study, Cain et al. (2023) found that among adolescent sexual minority men with at least one CAS occurrence regardless of sexual agreement type reported more CAS compared to single participants. While Cain et al. and existing literature with emerging adult and adult populations provide valuable insights into sexual agreement formation, adherence, and breakage (Dellucci et al., 2021; Gass et al., 2012; Gomez et al., 2012; Hoff & Beougher, 2010; Hoff et al., 2009, 2010; Mitchell, 2014a, 2014b; Mitchell et al., 2012a, 2012b, 2017, 2019; Rogers et al., 2020), these findings may not necessarily relate to the lived experiences of adolescent sexual minority men.

Developmental theory and research have described the importance of identity, intimacy, and sexual development as key milestones for adolescents (Arnett, 2015; Erikson, 1968; Macapagal et al., 2015). Specifically, adolescents are often characterized as a time of self-discovery and experimentation in relationships (Fortenberry, 2013; Jamison & Sanner, 2021; Patrick et al., 2007). Qualitative studies with sexual minority adult men have shown that motivations and reasons for sexual agreements are a product of desires for intimacy, commitment, sexual satisfaction, and protecting their partners HIV/STI acquisition (Hoff & Beougher, 2010; Hoff et al., 2010). However, adolescent sexual minority men may have different motivators and reasons behind the formation and adherence to sexual agreements. Thus, examining the ways adolescent sexual minority men navigate sexual agreements can better inform HIV prevention strategies among this priority population. As such, we sought to qualitatively explore the ways adolescent sexual minority men define sexual agreements, their motivations for initiating sexual agreement conversations, their perceptions of exclusivity and non-monogamy, and the content of these conversations.

Method

Participants and Procedure

The current study is a secondary analysis of data from We Prevent, which is project designed to develop and assess the feasibility and acceptability of a relationship-focused HIV prevention intervention for partnered adolescent sexual minority men (Gamarel et al., 2019; Hightow-Weidman et al., 2018). In the first phase of We Prevent, 30 partnered adolescent sexual minority men ages 15–19 were recruited to participate in a one-time in-depth interview. The study details for the first phase have been described previously (Gamarel et al., 2021; Stephenson et al., 2022).

Participants were recruited between July and November 2018, using advertisements placed on Facebook, Instagram, and Snapchat that demonstrated young same-sex male couples representing a range of race/ethnicities. People who clicked on the advertisement were directed to a study screener webpage where they completed a brief survey to determine their eligibility. Participants were considered eligible if they (1) were between the ages of 15 and 19 years; (2) identified that they were in an emotional and/or sexual relationship with another man; (3) were assigned male on their birth certificate and currently identified as male or transgender man with an intention to have sex with men; (4) reported that they have engaged in any sex (oral, anal, vaginal) in their lifetime; (5) met the age of sexual consent in their state of residence; (6) had access to a personal device with internet access within their home; (7) self-reported being HIV-negative or unknown HIV serostatus; and (8) spoke and read English. To learn from adolescent sexual minority men who might have been preparing to have sex in their current relationships, we did not require participants to be sexually active with their current partner since sexual agreements may occur between partners in preparation or even at the beginning of a sexual relationship. We decided not to require dyadic participation because many adolescent men might not be ready to engage their partners in couples-based research; therefore, we sought to enroll individuals and not dyads, despite the criterion of relationship status, to reach a diverse group of adolescent sexual minority men.

Eligible men were then sent to the study webpage that provided the consent/assent form. A waiver of parental consent to screen and enroll those 15–17 years of age was approved by the IRB at University of North Carolina at Chapel Hill. Once the eligible participant completed the consent/assent and provided their contact information, a study staff member emailed them a link to a brief online survey to capture participant demographics. Upon survey completion, participants were scheduled for an in-depth interview conducted virtually via the VSee HIPPA compliant video-conferencing platform.

A research staff member who identified as a cisgender woman interviewed all study participants. Interviews examined the following topics: relationship history, relationship strengths and challenges, the nature of sexual agreements, and communication. Example questions included: “Tell me about some of the relationship rules that you might have had with each of them? What, if any, rules did you have about sex with each other or other people? What do these rules mean to you? Tell me about conversations you had?” Follow-up questions inquired about sexual agreements and arrangements regardless of how the participant defined their relationship. The analysis defines monogamous relationships as those who are romantically and sexually exclusive. Moreover, non-monogamous relationships are those who are romantically and/or sexually open. Participants were also asked to share their opinions on desired content for relationship-focused HIV prevention interventions. Interviews lasted from 45 to 60 min, and participants received a $40 gift card for participation.

Analysis

Interviews were audio-recorded and then transcribed by the UNC/Emory Center for Innovative Technology (iTech) as part of the ATN (Hightow-Weidman et al., 2018). The interviewer reviewed the transcriptions to ensure their accuracy and to remove identifying information.

Our analytic approach was a thematic analysis, a method for identifying, analyzing, and reporting patterns and themes in qualitative data that often involve subsequent levels of interpretation by the researchers (Boyatzis, 1998; Braun & Clarke, 2006). We employed inductive and deductive coding as we sought to provide a detailed account of the sexual agreements’ participants experienced within the context of their intimate relationships. Initial coding was inductive in so far as themes were not based on any pre-determined hypotheses (Patton, 1990). Subsequent coding included both inductive and deductive elements (Boyatzis, 1998). The deductive elements were initially based on prior conceptualizations of adult samples of sexual minority men’s sexual agreements, specifically definitions and conversations (Hoff et al., 2010; Rios-Spicer et al., 2019).

The first two authors followed Braun and Clarke’s (2006) five steps to thematic analysis. First, we listened to audio-recordings and re-read transcripts of the interviews to familiarize ourselves with the data. Second, we undertook an iterative process to coding the data whereby we each independently coded one interview and then met to discuss our coding, creating and defining appropriate subcodes through a consensus-based process. In the third step, a second round of coding involved discussion of each transcript between the two coders to identify additional details about the excerpts and to create and define appropriate subcodes to capture these nuances. In the fourth step, the analysts each independently coded the transcripts in detail and met to discuss similarities and differences, resolving divergences through discussion and consensus. This was repeated for all transcripts. The fifth step involved discussing and collapsing codes to develop overarching themes across the interviews. Before finalizing and writing up the themes, the first and second author discussed the codes and themes with other authors who have extensive expertise in sexual agreements and HIV prevention with adolescent and emerging adult sexual minority men who each made recommendations for revisions and interpretations. Illustrative quotes were then chosen to reflect themes along with the race, ethnicity, sexual identity, and age that the participant reported in the brief online survey.

Results

Sample Characteristics

As shown in Table 1, a total of 30 adolescent sexual minority men completed the in-depth interviews. Participants ranged in age from 15 to 19 years of age (M = 18, SD = 1). Most participants identified as gay (83%, n = 25), with some identifying bisexual (13%, n = 4) or pansexual (3%, n = 1). All participants identified as cisgender men and resided in 30 states. More than half of the participants identified as a person of color (3% Black, 7% Asian, 3% Multiracial, 37% Latinx, and 7% other). Approximately one-third of the participants were completing their High School degree or GED (37%, n = 11) and over half of the participants had been in their current relationship for six months or less (53%, n = 16). All quotes represent responses from participants following questions in the interview guide. Every quote is paired with a pseudonym, the race, ethnicity, and age of the participant.

Table 1 Characteristics of study sample
Full size table

Sexual Arrangements

Participants’ understanding of their relationships with former and current partners was often attributed to sexual arrangements, which has been defined as a couple’s understanding of whether sex is allowed outside the relationship without an explicit discussion (Dellucci et al., 2021). That is, participants discussed that sexual arrangements based on assumptions of monogamy and sexual exclusivity, for example when asked about whether there was a conversation about his sexual agreement, one participant stated: “No, we didn’t [talk about it]. It was just something that was just assumed” (Daniel, White gay man, age 18). Participants reported a range of experiences in which they created arrangements, such as the point of deciding to be in a relationship rather than be friends.

We never really had like formal discussion about it. We just kind of like came to it, a silent agreement I guess. – Hunter, White gay man, age 17

I haven’t brought it up because it was very implied between us. It’s very clear our expectations of one another. – Elijah White gay man, age 17

Interviewer: And so the rule about you know only seeing each other how did you work out this rule between you and your partners? Interviewee: We never really had like formal discussion about it. We just kind of like came to it, a silent agreement I guess. -Jayden, Multiracial gay man, age 19

For other participants, sexual arrangements conveyed exclusivity in the relationships.

We were talking and eventually as feelings progressed, we just decided, I just asked him to be my partner and then that was it, I feel like with asking to be a partner that also came exclusivity. – Rafael, Latinx gay man, age 17

One participant noted that his past partners expressed feelings of jealousy and this prompted conversations that he described as “aggressive” in nature. When asked how exclusivity was established in two of his previous relationships, this participant said described how the tone of these conversations and his reaction led to the formation of sexual arrangements.

They both were really jealous people. And so it kind of turned into a conversation, um you know, when uh, they would get jealous about somebody I was hanging out with, or something stupid. It was always very aggressive and like, “You can’t be with that person. They uh, don’t think you’re just a friend and they’re trying to take you away from me.” That kind of thing. – Oliver, White gay man, age 17

Definitions and Terms for Sexual Agreements

Participants also described the explicit conversations they had with partners about sexual agreements. These conversations occurred during, or after, their first dates. For example, one young man described how he started with declarations of his own desires and inquired into his partner’s intentions before officially proclaiming their status as being in a relationship.

It was after dinner, it was after the first date I was like, “I want you to be my boyfriend. I don’t -,” I’m like, “I don’t know if you’re into like polygamy and sharing and stuff. But like if you’re my boyfriend I don’t want to share you. I’m very monogamous—that’s how relationships should be between two people.” You know, I told him all this and he was like, “Yeah, I also think that I’m like not very—I don’t want to share you, you know-.” So then I was like, “Yeah, so like we’re boyfriends you know-.” I didn’t flat out say we’re boyfriends, but like I addressed as, “Yeah, you’re my boyfriend now.” – Kai, Asian gay man, age 18

Another participant noted his intentionality in bringing up the issue of sex with outside partners and desires for a monogamous relationship. This young man also described the importance of this conversation even if they were not “rushing into anything.”

Oh, it was a conversation, we sat down, I told him I wanted to speak about how our relationship would work out and what we should do and—one of the first things I mentioned was monogamy, I didn't want anything to be up in the air about that. I think that was one of the biggest things we talked about, like, we talked about—we said we would take things at our own pace; we didn't want to rush into anything. I think that was it. We just had a conversation about it. – Edward, White bisexual man, age 17

Participants defined sexual exclusivity in the same way, stating that it referred to a situation in which partners did not have sex with outside partners:

Interviewer: So and by exclusive you mean–? Interviewee: You can’t see anybody [else], you can’t touch anybody [else]. - Omar, Middle Eastern gay man, age 19

For monogamous couples, these conversations affirmed the terms of their relationship—that they would practice exclusivity.

I asked him to be my boyfriend and he said yes, and we made it clear that we were just exclusively with each other. I said like, “Are you okay like just being us or you don't want a relationship?” He was like, “No, I just want one person; I just want to be with you.” It was pretty simple. – Ben, White gay man, age 18

Sharing these definitions with their partners initiated explicit sexual agreement conversations that resulted in the establishment of rules. One participant shared how his two previous partners responded to this approach:

So, with [redacted current partner name] and [redacted prior partner name] we both had the same connection where it was pretty much, “Hey, I want to be exclusive meaning you can’t date anybody else.” This was within the first week of the relationship and they both were kind of like, “I want the same because I would like it. So, we are in a relationship and I know that you’re not going to be with anybody else.” –Jackson, White gay man, age 16

Definitions of non-monogamy varied by degree of emotional and physical intimacy outside of the primary relationship. One participant preferred a relationship that was sexually open, but emotionally monogamous.

We were kind of letting each other see other people in the sense of just, you know, like physical intimate things, but not so much as like, you know, allowing ourselves to get emotionally attached to others. –Miguel, Latinx gay man, age 19

Another participant reported accepting being both sexually and emotionally open while being in the “experimental” stage of a relationship, but not during the “dating stage.”

With [redacted prior partner name], we had a—like I told him that he can date other people because that’s experimenting and I was fine with that. But with [redacted current partner name], I was um, like, no, we were dating, like, he wasn’t dating anyone just ourselves, just me. – Carlos, Latinx gay man, age 17

Reasons for Creating Sexual Agreements

Participants shared a range of developmental milestones that they felt had prompted conversations around sexual agreements. Participants described discordant sex drives between partners as a trigger for sexual agreement conversations. For example, one participant relayed a story about how his partner started taking anti-depressants that lowered his libido, which caused him to worry that his own unmet needs in his relationship. As a result, he and his partner had a discussion regarding opening up their relationship for other sex partners.

He started having some trouble with mental health, um, and he started some anti-depressants, which, you know, like his sex drive. So, yeah, for some time I was like, “I want to see other people,” um, and he said like, “That would really hurt me,” so I didn’t. – Lucas, White gay man, age 18

One participant mentioned that the upcoming college semester served as catalyst to defining his relationship and the decision to be non-monogamous:

I said, “So how are we going to do this? I'm going to be going to college. How are you going to just kind of really signify that?” And he said, “Well, we’ll just put it on Facebook,” and that was it. That was the beginning of our relationship. We've been open for a majority of the relationship and that was actually his decision and in his own words, he said he didn't want to take away from my college experience. – Miguel, Latinx gay man, age 19

Participants also described the emotions and guarantees associated with the concept of exclusivity. Participants noted that monogamy inferred trust, commitment, stability, loyalty and respect between them and their partners:

So I think that's where like the trust and stability comes in. Because you—I guess you are like—there’s less of a fear of like insecurity that's it’s not going to work out. Or like that they're going to choose someone else because they agreed to be exclusive with you. – Ali, Pakistani gay man, age 19

We’re agreeing—let’s be loyal to each other, let’s respect each other, let’s respect each other’s emotional minds and physical minds. – Wyatt, White gay man, age 18

I like being able to trust them completely and know that at least it's something that I, you know, can trust but yeah, I don't know like not having to worry about other people, you know, involved in the relationship and it's just us. – Diego, Latinx gay man, age 16

Two participants saw exclusivity as a way to ensure sexual health as a form of “STD” prevention:

I think it is more secure kind of it creates a commitment to each other. Also just sexually if you're only sleeping with each other it's like a less risk of transmitting STDs. – Henry, White gay man, age 18

“I think it makes things more trustable. And obviously like safety wise there's less risk for STDs and what not.” – Jayden, Multiracial gay man, age 19

On the other hand, participants also described the need for trust in emotionally non-monogamous relationships, and how that trust is unnecessary while sexually experimenting.

With [redacted current partner name] the motivation [to be non-monogamous] was to keep each other happy, and to—and to trust each other. And with [redacted prior partner name], it was the same thing as well, kind of. We were not official, we were just experimenting, so I didn’t have to trust him that he was going to cheat on me or anything. – Carlos, Latinx gay man, age 17

Two participants who were in open relationships during college associated non-monogamy with feelings of flexibility, excitement, and less stress in their relationship. One participant noted that having a primary partner while being non-monogamous provided a sense of stability.

Like it keeps the relationship exciting and lets them value you know the people more and it's—I don’t know. I think just for me it's just a way for me to not be bored, especially since I'm not around like [redacted partner name]. – Miguel, Latinx gay man, age 19

I think it's a little bit more flexibility and a lot less stress. Because I think like part of being in college is kind of like exploring with like other people and wherever that leads, and so I think that this allows me to do it but also like have the stability of knowing that I like have this person to come back to no matter what happens. – Manuel, Latinx gay man, age 17

Lastly, participants discussed both exclusivity and non-monogamy as way to avoid sexual stigma, which are the negative beliefs and behaviors in response to sexual minorities’ relationships and sexual behaviors. One participant placed value on avoiding the stigma associated with non-monogamy:

“I guess for that in my mind, I didn't really even ever acknowledge the fact that there was anything, but being exclusive to each other until fairly recently actually. I think it was more of an outside pressure rather than coming from me, like it was not a pressure but it was a stigma or a generally accepted fact that it was weird or wrong to have more than one.” – Joseph, White gay man, age 19

In contrast, another participant used non-monogamy to avoid the discrimination and prejudice of heterosexism. He and his partner would date women and would have sex with other people to ward off any attention to their own relationship:

Because with [redacted prior partner name], only seeing other people because we didn't want—because we were in school when we were together, so we didn't want no students to know that we were together. So we had an agreement that “Hey, you go with this friend and I'll go with this friend and just be that.” – James, Black gay man, age 19

Communication About Sexual Agreements

Among those who had discussed sexual agreements with their partners, participants described a range of emotions, for example, participants who described negative feelings around the tone of the conversation such “intimidating” and “intense.” One young man described how it was challenging for him when his partner wanted to open their relationship to see other people.

I feel like the conversation I had with [redacted partner name] was a little bit intimidating because [redacted partner name] is quite a bit larger than me, like quite a bit taller. And he, he's a very stubborn person so for him to want to change anything is something that he has to actively want to do. And he, God, he, I don't know. He was just much more intimidating, not in a controlling sense more that he was just physically more intimidating and a little bit mentally too.– Antonio, Latinx gay man, age 19

In contrast, other participants reported that these conversations were “easy” and “fun.” Two participants wanted to have explicit conversations because they were not satisfied with arrangements established in previous relationships. One participant shared that his prior relationship consisted of sexual arrangements around monogamy. His previous partner “broke” their assumed agreement, and it encouraged the participant to have an explicit conversation in his current relationship.

Well with [redacted prior partner name], it was implied monogamy, but he didn't follow that. So there's that. [Redacted current partner name], it's thing that was more verbally addressed. It was more of a chat, like, “By the way, we're like in a monogamous relationship, right?” And, “Yeah.” Yeah, that's pretty much it. I thought it was easy because I was sure about it, like there was no question, yeah. – Luis, Latinx gay man, age 18

When Liam described his more recent partners, he described how he wanted to be in monogamous agreements. As example, Liam conveyed how he was not comfortable being in an open sexual agreement.

So that’s really I was exclusive to him. So like I wasn't comfortable with the idea of an open relationship. So pretty much for all of them I—nothing was open because I like dude I'm not comfortable with the idea of like dating round while you're dating someone else. It didn’t make me that much uncomfortable to like talk about it. But once we did, like it was fun, yeah. – Liam, White gay man, age 18

Discussion

Adolescent sexual minority men in the current study reported similar reasons, definitions, and desires for creating sexual arrangements and sexual agreements as those reported in previous studies with adult sexual minority men (Hoff et al., 2010; Rios-Spicer et al., 2019). Monogamy, as a sexual agreement type, refers to refraining from romantic and sexual relationships with others (Hoff & Beougher, 2010; Sharma et al., 2020). Adolescent sexual minority men who reported a preference for exclusive sexual arrangements did so in the pursuit of increased trust and commitment, which are tenants valued by adults while creating their sexual agreements (Greene et al., 2014; Hoff & Beougher, 2010). The variety of definitions that defined non-monogamy for these young men were similar to those noted by Pruitt et al. (2015) who described the diversity of arrangements that are considered as non-monogamy. Similarly, participants in open relationships shared similar desires, specifically prospects of sexual freedom and adventure, which have been documented in the literature with adult sexual minority men (Greene et al., 2014; Mitchell et al., 2016, 2017; Mitchell, 2014b).

Similar to prior literature (Hoff & Beougher, 2010; Hoff et al., 2010; Rios-Spicer et al., 2019), the adolescent sexual minority men in our sample saw sexual agreement conversations as a tool to initiate or preserve their relationships rather than solely by HIV and STI risk reduction motives. Sexual agreements were also a way to navigate heterosexism where open and monogamous sexual agreements were a means to conceal one’s sexuality or to avoid stereotypes, which is similar to literature with adult sexual minority men (Mitchell et al., 2016). As such, there is a need for future research to focus on relationship motives and the role of heterosexism in sexual agreements among adolescent sexual minority men.

Consistent with developmental theories (Arnett, 2015; Jamison & Sanner, 2021), sexual agreement conversations were used as a gateway into personally novel relationship dynamics for several of these young men as they were exploring their intimacy and relationship needs. The conclusions made by the end of these conversations signaled the change from friends to partners or monogamy either to non-monogamy (or vice versa). Additionally, sexual agreement conversations sometimes occurred in line with specific life events that required their relationship with partners to be defined or redefined. While adults may have a life event that serves a motivator or catalyst for conversation about sexual agreements, the developmental context was specific to adolescents’ life events or milestones (i.e., college). Adolescent sexual minority men also discussed modifying their sexual agreements in reaction to the fear of being unsatisfied sexually or romantically in their relationship, which is consistent with developmental theories in which young people are exploring their desires and relational goals (Jamison & Sanner, 2021).

Participants fell into two overarching categories of agreement type: those whose agreements were explicitly defined and those whose arrangements were implied or assumed. Arranged, or unspoken and assumed terms, were common among participants who were in one of their first relationships. Those who engaged in intentionally explicit sexual agreement conversations often reflected on past relationships where the agreement was unsatisfactory or broken. Our findings suggest that adolescent sexual minority men who have more relationship experiences may make explicit sexual agreements and conversations. Participants referred to previous relationships when discussing their current relationships and sexual agreements. It is possible that for adolescent sexual minority men, the amount of past relationship experience aids in their comfort while having explicit sexual agreement conversations (Jamison & Sanner, 2021). Therefore, adolescent sexual minority men might be less likely to employ explicit sexual agreement conversations than the older populations typically studied in this area of research. Thus, study findings highlight the need for HIV prevention interventions to include a focus on sexual arrangements and sexual agreements as adolescent sexual minority men with less relationship experience may struggle with the communication skills and confidence required to have conversations with partners about sexual agreements.

Limitations

There are several limitations to this study, specifically related to the generalizability of these results. Our sample was susceptible to selection bias because we recruited solely using social media platforms for convenience sampling methods. We were most likely not able to reach those who do not use social media and those who face significant structural vulnerability and may have challenges seeking HIV prevention services. Our sample skewed older in age, with a mean of 17.8. Our quantitative survey only included demographic information, which precluded us from having an estimate of the number of participants that reported sexual agreements versus sexual arrangements, which as in an important area for additional research. Additionally, we only interviewed participants in sero-concordant relationships. Future research is warranted with adolescent sexual minority men in sero-discordant relationships. We interviewed only one member of the dyad, which prevented our ability to check the parity of their responses with those of their partners. In addition, recall bias could have shaped our participant’s reports. The interviewer was a cisgender woman and was well trained in interviewing techniques and had experience working with the LGBTQ + community. Nonetheless, the participants could have felt reluctant to recount aspects of their sexual agreement or relationship history to the interviewer. A strength of this study is the qualitative exploration of sexual agreements in a small sample of adolescent sexual minority men; however, the purpose and design of the study precluded us from counting or reporting the frequencies of themes (Morse, 2007). Future quantitative research using validated measures with adolescent sexual minority men is warranted to understand the frequency of sexual agreements and arrangements.

Conclusion

Our study findings provide insights into sexual agreements among adolescent sexual minority men and add to the existing literature, which has predominantly focused on adult and emerging adult populations. Participants’ described how past relationship experiences shaped their current sexual agreements. These experiences demonstrate the central role that teaching youth communication skills to use in relationships can play in HIV prevention. HIV prevention interventions should incorporate communication skills training to help adolescent sexual minority men feel confident about having conversations about sexual agreements. Such interventions could include topics such as knowledge of arrangement and agreement types and communication training skills that can help adolescent sexual minority men broach sexual agreement conversations that can be difficult. Skills-based interventions that include content on sexual agreements may be a promising pathway to help adolescent sexual minority men improve their relationships and navigate HIV prevention strategies.