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Washington C, Gamarel KE, Darbes LA, Hightow-Weidman LB, Sullivan P, Stephenson R. Sexual Agreement Discussions Among Adolescent Sexual Minority Men in the USA. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3129-3138. [PMID: 38890225 DOI: 10.1007/s10508-024-02915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
Nearly two-thirds of new HIV infections are attributed to primary partners, necessitating a greater understanding of relationship context of HIV transmission among sexual minority men. Sexual agreements, which are the explicit decisions couples make about sexual behaviors allowed inside and outside of their relationship, have been primarily studied among adult sexual minority men. Little work has sought to understand how adolescent sexual minority men utilize and navigate sexual agreement conversations. In this qualitative study, we explored adolescent sexual minority men's motivations for having these conversations, how they define different types of agreements (e.g., monogamous, non-monogamous), and the topics most commonly discussed in their conversations. We conducted thematic analysis of in-depth interviews with 30 partnered, HIV-negative, adolescent sexual minority men ages 15-19 years. Participants reported similar reasons, definitions, and desires for creating sexual agreements as those reported in the adult literature. Novel to this population was the influence of stigma and heterosexism on the participants' choice of sexual agreement type. Like adult sexual minority men, participants used sexual agreement conversations to respond to life events; however, the adolescents in our sample, when talking with their partners, led with the context of developmentally specific events such as leaving for college or attending a school dance. Those with more relationship experience often described having intentional, explicit sexual agreement conversations. Study findings suggest that content focused on sexual agreements is important for HIV prevention interventions designed with adolescent sexual minority men, especially young men who have less relationship experiences.
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Affiliation(s)
- Catherine Washington
- Michigan Department of Health and Human Services, Michigan Public Health Institute, Okemos, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Lisa B Hightow-Weidman
- Institute for on Digital Health and Innovation, College of Nursing, Florida State University, Tallassee, FL, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
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2
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Martinez O, Fernandez MI, Yang C, Wu E, Valentin O, Johnson M. Feasibility and Acceptability Pilot Test of Connecting Latinos en Parejas: A Couples-Based HIV Prevention Intervention for Latino Male Couples. Am J Mens Health 2023; 17:15579883231167106. [PMID: 37096329 PMCID: PMC10141303 DOI: 10.1177/15579883231167106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
Despite recent emphasis on couples-based HIV prevention interventions, efficacious interventions for Latino male couples have yet to be tested. The study examined the feasibility and acceptability of the Connecting Latinos en Pareja (CLP) intervention, a couples-based HIV prevention intervention for Latino male couples. This pilot demonstrated high feasibility, meeting targets for recruitment, retention, and intervention completion. We recruited a diverse cohort of 46 individuals/23 couples with a retention rate of 80% over 6 months and a 100% intervention completion rate in both conditions (four structured couple sessions in each condition). This pilot RCT was not powered to detect significant intervention impact on the primary outcome; however, there was a significant increase in relationship functioning among couples in the intervention group relative to controls and promising trends in changes in several key outcome and mediating variables. Secondary analysis documented trends in the expected directions for several other key hypothesized mechanisms of action (stimulant use, psychological symptoms, quality of life) as well as the primary outcome of proportion of protected sex acts (overall and broken out by main vs. outside partners). Qualitative exit interviews revealed high levels of acceptability of the CLP intervention. Participants highlighted affective component of the intervention and perceived effectiveness in improving dyadic communication skills and safer sex practices. Our findings show that a pilot trial of CLP is highly feasible and acceptable, with CLP demonstrating promising evidence of changes in key intervention mechanisms.
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Affiliation(s)
- Omar Martinez
- College of Medicine, University of
Central Florida, Orlando, FL, USA
| | - M. Isabel Fernandez
- College of Osteopathic Medicine, Nova
Southeastern University, Fort Lauderdale, FL, USA
| | - Cui Yang
- College of Public Health, Rutgers
University, Piscataway, NJ, USA
| | - Elwin Wu
- School of Social Work, Columbia
University, New York, NY, USA
| | - Omar Valentin
- College of Medicine, University of
Miami, Coral Gables, FL, USA
| | - Mallory Johnson
- School of Medicine, University of
California San Francisco, San Francisco, CA, USA
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3
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Predictors of Re-Initiation of Daily Oral Preexposure Prophylaxis Regimen After Discontinuation. AIDS Behav 2022; 26:2931-2940. [PMID: 35267107 PMCID: PMC8907393 DOI: 10.1007/s10461-022-03625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
Daily oral preexposure prophylaxis (PrEP) for reducing HIV transmission is recommended for those at elevated risk, including sexual gender and minorities assigned male at birth (SGM-AMAB). Few studies have examined re-initiation among PrEP discontinuers, which is critical to ensuring optimization of PrEP’s protection. The current study examined predictors of re-initiation in a longitudinal sample of SGM-AMAB PrEP discontinuers (n = 253) from 10 waves of an ongoing cohort study (analytic n = 1,129). Multilevel structural equation models were used to examine the effects of psycho-social variables on re-initiation. In adjusted models, health insurance, and partner HIV positive status were significantly positively associated with PrEP re-initation. Being bisexual was significantly negatively associated with re-initiation relative to gay participants. Single status and open relationship agreements were associated with higher odds of re-initiation relative to monogamous relationships. Findings suggest that demographic, partnership characteristics and structural factors influence decisions to re-initiate PrEP after discontinuation.
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Luz R, Alvarez MJ, Godinho CA, Pereira CR. A Fertile Ground for Ambiguities: Casual Sexual Relationships Among Portuguese Emerging Adults. Front Psychol 2022; 13:823102. [PMID: 35250764 PMCID: PMC8894867 DOI: 10.3389/fpsyg.2022.823102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Casual sexual relationships (CSRs) are frequent relationship experiences in young adulthood that provide opportunities for many to explore sexual relationships and to construct their sexual identity. Empirical research on casual sex is still lacking outside North-American countries, despite evidence pointing to the need to contextualize sexual interactions in their own sociocultural context. In order to better understand casual sexual relationships, these should be examined in with novel samples in other countries where a “hookup culture” as it is described in the North-American university campus is apparently absent. Through a qualitative study, we explored what casual sexual relationships consist of according to the perceptions of Portuguese college students (N = 35). The thematic analysis of eight focus group interviews resulted in the generation of six themes, three of which are presented here: (1) What CSRs are, regarding features and types of CSRs, (2) Why individuals engage in CSRs, focusing on positive and negative motivations, and (3) What one gets from CSRs, focusing on positive and negative outcomes of CSRs. Our findings showed that Portuguese emerging adults are familiarized with CSRs, particularly with one-night stand, friends with benefits and “curte”/hookup. Sexual interactions associated with other CSRs, such as booty call or fuck buddies, were mentioned but rarely associated with a distinctive label and established characteristics. Participants described the CSRs in a partially overlapping manner presenting some areas of ambiguity, such as with regard to sexual exclusivity and still-unlabeled sexual interactions. CSRs are generally evaluated as positively motivated and mainly beneficial. This study adds to the literature around casual sexual relationships by exploring and describing CSRs in a different sociocultural context, as well as indicating directions for future research in order to better prepare and empower young adults in their sexual and relational trajectories.
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Affiliation(s)
- Rita Luz
- Faculdade de Psicologia, CICPSI, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Rita Luz,
| | - Maria-João Alvarez
- Faculdade de Psicologia, CICPSI, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina A. Godinho
- Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Lisbon, Portugal
- Centro de Investigação e Intervenção Social, ISCTE, Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Cicero R. Pereira
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, Brazil
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5
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Dellucci TV, Carmichael C, Starks TJ. Arrangements versus Agreements: Evaluating Two Approaches to Measuring Male Couples' Rules and Understandings Around Sex with Outside Sex Partners. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1689-1700. [PMID: 32128651 PMCID: PMC7809916 DOI: 10.1007/s10508-019-01621-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 05/06/2023]
Abstract
One- to two-thirds of new HIV infections among sexual minority men occur within the context of main partnerships. This has led to increasing attention to the rules and boundaries male couples form around sex with outside partners as a mechanism to manage HIV risk. These rules and boundaries have generally been operationalized either as a sexual agreement-the decisions couples make together about their sexual boundaries with outside partners-or a sexual arrangement-how couples handle sex outside the relationship, which may or may not involve an implicit or explicit consensus between partners. The goal of the current study was to examine the correspondence of these two approaches to the operationalization of rules and boundaries. Additionally, the study tested whether agreements and arrangements were differentially associated with dyadic communication and sexual behavior with casual partners. Results indicated a high level of correspondence between assessment methods. Similarly, patterns of sexual behaviors with casual partners were consistent across both sexual agreements and sexual arrangements. In contrast, patterns of communication varied as a function of assessment type. Specifically, constructive, avoidant, and sexual communication varied across sexual agreement types, whereas sexual arrangement types only differed with respect to constructive communication. These findings suggest that there is substantial overlap between arrangements and agreements. Findings particularly related to associations with sexual behavior may largely generalize across these methods of operationalization. In contrast, survey-reported sexual agreements were a more sensitive correlate of dyadic communication.
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Affiliation(s)
- Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, 10016, USA
| | - Cheryl Carmichael
- Department of Psychology, Brooklyn College of the City University of New York, New York, NY, USA
| | - Tyrel J Starks
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, 10016, USA.
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA.
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6
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Gusakova S, Chin K, Ascigil E, Conley TD, Chakravarty D, Neilands TB, Hoff CC, Darbes LA. Communication Patterns Among Male Couples with Open and Monogamous Agreements. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1419-1431. [PMID: 33140245 PMCID: PMC8631168 DOI: 10.1007/s10508-020-01821-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 05/11/2023]
Abstract
Male couples in open relationships tend to have as equally fulfilling relationships as monogamous male couples; however, less is known about communication differences between monogamous and open couples. Because couples with open agreements permit sex with outside partners, they must navigate different relationship issues than monogamous couples, and this can translate to differences in communication. We therefore examined differences between cisgender men in monogamous versus open relationships regarding communication about sexual agreements, safety agreements, breaking of sexual and safety agreements, the disclosure of broken sexual and safety agreements, and general relationship communication. Using a sample of 395 couples, we found that while certain aspects of communication are different for monogamous couples compared to open couples, similarities also exist. Specifically, we identified no differences in how explicitly couples discussed their sexual and safety agreements, attitudes toward communication about safety agreements, and mutual avoidance and withholding communication. However, monogamous couples had more positive attitudes toward communication about sexual agreements. The results were mixed on the perceived impact that broken safety agreements had on communication with the primary partner. Our results are interpreted with attention to relationship well-being and implications for safer sex practices.
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Affiliation(s)
- Staci Gusakova
- Departments of Psychology and Women's and Gender Studies, University of Michigan, 530 Church St., Ann Arbor, MI, 48104, USA.
| | - Kristi Chin
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Esra Ascigil
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Terri D Conley
- Departments of Psychology and Women's and Gender Studies, University of Michigan, 530 Church St., Ann Arbor, MI, 48104, USA
| | - Deepalika Chakravarty
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Jin H, Biello K, Garofalo R, Lurie M, Sullivan PS, Stephenson R, Mimiaga MJ. Better Communication Regarding Sexual Agreements Within Serodiscordant Male Couples Leads to Improved Antiretroviral Therapy Adherence Among the HIV-Positive Partner. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1771-1779. [PMID: 34021459 DOI: 10.1007/s10508-021-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
Sexual agreements (SAs)-guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship-are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, 615 S Wolfe St., Baltimore, 21205, USA.
| | - Katie Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Robert Garofalo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
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Gamarel KE, Darbes LA, Kutsa O, Hightow-Weidman LB, Sullivan P, Stephenson R. Perspectives from Young Partnered Gay, Bisexual, and Other Men Who Have Sex with Men on the Adaptation of Couples HIV Testing and Counseling (CHTC). AIDS Behav 2021; 25:836-846. [PMID: 32975615 PMCID: PMC7886959 DOI: 10.1007/s10461-020-03037-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 01/05/2023]
Abstract
Young gay, bisexual, and other men who have sex with men (YGBMSM) are a priority population for HIV prevention efforts. Although there has been a growing focus on dyadic HIV prevention interventions for same-gender male couples, the unique needs of partnered YGBMSM have been largely overlooked. In this qualitative study, we explored partnered YGBMSM's perceptions of existing HIV prevention interventions to inform the design of a relationship-focused HIV prevention intervention. Between July and November 2018, we conducted in-depth interviews with 30 young partnered YGBMSM (mean age = 17.8, SD = 1.1). Participants described that interventions were needed to address skills regarding: (1) implicit versus explicit communication about sexual agreements; (2) boundary setting and identifying signs of abusive relationships; and (3) relationship dynamics (e.g., trust). Participants noted the absence of inclusive sexual education for them; thus, findings suggest that the provision of relationship skills training are requisites for HIV prevention interventions with YGBMSM in the US.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029d, USA.
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Lynae A Darbes
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Oksana Kutsa
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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9
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Managing the COVID-19 Pandemic: Biopsychosocial Lessons Gleaned From the AIDS Epidemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward:S39-S42. [PMID: 33239562 DOI: 10.1097/phh.0000000000001267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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10
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Starks TJ, Jones SS, Kyre K, Robles G, Cain D, Jimenez R, Stephenson R, Sullivan PS. Testing the drug use and condomless anal sex link among sexual minority men: The predictive utility of marijuana and interactions with relationship status. Drug Alcohol Depend 2020; 216:108318. [PMID: 33022531 PMCID: PMC7959658 DOI: 10.1016/j.drugalcdep.2020.108318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered monogamish -outside partners permitted when main partners are together). METHODS A nationwide sample of SMM (N = 65,707) were recruited through a geosocial networking app between November 2017 and November 2019. Participants reported on drug use and instances of CAS with casual partners in the previous 30 days. RESULTS Both marijuana and club drug use were associated with the occurrence of CAS with casual partners among single men. Only club drug use was associated with CAS frequency in this group. The association between marijuana and the occurrence of CAS did not differ significantly among monogamous men, while the associations between club drug use and the occurrence as well as frequency of CAS were significantly weaker. Meanwhile, the associations between club drug use and the occurrence as well as frequency of CAS did not differ significantly between single and non-monogamous (open and monogamish) subgroups; however, the association between marijuana and the occurrence of CAS was significantly weaker. CONCLUSIONS Findings largely replicated the robust association between club drug use and CAS with casual partners. They support the assertion that marijuana use predicts sexual risk for some SMM subgroups. Finally, they illustrate the potential for relationship status - and sexual agreements - to contextualize associations between drug use and CAS.
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Affiliation(s)
- Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA,Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA
| | - S. Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Kory Kyre
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Ruben Jimenez
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Philpot SP, Bavinton BR, Prestage G, Grierson J, Ellard J, Duncan D. Exploring Diversity in HIV Research in the Sexual Partnerships of Australian Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2069-2080. [PMID: 31863315 DOI: 10.1007/s10508-019-01540-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Gay and bisexual men engage in a variety of sexual partnerships, but the most common distinction made in HIV research and behavioral surveillance is a binary between "regular" and "casual" partners. The "regular partner" category is often perceived as pertaining to ongoing coupled "boyfriend" relationships, with the literature to date rarely troubling what actually constitutes a "regular partner." Some emerging literature has identified "fuckbuddy" partnerships as a type of regular partnership requiring attention, but it is relatively new and not well understood. Currently, assumptions of the regular partner category do not capture how men perceive and conduct commitment in different sexual partnerships that could also be considered "regular," and the implications this has for HIV prevention. Drawing on in-depth interviews with a sample of 61 Australian gay-identified men, we explore a diversity of partnership types that represent unique ways of enacting commitment. We identify three sexual partnerships: "fuckbuddies," dating, and serial monogamy, each with specific issues for HIV risk and prevention. These partnerships suggest important differences in the way men conceive of and practice intimacy and sex.
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Affiliation(s)
- Steven P Philpot
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jeffrey Grierson
- Health, Social Care and Education, Anglia Ruskin University, Cambridge Campus, Cambridge, UK
| | - Jeanne Ellard
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Duane Duncan
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, Australia
- School of Humanities, Arts and Social Sciences, University of New England, Armidale, NSW, Australia
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12
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Gamarel KE, Golub SA. Sexual goals and perceptions of goal congruence in individuals' PrEP adoption decisions: A mixed-methods study of gay and bisexual men who are in primary relationships. Ann Behav Med 2020; 54:237-248. [PMID: 31624825 PMCID: PMC7093261 DOI: 10.1093/abm/kaz043] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although health goals are recognized as a central feature of health behavior theories, the relational context through which goals are conceptualized is often overlooked. Interdependence theory represents a valuable framework for understanding goals in the adoption of health behaviors, such as pre-exposure prophylaxis (PrEP), among gay and bisexual men in primary relationships. PURPOSE We examined the content and focus of men's sexual health goals, as well as whether goal content, goal focus, or perceptions of goal congruence with a primary partner were related to PrEP adoption among gay and bisexual men in primary relationships. METHODS Mixed-methods data were collected from a PrEP demonstration project from 145 HIV-negative gay and bisexual men in primary relationships. Participants reported their sexual health goals and completed measures of perceptions of goal congruence, relationship factors, and sociodemographic factors. RESULTS Three main goal content categories were identified: prevention, satisfaction, and intimacy. In expressing these goals, participants framed them with either a self-focus or a relationship-focus. Men in serodiscordant relationships reported more intimacy goals and greater perceptions of goal congruence. There were no differences in goal content or focus by sexual agreement. In the multivariable logistic regression model, perceived goal congruence was associated with PrEP adoption, over and above covariates. CONCLUSIONS Intimate relationships play a significant role in the formation of health-related goals. Goal content, focus, and perceived congruence with partners may represent important targets for HIV prevention interventions for gay and bisexual men in primary relationships, especially in the context of PrEP.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarit A Golub
- Hunter College and the Graduate Center of the City University of New York, New York, NY USA
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13
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Stephenson R, Sullivan S, Sharma A, Kahle E. Discordant Reporting of Partner Labels, HIV Testing and Sexual Behavior Among a Sample of Partnered Men Who have Sex with Men in the US. AIDS Behav 2020; 24:540-550. [PMID: 31691044 DOI: 10.1007/s10461-019-02725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is growing evidence that sexual behaviors among male couples are strongly shaped by emotional and quality characteristics of the relationship, and that the labels that men attach to their relationships may indicate how men perceive and engage in risk taking. There has been a lack of attention to how male couples label their relationships, and how discordant understandings of relationship labels may shape HIV risk behavior. Using data from a sample of 804 partnered men who have sex with men, this analysis examines associations between discordant relationship labeling and participation in HIV testing and sexual behavior. Men who labeled their relationship differently from their partners were less likely to have been recently tested for HIV and more likely to engage in sexual risk. The results underscore the need to develop interventions that provide spaces and skills for men to learn how to effectively navigate HIV risks in their relationships.
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Affiliation(s)
- Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA.
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Stephen Sullivan
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
| | - Akshay Sharma
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Erin Kahle
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Relationship Characteristics Associated with Perceptions of Partners' HIV Testing Behavior Among Male Couples. AIDS Behav 2020; 24:516-531. [PMID: 31758348 DOI: 10.1007/s10461-019-02740-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Partnered men who have sex with men are not immune to the risk of HIV. Analyzing dyadic data from 360 male couples recruited from April 2016 to June 2017, we examined how relationship characteristics might influence HIV testing behavior and perceptions of partners' HIV testing. Increasing levels of mutual trust were associated with lower odds of both partners (versus neither) having been tested in the past year (aOR = 0.91, 95% CI 0.83-0.99), but increasing levels of communal coping were associated with higher odds (aOR = 1.06, 95% CI 1.02-1.10). Only one partner was more likely to be correct about whether or not his partner had been tested in the past year (versus both) if someone had broken their sexual agreement (aOR = 2.60, 95% CI 1.17-5.76). Increasing differences in trust (aOR = 1.10, 95% CI 1.01-1.20) were also associated with higher odds of only one partner being correct. Dyadic HIV prevention efforts should incorporate skills building around negotiating sexual agreements and constructive communication.
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Stephenson R, Chavanduka TM, Sullivan S, Mitchell JW. Correlates of Successful Enrollment of Same-Sex Male Couples Into a Web-Based HIV Prevention Research Study: Cross-Sectional Study. JMIR Public Health Surveill 2020; 6:e15078. [PMID: 31917373 PMCID: PMC6996732 DOI: 10.2196/15078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background The recognition of the role of primary partners in HIV transmission has led to a growth in dyadic-focused HIV prevention efforts. The increasing focus on male couples in HIV research has been paralleled by an increase in the development of interventions aimed at reducing HIV risk behaviors among male couples. The ability to accurately assess the efficacy of these interventions rests on the ability to successfully enroll couples into HIV prevention research. Objective This study aimed to explore factors associated with successful dyadic engagement in Web-based HIV prevention research using recruitment and enrollment data from a large sample of same-sex male couples recruited online from the United States. Methods Data came from a large convenience sample of same-sex male couples in the United States, who were recruited through social media venues for a Web-based, mixed method HIV prevention research study. The analysis examined the demographic factors associated with successful dyadic engagement in research, measured as both members of the dyad meeting eligibility criteria, consenting for the study, and completing all study processes. Results Advertisements generated 221,258 impressions, resulting in 4589 clicks. Of the 4589 clicks, 3826 individuals were assessed for eligibility, of which 1076 individuals (538/1913, 28.12% couples) met eligibility criteria and were included in the study. Of the remaining 2740 ineligible participants, 1293/3826 (33.80%) were unlinked because their partner did not screen for eligibility, 48/2740 (1.75%) had incomplete partner data because at least one partner did not finish the survey, 22/2740 (0.80%) were ineligible because of 1 partner not meeting the eligibility criteria. Furthermore, 492/3826 (12.86%) individuals were fraudulent. The likelihood of being in a matched couple varied significantly by race and ethnicity, region, and relationship type. Men from the Midwest were less likely to have a partner who did not complete the survey. Men with college education and those who labeled their relationships as husband or other (vs boyfriend) were more likely to have a partner who did not complete the survey. Conclusions The processes used allowed couples to independently progress through the stages necessary to enroll in the research study, while limiting opportunities for coercion, and resulted in a large sample with relative diversity in demographic characteristics. The results underscore the need for additional considerations when recruiting and enrolling, relative to improving the methods associated with these research processes.
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Affiliation(s)
- Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States.,Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Tanaka Md Chavanduka
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stephen Sullivan
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jason W Mitchell
- Office of Public Health Studies, Myron B Thompson School of Social Work, University of Hawai'i at Manoa, Honolulu, HI, United States
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Pantalone DW, Holloway IW, Goldblatt AEA, Gorman KR, Herbitter C, Grov C. The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:147-160. [PMID: 31628628 PMCID: PMC7018565 DOI: 10.1007/s10508-019-01478-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 05/10/2019] [Accepted: 05/30/2019] [Indexed: 05/29/2023]
Abstract
Pre-exposure prophylaxis (PrEP) has altered the public health landscape for gay, bisexual, and other men who have sex with men (GBM) by significantly increasing protection against HIV infection. Early epidemiologic data showed GBM generally used PrEP as prescribed, i.e., as an additional protective tool over and above barrier protection, although subsequent reports have been equivocal. Irrespective of population-level trends, some GBM appear to have reevaluated their HIV risk tolerance and changed their interactions with sex partners. Scant published data have focused on factors that influence PrEP-using GBM's decisions about sexual behavior-including condom use as well as sex with HIV-positive partners-and sexual communication practices. Thus, in this study, we investigated those research concerns qualitatively via content analysis of individual interviews conducted with 103 GBM in New York City (M age 32.5 years, 50% White, 64% on PrEP > 6 months). Emergent themes reflect (1) participants' strong HIV knowledge; (2) changing GBM community norms about condom use on PrEP; (3) increased focus on risk tolerance with individual differences in post-PrEP condom use; (4) appreciation for routine sexually transmitted infection (STI) screening in PrEP care concomitant with some STI knowledge deficits; (5) decreased stigma concerning, and greater comfort with, HIV-positive sex partners; and (6) increased confidence discussing HIV status and condom use preferences with partners. Findings have implications for future research as well as for clinical practice, such as enhanced STI education and provider-initiated discussions about risk compensation, serosorting, and sexual communication skills.
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Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts, Boston, MA, 02125, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Ian W Holloway
- Department of Social Welfare, University of California, Los Angeles, CA, USA
| | | | - Kaitlyn R Gorman
- Department of Psychology, University of Massachusetts, Boston, MA, 02125, USA
| | - Cara Herbitter
- Department of Psychology, University of Massachusetts, Boston, MA, 02125, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
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Algarin AB, Shrader CH, Bhatt C, Hackworth BT, Cook RL, Ibañez GE. The Pre-exposure Prophylaxis (PrEP) Continuum of Care and Correlates to Initiation Among HIV-Negative Men Recruited at Miami Gay Pride 2018. J Urban Health 2019; 96:835-844. [PMID: 31165357 PMCID: PMC6904709 DOI: 10.1007/s11524-019-00362-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While the national HIV infection rate is decreasing, the highest rates of infections continue among men who have sex with men (MSM), particularly minority MSM. It is important to understand attitudes, knowledge, and behaviors surrounding HIV prevention methods, such as pre-exposure prophylaxis (PrEP). In the present study, we created a snapshot of the PrEP continuum of care and identified participant demographic and sources of PrEP awareness factors that were associated with PrEP initiation. Data were collected using anonymous paper-based surveys employing a venue intercept procedure. A total of 188 HIV-negative men completed the survey at Miami Gay Pride 2018. Participants answered questions regarding demographics, PrEP use, and sources of PrEP awareness. The sample was majority Hispanic (55.4%), gay (83.0%), and single (57.7%). The constructed PrEP continuum revealed that a low proportion of those identified as PrEP naïve (n = 143) for HIV infection had PrEP interest (49/143). Moreover, among those who initiated PrEP (n = 45), a high proportion were retained in a PrEP program (37/45), with approximately half achieving medication adherence (25/45). Age group, PrEP knowledge, and source of PrEP awareness were all significantly associated with PrEP initiation. In areas with high HIV infection rates, studies like these offer crucial insight on how public health practitioners should proceed in the goal of decreasing HIV transmission rates. More research is needed to increase PrEP uptake and adherence.
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Affiliation(s)
- Angel B Algarin
- Department of Epidemiology; Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street AHC5, Miami, FL, 33199, USA.
| | - Cho Hee Shrader
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Chintan Bhatt
- Department of Health Promotion and Disease Prevention; Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | | | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology; Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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18
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Robles G, Bosco SC, Dellucci TV, Starks TJ. Integrating intra-individual and dyadic factors in examining health among gay and bisexual men: A narrative review of recent literature. JOURNAL OF GLBT FAMILY STUDIES 2019; 16:488-513. [PMID: 33041710 PMCID: PMC7546157 DOI: 10.1080/1550428x.2019.1682740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current state of the relationship science literature using a health framework, Relationship Process and Health. We conducted a search for articles using PubMed, PsycInfo, and Web of Science for empirical articles in English published in the past 15 years on GBM in a relationship, assessing attachment, and relationship functioning as predictors of health outcomes. We found 649 articles. After screening, 23 articles were identified and reviewed. Findings overwhelming identified HIV risk as the primary health outcome. Attachment was associated with relationship functioning and sexual risk behaviors. Relationship-specific components were largely used as predictors of sexual HIV transmission risk behaviors. Together, these studies suggest that relationship functioning is a prospective link between attachment and health-related outcomes. The literature has yet to examine empirically dyadic-level mechanisms that may explain the association between individual attachment and health outcomes aside from HIV risk, and needs more examination of other health disparities affecting GBM.
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Affiliation(s)
- Gabriel Robles
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Stephen C. Bosco
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Trey V. Dellucci
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Tyrel J. Starks
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave, New York, NY 10065, USA
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Mitchell JW, Wu Y, Gamarel KE. Timing and Sequence of Events: HIV Status Disclosure, Condomless Anal Sex, and Sexual Agreement Formation Among Same-Sex Male Couples. JOURNAL OF SEX RESEARCH 2019; 56:728-739. [PMID: 30295545 DOI: 10.1080/00224499.2018.1523361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the implications for human immunodeficiency virus (HIV) prevention and sexual health, little is known about the timing and chronological order of when same-sex male couples disclose their HIV serostatus, establish a sexual agreement, and first engage in condomless anal sex (CAS) in their relationships. Dyadic data from 357 dyads were used to describe when these respective events occurred; whether members of a couple concurred about when the events happened; and the chronological order of these events. For many, disclosure and CAS happened within the first month, whereas an agreement tended to occur much later (if at all). Couples' concordance of when disclosure and agreement formation happened differed by their serostatus, whereas there was little difference by serostatus for CAS. The chronological order of these events revealed interesting patterns and varied substantially. Although two-thirds of partners reported disclosure had occurred first, some reported events happening on the same day. These findings reveal that the first few months in a same-sex male couple's relationship is a critical time period for when information and decisions about sexual health occur. Suggestions are provided for how current and future HIV prevention efforts could assist couples with their sexual health needs.
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Affiliation(s)
- Jason W Mitchell
- a Myron B. Thompson School of Social Work, Office of Public Health Studies , University of Hawaii at Manoa
| | - Yanyan Wu
- a Myron B. Thompson School of Social Work, Office of Public Health Studies , University of Hawaii at Manoa
| | - Kristi E Gamarel
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health
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20
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Neilands TB, Dworkin SL, Chakravarty D, Campbell CK, Wilson PA, Gomez AM, Grisham KK, Hoff CC. Development and Validation of the Power Imbalance in Couples Scale. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:763-779. [PMID: 29850977 PMCID: PMC6269212 DOI: 10.1007/s10508-018-1190-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 02/28/2018] [Accepted: 03/03/2018] [Indexed: 05/03/2023]
Abstract
Few researchers have quantitatively explored the relationship power-HIV risk nexus in same-sex male couples. We developed and validated the Power Imbalance in Couples Scale (PICS) to measure relationship power among men in same-sex, committed relationships and its association with sexual risk behaviors. We recruited three independent and diverse samples of male couples in the greater San Francisco and New York City metropolitan areas and conducted qualitative interviews (N1 = 96) to inform item development, followed by two quantitative surveys (N2 = 341; N3 = 434) to assess the construct, predictive, convergent, and discriminant validity of the PICS. Exploratory factor analysis of the first survey's data yielded four factors-overtly controlling partner, supportive partner, conflict avoidant actor, and overtly controlling actor-that accounted for more than 50% of the shared variance among the PICS items. Confirmatory factor analysis (CFA) of the second survey's data supported these four factors: χ2(1823) = 2493.40, p < .001; CFI = .96, RMSEA = .03 and WRMR = 1.33. Strong interfactor correlations suggested the presence of a higher-order general perception of power imbalance factor; a higher-order factor CFA model was comparable in fit to the correlated lower-order factors' CFA: χ2(2) = 2.00, p = .37. Internal reliability of the PICS scale was strong: α = .94. Men perceiving greater power imbalances in their relationships had higher odds of engaging in condomless anal intercourse with outside partners of discordant or unknown HIV status (OR 1.27; 95% CI 1.01-1.60; p = .04). The PICS is an important contribution to measuring relationship power imbalance and its sequelae among male couples; it is applicable to research on relationships, sexuality, couples, and HIV prevention.
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Affiliation(s)
- Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Shari L Dworkin
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA
| | - Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Kirk K Grisham
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA.
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Reisner SL, Menino D, Leung K, Gamarel KE. "Unspoken Agreements": Perceived Acceptability of Couples HIV Testing and Counseling (CHTC) Among Cisgender Men with Transgender Women Partners. AIDS Behav 2019; 23:366-374. [PMID: 29936604 DOI: 10.1007/s10461-018-2198-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transgender women (TW) are one of the highest risk groups for HIV infection globally; however, the HIV testing needs of their cisgender (non-transgender) male partners remain largely unknown. This study sought to examine the perceived acceptability of couples HIV testing and counseling (CHTC) for TW-male dyads from the perspective of cisgender men who partner with TW. Between September 2016 and June 2017, 19 cisgender men (mean age = 40.1, SD = 12.8) who currently have, or have ever had a TW partner completed an in-depth semi-structured phone interview and brief survey to gather data on acceptability of CHTC, as well as perceived barriers and facilitators to CHTC for TW-male couples. Qualitative data were thematically analyzed and integrated with survey data. Acceptability of CHTC was high in the sample (89.5%) but was complex and largely contingent on: (1) monogamy and commitment as critical precursors to CHTC acceptability; (2) risk perception and level of comfort with CHTC; (3) understandings of sexual agreements; and (4) personal relationships versus other TW-male relationships. Findings have implications for culturally-adapting and implementing CHTC in real-world settings for TW-male couples, as well as for meeting the individual HIV testing needs of cisgender men who partner with TW.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - David Menino
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Kingsley Leung
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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22
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Concordance in Reported Love, Trust, and Relationship Quality among Same-Sex Male Relationships. ACTA ACUST UNITED AC 2019; 9. [PMID: 31447951 DOI: 10.1017/jrr.2018.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper examines concurrence of self-reported love, trust, and dyadic quality experiences between partners in 293 male couples. Significant yet poor concurrence was observed for all three self-reported relationship measures, but varied by relationship characteristics. Using an actor-partner interdependence model (APIM), actor and partner characteristics were shown to be associated with self-reported relationship concerns, such as satisfaction and intimate partner violence. This knowledge is important in the development and delivery of couples-based health interventions, such as couples HIV testing and counseling, for interventions that respect the unique relationship dynamics of each couple are needed to effectively address dyadic health.
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Gamarel KE, Darbes LA, Hightow-Weidman L, Sullivan P, Stephenson R. The Development and Testing of a Relationship Skills Intervention to Improve HIV Prevention Uptake Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Their Primary Partners (We Prevent): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10370. [PMID: 30602433 PMCID: PMC6746068 DOI: 10.2196/10370] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/12/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Young gay, bisexual, and other men who have sex with men (YMSM) continue to be the group most heavily impacted by HIV in the United States. Substantial evidence indicates that up to two-thirds of new HIV infections occur in the context of a main partnership. Couples HIV testing and counseling (CHTC) has been shown to be a promising and effective strategy for increasing HIV prevention uptake among male couples; however, YMSM who are new to relationships may not have yet developed the efficacy, negotiation, and communication skills to navigate HIV testing in their relationship and communicate around developing a prevention plan. OBJECTIVE This study aims to develop and test a relationship skills-focused HIV prevention intervention for YMSM and their partners. The intervention consists of two telehealth-delivered sessions: the first focuses on relationship skills and the second consists of CHTC and prevention planning. Both sessions are attended by both members of the dyad. METHODS This protocol describes the development of the proposed intervention (We Prevent) and pilot test to examine its feasibility and preliminary efficacy. The intervention will include two motivational interviewing-based sessions: session one is a relationship skills-building session, focused on techniques to explore and build communication skills in a relationship, to help YMSM develop and enhance necessary skills for their current and future relationships; the second session is a CHTC session with YMSM and their partners, to help them develop an HIV prevention plan. Through qualitative data collection and a one-arm pilot with YMSM, we will develop and refine a developmentally appropriate relationship skills session as an addition to the current CHTC intervention. We will then conduct a pilot randomized controlled trial (RCT), comparing the acceptability, feasibility, and preliminary efficacy of the adapted two-session telehealth intervention for YMSM versus a control group receiving one session only-a CHTC session delivered via telehealth. RESULTS The We Prevent intervention is designed to increase uptake of HIV prevention, shown through self-reported reductions in condomless sex and increases in knowledge and uptake of pre-exposure prophylaxis. In addition, the intervention is designed to increase HIV and sexually transmitted infection (STI) testing. STI incidence is examined as a secondary outcome. A cost-input analysis will examine the costs associated with intervention delivery to inform future scale-up of the intervention. CONCLUSIONS Drawing on theory and existing CHTC protocols delivered with video-based counseling, this proposed intervention affords the opportunity to empower YMSM with the skills necessary to communicate with their partners and protect themselves from HIV in their current and future relationships. TRIAL REGISTRATION Clinicaltrials.gov NCT03551938; https://clinicaltrials.gov/ct2/show/NCT03551938 (Archived by WebCite at http://www.webcitation.org/73omJCz1a). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10370.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Lynae A Darbes
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Abstract
A sexual agreement is a mutual understanding between two partners regarding sexual and relational behaviors both within and outside of their relationship. Sexual agreements have been central to research and programming efforts around HIV prevention, primarily for male couples. A comprehensive scoping review of the primary literature on sexual agreements, including negotiated safety, was performed to identify what is known about sexual agreements among couples (n = 66). Results indicate a wide range of prevalence of agreements and measurements used to characterize sexual agreements. Findings also report associations between sexual agreements and health and relational outcomes. Several knowledge gaps were identified; specifically, the need to expand sexual agreements research beyond MSM populations and the need to better understand agreement breaks, break disclosure, and how variation in agreement categorization may impact reported prevalence. This review demonstrates the importance of broadening the evidence-base of sexual agreements research and programmatic focus.
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25
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Starks TJ, Parsons JT. Drug Use and HIV Prevention With Young Gay and Bisexual Men: Partnered Status Predicts Intervention Response. AIDS Behav 2018; 22:2788-2796. [PMID: 29556833 PMCID: PMC6076862 DOI: 10.1007/s10461-018-2091-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Young Men's Health Project (YMHP) has shown efficacy in reducing drug use and condomless anal sex (CAS) with casual partners among young gay, bisexual and other men who have sex with men (YGBMSM). The study examined whether relationship status at the time of intervention predicted response to YMHP by comparing baseline (pre-intervention) and follow-up (3, 6, 9, and 12 months post-intervention) data from the original trial. A group of 13 partnered YGBMSM who received YMHP was compared to a matched subsample of single YGBMSM. Among single men, drug use declined significantly at all follow-ups. Among partnered men, drug use was largely stable. While significant reductions were observed at 9 month assessment, 3, 6, and 12 month use did not differ significantly from baseline. Regardless of relationship status, CAS with casual partners declined significantly at 12 month follow-up. Results suggest the incorporation of components which address relationship factors, particularly those associated with drug use, may enhance benefits of YMHP for partnered YGBMSM.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA.
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA.
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Feinstein BA, Dellucci TV, Sullivan PS, Mustanski B. Characterizing Sexual Agreements With One's Most Recent Sexual Partner Among Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:335-349. [PMID: 30148672 PMCID: PMC6311095 DOI: 10.1521/aeap.2018.30.4.335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Men who have sex with men (MSM) often create sexual agreements with their partners, but little is known about agreements with serious versus causal partners. We used data from 472 young MSM to examine agreements with one's most recent partner, individual differences across types of partnerships and agreements, and predictors of condomless anal sex (CAS). Two-thirds of participants did not have agreements. Monogamous agreements were most common among those who were seriously dating their partner, but also present among those who were casually dating their partner and those who were not dating their partner. Participants who were seriously dating their partner reported the most frequent sexual health communication. Participants without agreements reported the lowest frequency of and comfort with sexual health communication. Participants who were seriously dating their partner and those with monogamous agreements were most likely to report CAS. HIV prevention should address communication with serious and casual partners.
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Affiliation(s)
- Brian A. Feinstein
- Northwestern University, Institute for Sexual and Gender Minority Health and Wellbeing
| | - Trey V. Dellucci
- Center for HIV Educational Studies & Training, Hunter College of the City University of New York
- Health Psychology and Clinical Science Doctoral Training Program, Graduate Center of the City University of New York
| | | | - Brian Mustanski
- Northwestern University, Institute for Sexual and Gender Minority Health and Wellbeing
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
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27
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Sullivan SP, Pingel ES, Stephenson R, Bauermeister JA. "It Was Supposed To Be a Onetime Thing": Experiences of Romantic and Sexual Relationship Typologies Among Young Gay, Bisexual, and Other Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1221-1230. [PMID: 28875247 PMCID: PMC5837906 DOI: 10.1007/s10508-017-1058-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 06/03/2023]
Abstract
Young gay, bisexual, and other men who have sex with men (MSM) are at elevated risk for HIV infection, highlighting the need to understand the elements of prevention and risk associated with their relationships. We employed a phenomenological approach to explore how young MSM become involved in different romantic and sexual experiences. We analyzed 28 semi-structured interviews conducted with young MSM living in Michigan. Using a phenomenological approach, we analyzed the data using an inductive coding strategy and thematic analysis. Participants defined their romantic and sexual interactions with a limited set of partner classifications (e.g., dating, hooking up, friends-with-benefits), but recognized how these classifications were shifting, sometimes unexpectedly so (e.g., a date turning into a hook up and vice versa). Young MSM described relationships in transition that at times defied available typologies or hybridized elements of multiple partner types at once. Based on our analyses, we underscore the need to acknowledge the fluctuating and contextual nature of young MSM's romantic and sexual experiences. We discuss the relevance of our findings in terms of the developmental period of young adulthood and the implications our findings have HIV prevention efforts among young MSM.
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Affiliation(s)
- Stephen P Sullivan
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA.
| | - Emily S Pingel
- Department of Sociology, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA
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John SA, Starks TJ, Rendina HJ, Grov C, Parsons JT. Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men. AIDS Behav 2018. [PMID: 28634660 DOI: 10.1007/s10461-017-1835-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An estimated 35-68% of new HIV infections among gay, bisexual, and other men who have sex with men (GBM) are transmitted through main partnerships. Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV seroconversion, yet PrEP uptake has been modest. PrEP-naïve GBM with HIV-negative, PrEP-naïve main partners enrolled in One Thousand Strong (n = 409), a U.S. national cohort of GBM, were asked about (1) the importance of partner PrEP use and (2) their willingness to convince their partner to initiate PrEP. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP. Personal PrEP uptake willingness and intentions were the strongest indicators of partner PrEP outcomes. Being in a monogamish relationship arrangement (as compared to a monogamous arrangement) and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP.
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Affiliation(s)
- Steven A John
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Tyrel J Starks
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
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29
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Stephenson R, Suarez NA, Garofalo R, Hidalgo MA, Hoehnle S, Thai J, Mimiaga MJ, Brown E, Bratcher A, Wimbly T, Sullivan P. Project Stronger Together: Protocol to Test a Dyadic Intervention to Improve Engagement in HIV Care Among Sero-Discordant Male Couples in Three US Cities. JMIR Res Protoc 2017; 6:e170. [PMID: 28860107 PMCID: PMC5599729 DOI: 10.2196/resprot.7884] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An estimated one- to-two-thirds of new human immunodeficiency virus (HIV) infections among US men who have sex with men (MSM) occur within the context of primary partnerships. Despite this fact, there remains a lack of prevention interventions that focus on male sero-discordant dyads. Interventions that provide male couples with skills to manage HIV risk, and to support each other towards active engagement in HIV prevention and care, are urgently needed. OBJECTIVE The objective of this paper is to describe the protocol for an innovative dyadic intervention (Stronger Together) that combines couples' HIV testing and dyadic adherence counseling to improve treatment adherence and engagement in care among HIV sero-discordant male couples in the United States. METHODS The research activities involve a prospective randomized controlled trial (RCT) of approximately 165 venue- and clinic-recruited sero-discordant male couples (330 individuals: 165 HIV sero-negative and 165 HIV sero-positive). Couples randomized into the intervention arm receive couples' HIV counseling and testing plus dyadic adherence counseling, while those randomized to the control arm receive individual HIV counseling and testing. The study takes place in three cities: Atlanta, GA (study site Emory University); Boston, MA (study site The Fenway Institute); and Chicago, IL (study site Ann & Robert H. Lurie Children's Hospital of Chicago). Cohort recruitment began in 2015. Couples are followed prospectively for 24 months, with study assessments at baseline, 6, 12, 18, and 24 months. RESULTS Stronger Together was launched in August 2014. To date, 160 couples (97% of the target enrollment) have been enrolled and randomized. The average retention rate across the three sites is 95%. Relationship dissolution has been relatively low, with only 13 couples breaking up during the RCT. Of the 13 couples who have broken up, 10 of the 13 HIV-positive partners have been retained in the cohort; none of these HIV-positive partners have enrolled new partners into the RCT. CONCLUSIONS The intervention offers a unique opportunity for sero-discordant couples to support each other towards common HIV management goals by facilitating their development of tailored prevention plans via couples-based HIV testing and counseling, as well as problem-solving skills in Partner Strategies to Enhance Problem-solving Skills (STEPS). TRIAL REGISTRATION ClinicalTrials.gov NCT01772992; https://clinicaltrials.gov/ct2/show/NCT01772992 (Archived by WebCite at http://www.webcitation.org/6szFBVk1R).
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Affiliation(s)
- Rob Stephenson
- Center for Sexual and Health Disparities, University of Michigan, Ann Arbor, MI, United States.,Department of Health Behaviors and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Nicolas A Suarez
- Center for Sexual and Health Disparities, University of Michigan, Ann Arbor, MI, United States.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Robert Garofalo
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marco A Hidalgo
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Samuel Hoehnle
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jennie Thai
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, United States.,Departments of Behavioral and Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Emily Brown
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Anna Bratcher
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Taylor Wimbly
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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30
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Carter A, Lachowsky N, Forrest JI, Cui Z, Sereda P, Kaida A, Armstrong HL, Card KG, Montaner JS, Moore D, Roth EA, Hogg RS. A latent class analysis of sexual and romantic relationships among HIV-positive and HIV-negative gay and bisexual men in Vancouver. CANADIAN JOURNAL OF HUMAN SEXUALITY 2017. [DOI: 10.3138/cjhs.262.a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nathan Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
| | - Jamie I. Forrest
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Zishan Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Paul Sereda
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Heather L. Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Department of Medicine, University of British Columbia, Vancouver, BC
| | - Kiffer G. Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Julio S.G. Montaner
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Department of Medicine, University of British Columbia, Vancouver, BC
| | - David Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Department of Medicine, University of British Columbia, Vancouver, BC
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, Victoria, BC
| | - Robert S. Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
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31
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Stephenson R, Freeland R, Sullivan SP, Riley E, Johnson BA, Mitchell J, McFarland D, Sullivan PS. Home-Based HIV Testing and Counseling for Male Couples (Project Nexus): A Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e101. [PMID: 28559225 PMCID: PMC5470011 DOI: 10.2196/resprot.7341] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND HIV prevalence remains high among men who have sex with men (MSM) in the United States, yet the majority of research has focused on MSM as individuals, not as dyads, and has discussed HIV risks primarily in the context of casual sex. Nexus is an online prevention program that combines home-based HIV testing and couples HIV testing and counseling (CHTC). It allows partners in dyadic MSM relationships to receive HIV testing and care in the comfort of their designated residence, via video-based chat. By using video-based technologies (eg, VSee video chat), male couples receive counseling and support from a remote online counselor, while testing for HIV at home. OBJECTIVE This randomized control trial (RCT) aims to examine the effects of video-based counseling combined with home-based HIV testing on couples' management of HIV risk, formation and adherence to explicit sexual agreements, and sexual risk-taking. METHODS The research implements a prospective RCT of 400 online-recruited male couples: 200 self-reported concordant-negative couples and 200 self-reported discordant couples. Couples in the control arm will receive one or two home-based HIV self-testing kits and will be asked to report their results via the study's website. Couples in the experimental arm will receive one or two home-based HIV self-testing kits and will conduct these tests together under the facilitation of a remotely located counselor during a prescheduled VSee-based video CHTC session. Study assessments are taken at baseline, as well as at 3- and 6-month follow-up sessions. RESULTS Project Nexus was launched in April 2016 and is ongoing. To date, 219 eligible couples have been enrolled and randomized. CONCLUSIONS Combining home-based HIV testing with video-based counseling creates an opportunity to expand CHTC to male couples who (1) live outside metro areas, (2) live in rural areas without access to testing services or LGBTQ resources, or (3) feel that current clinic-based testing is not for them (eg, due to fears of discrimination associated with HIV and/or sexuality). TRIAL REGISTRATION ClinicalTrials.gov NCT02335138; https://clinicaltrials.gov/ct2/show/NCT02335138 (Archived by WebCite at http://www.webcitation.org/6qHxtNIdW).
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Affiliation(s)
- Rob Stephenson
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Ryan Freeland
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Stephen P Sullivan
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Erin Riley
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Brent A Johnson
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Jason Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Deborah McFarland
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States
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32
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Golub SA, Gamarel KE, Lelutiu-Weinberger C. The Importance of Sexual History Taking for PrEP Comprehension Among Young People of Color. AIDS Behav 2017; 21:1315-1324. [PMID: 27475944 PMCID: PMC5280583 DOI: 10.1007/s10461-016-1512-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite demonstrated efficacy, uptake of pre-exposure prophylaxis (PrEP) remains low, especially among highest priority populations. This study examined four PrEP messaging factors hypothesized to impact comprehension of PrEP educational information: (1) modality (video versus in-person message delivery); (2) frame (risk versus health focus); (3) specificity (gist versus verbatim efficacy information); and (4) sexual history (administered either before or after PrEP education). We examined message comprehension among 157 young people of color (YPoC) eligible for PrEP, using a series of multiple choice questions. Overall, 65.6 % (n = 103) got all message comprehension questions correct. In multivariate analyses, engaging in a sexual history before receiving PrEP education was associated with increased odds of message comprehension (aOR 2.23; 95 % CI 1.06-4.72). This effect was even stronger among those who received PrEP education via video (aOR 3.53; 95 % CI 1.16-10.81) compared to via health educator. This research underscores the importance of sexual history-taking as part of PrEP education and clinical practice for YPoC, and suggests that engaging patients in a sexual history prior to providing them with PrEP education may be key to increasing comprehension.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of CUNY, New York, NY, USA.
- Department of Psychology, Graduate Center of CUNY, New York, NY, USA.
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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33
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White D, Grey JA, Gorbach PM, Rothenberg RB, Sullivan PS, Rosenberg ES. Racial Differences in Partnership Attributes, Typologies, and Risk Behaviors Among Men Who Have Sex With Men in Atlanta, Georgia. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:961-975. [PMID: 27169406 PMCID: PMC5106333 DOI: 10.1007/s10508-016-0743-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 05/31/2023]
Abstract
The role of main partnerships in shaping HIV transmission dynamics among men who have sex with men (MSM) has gained recognition in recent studies, but there is little evidence that existing definitions of partnership type are accurate or have consistent meaning for all men. Using data collected from 2011 to 2013 on 693 partnerships described by 193 Black and White MSM in Atlanta, GA, partnership attributes and risk behaviors were examined and compared by race, stratified in two ways: (1) by commonly used definitions of partnerships as "main" or "casual" and (2) by a new data-driven partnership typology identified through latent class analysis (LCA). Racial differences were analyzed using chi-square, Fisher's exact, and Wilcoxon-Mann-Whitney tests. Black participants were less likely to report condomless anal sex (CAS) within partnerships they labeled as main, yet they were also less likely to describe these partnerships as "primary" on a parallel question. In contrast, within strata defined by the LCA-derived typology, most partnership attributes were comparable and the likelihood of CAS was equivalent by race. These findings suggest that classification of partnerships as main or casual does not accurately capture the partnership patterns of MSM, resulting in differential misclassification by race. Future studies and interventions should refine and utilize more evidence-based typologies.
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Affiliation(s)
- Darcy White
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA.
| | - Jeremy A Grey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard B Rothenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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34
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Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017; 14:357-365. [PMID: 28130018 DOI: 10.1016/j.jsxm.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Previous studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association. AIM To explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China. METHODS Three hundred fourteen Chinese MSM participated in a web-based survey. MAIN OUTCOME MEASURES SEM consumption, sexual risk behavior, and measurements of covariates. RESULTS SEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors. CONCLUSION Future research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates. Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357-365.
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Affiliation(s)
- Yin Xu
- Faculty of Psychology, Southwest University, Chongqing, China; Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
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35
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Lelutiu-Weinberger C, Golub SA. Enhancing PrEP Access for Black and Latino Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2016; 73:547-555. [PMID: 27454250 PMCID: PMC5110381 DOI: 10.1097/qai.0000000000001140] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Implementation of HIV pre-exposure prophylaxis (PrEP) programs for populations with highest incidence is critical to reducing new infections in the United States. Black and Latino men who have sex with men (BLMSM) are disproportionately burdened by HIV. We examined differences in perceived barriers and facilitators to PrEP access for BLMSM compared with other men who have sex with men (MSM). METHOD MSM who met the Centers for Disease Control and Prevention criteria for PrEP (n = 491) completed measures of barriers and facilitators to PrEP at the systems, provider, and individual levels. Multivariate analyses examined differences by race/ethnicity, adjusting for other sociodemographic factors. RESULTS Compared with other MSM, BLMSM (56% of the sample) were more likely to have public insurance and to access health care via public clinics [adjusted odds ratio(aOR) 3.2, P < 0.001; aOR 2.4, P < 0.01]. BLMSM were more likely to regard having to talk to their doctor about their sex life as a barrier to PrEP (aOR 3.7, P < 0.001) and were less likely to endorse agency in medical decision making (aOR 0.58, P < 0.001). BLMSM were more likely to report PrEP stigma (aOR 2.3, P < 0.001) and concerns regarding PrEP efficacy (aOR 1.6, P < 0.05). BLMSM were more likely to consider access to free sexual health care (aOR 2.1, P < 0.01) and additional supportive services, eg, counseling (aOR 3.1, P < 0.001) or text-based support (aOR 2.9, P < 0.001) to be significant facilitators of PrEP use. CONCLUSIONS Findings suggest specific points of multilevel intervention to increase PrEP access for BLMSM and increase representation of BLMSM along the PrEP continuum of care.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Basic and Applied Social Psychology PhD program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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Hoff CC, Campbell CK, Chakravarty D, Darbes LA. Relationship-Based Predictors of Sexual Risk for HIV Among MSM Couples: A Systematic Review of the Literature. AIDS Behav 2016; 20:2873-2892. [PMID: 27048237 DOI: 10.1007/s10461-016-1350-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behavioral and epidemiological studies report high risk for HIV among MSM couples. Over the last decade, studies have examined relationship dynamics associated with sexual risk for HIV. It is important to examine the impact this research has had on HIV prevention and what is still needed. We conducted a review of the literature focusing on relationship dynamics associated with sexual risk for HIV among MSM couples. Procedures used for this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses established to provide a framework for collecting, reviewing and reporting studies systematically (Mohler et al. in Ann Intern Med 151(4):264-269, 2009). We found that positive relationship dynamics are associated with less risk with partners outside the relationship, but were associated with greater odds of unprotected anal intercourse with primary partners. We also discuss other factors including sexual agreements about outside partners and make recommendations for next steps in HIV prevention research among MSM couples.
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Affiliation(s)
- Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA.
| | - Chadwick K Campbell
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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Mitchell JW, Sophus AS, Lee JY, Petroll AE. Anal Douche Practices and Willingness to Use a Rectal Microbicide Enema for HIV Prevention and Associated Factors Among an Internet Sample of HIV-Negative and HIV-Discordant Male Couples in the US. AIDS Behav 2016; 20:2578-2587. [PMID: 26597502 PMCID: PMC4877282 DOI: 10.1007/s10461-015-1250-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A significant proportion of MSM acquire HIV from their primary relationship partners. Rectal microbicides are currently being studied to determine their efficacy for HIV prevention, yet willingness to use rectal microbicides among male couples is largely unknown. Dyadic data from 333 HIV-negative and HIV-discordant male couples, representing 631 HIV-negative men, were used to assess anal douching practices and willingness to use a rectal microbicide for HIV prevention. 17 % of men douched 100 % of the time before having anal sex within their primary partner. Among those who had sex outside of their relationship, 36 % had douched 100 % of the time before having anal sex with a casual MSM partner. Most men (63 %) indicated a willingness to use a theoretically effective rectal microbicide prior to anal sex for HIV prevention. If found effective, rectal microbicides delivered as an anal douche may be an acceptable format for HIV prevention to some MSM who already engage in anal douching. Understanding current douching practices will be important in successfully promoting the uptake of rectal microbicides.
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Affiliation(s)
- Jason W. Mitchell
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - Amber S. Sophus
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - Ji-Young Lee
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Division of Infectious Diseases, Medical College of Wisconsin, WI, USA
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Abstract
The majority of HIV prevention studies and programs have targeted individuals or operated at the community level. This has also been the standard approach when incorporating technology (e.g., web-based, smartphones) to help improve HIV prevention efforts. The tides have turned for both approaches: greater attention is now focusing on couple-based HIV prevention and using technology to help improve these efforts for maximizing reach and potential impact. To assess the extent that technology has been used to help advance HIV prevention with couples, a literature review was conducted using four databases and included studies that collected data from 2000 to early 2015. Results from this review suggest that technology has primarily been used to help advance HIV prevention with couples as a tool for (1) recruitment and data collection and (2) intervention development. Challenges and limitations of conducting research (e.g., validity of dyadic data) along with future directions for how technology (e.g., mHealth, wearable sensors) can be used to advance HIV prevention with couples are then discussed. Given the growing and near ubiquitous use of the Internet and smartphones, further efforts in the realm of mHealth (e.g., applications or "apps") and eHealth are needed to develop novel couple-focused HIV-preventive interventions.
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Affiliation(s)
- Jason W Mitchell
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1021, Miami, FL, 33136, USA.
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39
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Bavinton BR, Duncan D, Grierson J, Zablotska IB, Down IA, Grulich AE, Prestage GP. The Meaning of 'Regular Partner' in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey. AIDS Behav 2016; 20:1777-84. [PMID: 26971284 DOI: 10.1007/s10461-016-1354-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.
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Affiliation(s)
- Benjamin R Bavinton
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | | | | - Iryna B Zablotska
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ian A Down
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Garrett P Prestage
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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40
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Mitchell JW, Lee JY, Woodyatt C, Bauermeister J, Sullivan P, Stephenson R. Perceived Challenges and Rewards of Forming a Sexual Agreement Among HIV-Negative Male Couples. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1525-34. [PMID: 26964794 PMCID: PMC4945420 DOI: 10.1007/s10508-016-0701-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 05/11/2023]
Abstract
Sexual agreements, explicit mutual understandings made between two partners about which sexual and related behaviors they agree to engage in within and/or outside of their relationship, are common among male couples. However, little is known about the perceived rewards and challenges partnered men face in the process of forming a sexual agreement. Such knowledge may be useful for the development of future HIV preventive and sexual health programs that encourage male couples to establish a sexual agreement in their relationship. By using qualitative dyadic data from a sample of 29 self-reported concordant HIV-negative male couples who had a sexual agreement, the present qualitative study sought to assess partnered men's perceived rewards and challenges of forming a sexual agreement in their relationship and examine whether both men in the couple concurred about their perceived rewards and challenges of forming a sexual agreement. Themes for perceived rewards were (1) being honest, (2) improving communication, (3) increasing understanding about expectations and permitted behaviors, (4) enhancing intimacy and relational bond, and (5) building trust. Themes for perceived challenges were: (1) stigma about having an open agreement; (2) awkwardness about the topic and talking about it; (3) jealousy; and (4) no perceived challenges. Few couples had both partners concur about their perceived rewards or challenges toward establishing a sexual agreement. The variety of perceived rewards and challenges highlight the need for tailoring given that a variety of factors may influence partnered men's establishment of a sexual agreement in their relationship.
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Affiliation(s)
- Jason W Mitchell
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Ji-Young Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Cory Woodyatt
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - José Bauermeister
- Department of Health Behavior and Health Education, School of Public Health, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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41
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Mitchell JW, Sophus AI. Perceptions and Definitions of Power Within the Context of HIV-Negative Male Couples' Relationships. Am J Mens Health 2016; 11:801-810. [PMID: 26186952 DOI: 10.1177/1557988315596038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Examining dynamics within relationships is critical for development of effective HIV prevention interventions for male couples. The dynamic of power has received little attention in research with male couples, though power has been reported to affect HIV risk among heterosexual couples. To help address this knowledge gap, the present cross-sectional analysis used mixed methods with dyadic data from 142 HIV-negative male couples to (1) assess partnered men's perception of who has the most power in their relationship and why, (2) examine whether partners concur about who has the most power and their reasoning for this selection, and (3) assess whether male couples' concurrence about who has the most power is associated with their engagement of condomless anal sex within and/or outside the relationship, type of relationship, and aspects of their sexual agreement. Individual- and couple-level responses about who has the most power were quantitatively assessed, whereas for why, their responses were coded qualitatively. Fifty-six percent of couples concurred about who has the most power in their relationship and of these, many said it was equal. Regarding why, themes of responses ranged from "compromise" and "shared responsibility" for those who concurred about who has the most power versus "dominant/compliant personality" and "money" among the couples who disagreed about who has the most power in their relationship. Concordance about who has the most power was only associated with condomless anal sex within the relationship. Further research is warranted to examine how power may affect other dynamics of male couples' relationships and risk-related behaviors.
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Affiliation(s)
| | - Amber I Sophus
- 1 University of Miami Miller School of Medicine, Miami, FL, USA
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42
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Conroy AA, Gamarel KE, Neilands TB, Dilworth SE, Darbes LA, Johnson MO. Relationship Dynamics and Partner Beliefs About Viral Suppression: A Longitudinal Study of Male Couples Living with HIV/AIDS (The Duo Project). AIDS Behav 2016; 20:1572-83. [PMID: 27150895 DOI: 10.1007/s10461-016-1423-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Accurate beliefs about partners' viral suppression are important for HIV prevention and care. We fit multilevel mixed effects logistic regression models to examine associations between partners' viral suppression beliefs and objective HIV RNA viral load tests, and whether relationship dynamics were associated with accurate viral suppression beliefs over time. Male couples (N = 266 couples) with at least one HIV-positive partner on antiretroviral therapy completed five assessments over 2 years. Half of the 407 HIV-positive partners were virally suppressed. Of the 40 % who had inaccurate viral load beliefs, 80 % assumed their partner was suppressed. The odds of having accurate viral load beliefs decreased over time (OR = 0.83; p = 0.042). Within-couple differences in dyadic adjustment (OR = 0.66; p < 0.01) and commitment (OR = 0.82; p = 0.022) were negatively associated with accurate viral load beliefs. Beliefs about a partner's viral load may factor into sexual decision-making and social support. Couple-based approaches are warranted to improve knowledge of partners' viral load.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA.
| | - Kristi E Gamarel
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
| | - Samantha E Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
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43
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Mitchell JW, Lee JY, Woodyatt C, Bauermeister J, Sullivan P, Stephenson R. Illuminating the Context and Circumstances of Male Couples Establishing a Sexual Agreement in Their Relationship. Am J Mens Health 2016; 11:600-609. [PMID: 27334670 DOI: 10.1177/1557988316655528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A sexual agreement is an explicit mutual understanding made between two partners about which sexual and relational behaviors they agree to engage in within and/or outside of their relationship. Factors that prompt male couples to form a sexual agreement and under what circumstances remain underinvestigated, yet are important considerations for development of couples-based sexual health and HIV prevention interventions. By using thematic analysis with qualitative dyadic data from a convenience sample of 29 HIV-negative male couples, the present study sought to describe the timing and investigate the context and circumstances that led male couples to establish a sexual agreement in their relationship at both the individual and couple levels, and by agreement type. Themes identified for when a sexual agreement was formed included within the first 6 months, and after 6 months in the relationship. Themes related to context and circumstances of couples' sexual agreement formation were as follows: (a) desire for sexual exploration, (b) arisen circumstances or events with other men, (c) influences from past relationship(s) and/or other couples (i.e., peers), (d) to protect against HIV, and (e) purposeful conversations versus understood. Findings suggest HIV prevention efforts should include skill-building exercises to help improve communication and promote sex positivity within male couples' relationships.
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44
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Relationship Power, Sociodemographics, and Their Relative Influence on Sexual Agreements Among Gay Male Couples. AIDS Behav 2016; 20:1302-14. [PMID: 26391687 DOI: 10.1007/s10461-015-1196-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Men who have sex with men (MSM) in primary relationships engage in condomless sex both within and outside their relationships and a majority of HIV transmission risk may actually occur within primary relationships. Sexual agreements regarding non-monogamy are a critical component to understanding HIV prevention in male couples. Relationship factors have been associated with how sexual agreements function and power is one dyadic construct likely to affect couple's maintenance of non-monogamy agreements. Multilevel modeling was used in a cross-sectional study of gay male couples (N = 566 couples) to examine associations between partners' demographic characteristics traditionally used to define relationship power, a scale of decision-making power, and outcomes related to sexual agreements, including investment, agreement breaks, and break disclosure. Results indicated that decision-making power relative to one's partner was not associated with any agreement outcome, contrary to hypotheses. However, controlling for decision-making power, demographic bases of power were variably associated with sexual agreements' functioning. Younger partners were less invested in and more frequently broke their agreements. Lower-earning partners broke their agreements more frequently, but also disclosed breaks more often. White men in white-minority relationships broke their agreement more often than their partners. Concordant HIV-positive couples were less invested in their agreements and HIV-positive men disclosed breaks more frequently. HIV prevention efforts for same-sex couples must attend to the social, developmental, and cultural influences that affect their agreements around non-monogamy.
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45
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Macapagal K, Greene GJ, Andrews K, Mustanski B. Evaluating the Relationship-Oriented Information, Motivation, and Behavioral Skills Model of HIV Preventive Behaviors in Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:165-179. [PMID: 27459167 PMCID: PMC4965181 DOI: 10.1521/aeap.2016.28.2.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Most HIV infections among young men who have sex with men (YMSM) occur within primary partnerships. Research on YMSM's knowledge, motivation, and behavioral skills regarding relationship-related HIV prevention, and how these correspond to HIV risk and partnership characteristics, is limited. We examined links among the Relationship-Oriented Information- Motivation-Behavioral Skills (RELO-IMB) model, relationship characteristics, and HIV risk in 96 YMSM. Condomless sex with a primary partner was associated with low relationship-related HIV preventive information, motivation, and behavioral skills. Lack of HIV testing and alcohol use before sex were associated with low behavioral skills. In multivariate analyses, behavioral skills were the only consistent predictor of these outcomes. Regarding relationship characteristics, feeling trapped in the relationship or being physically abused by a partner was associated with low motivation and behavioral skills. The RELO-IMB model can be used to understand HIV risk in relationships and points to targets for relationship-specific HIV prevention education for YMSM.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - George J Greene
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Katie Andrews
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
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46
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Mitchell JW. Differences in Relationship Characteristics Between HIV-Negative Male Couples Who Used and Did Not Use Substances with Sex. AIDS Behav 2016; 20:667-78. [PMID: 26223222 PMCID: PMC4733439 DOI: 10.1007/s10461-015-1148-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although substance use is linked to HIV seroconversion, little is known about male couples substance use with sex. The present study sought to: describe whether neither, one, or both partners in the couple used a particular substance with sex within or outside their relationship; assess, by substance type used with sex, whether relationship factors differed between these groups of couples. Dyadic data from 83 behaviorally non-monogamous HIV-negative male couples were used with multinomial regression models. Those who used with sex within the relationship varied by substance type; outside the relationship, most only had one partner who used with sex. Couples with one or both partners who used substances with sex within or outside the relationship were more likely to have higher commitment to their relationship yet less likely to trust their main partner; mixed results were found regarding communication. Further research is warranted toward the need for preventive intervention development.
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Affiliation(s)
- Jason W Mitchell
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1021, Miami, FL, 33136, USA.
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47
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Rodrigue C, Blais M, Lavoie F, Adam BD, Magontier C, Goyer MF. The structure of casual sexual relationships and experiences among single adults aged 18–30 years old: A latent profile analysis. CANADIAN JOURNAL OF HUMAN SEXUALITY 2015. [DOI: 10.3138/cjhs.243-a1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research on casual sexual relationships and experiences (CSREs) has increased in the last decade; however, there is no consensus about the scope and definition of CSREs. To describe the main forms of CSREs, a latent profile analysis was performed on single and sexually active men and women aged from 18 to 30 years old who described their last casual sexual experience. Five profiles were identified: 1) the one-time sexual encounter; 2) the ex-romantic partnership, in which one still has sexual contact after ending their romantic relationship; 3) the mostly about sex partnership, in which contacts are primarily sexual, whether or not a friendship exists; 4) the intimate and sexual partnership, a hybrid of friend and romantic partner with whom one has frequent sexual and social interactions without commitment or intent to form a couple; 5) the friendship first partnership, a friendship to which sex is added, where social activities and friendly interactions dominate. Participants across profiles differed according to the number of sexual partners in the past year, their intention of having other sexual contacts with the partner, being under the influence of alcohol or drugs during the most recent sexual encounter with their partner and their type of sexual exclusivity agreement. This research contributes to a better description and understanding of CSREs among young adults and to further specifying its area of investigation.
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Affiliation(s)
- Carl Rodrigue
- Département de Sexologie, Université du Québec à Montréal, Montreal, QC
| | - Martin Blais
- Département de Sexologie, Université du Québec à Montréal, Montreal, QC
| | | | - Barry D. Adam
- Department of Sociology, Anthropology & Criminology, University of Windsor, Windsor, ON
| | - Céline Magontier
- Département de Sexologie, Université du Québec à Montréal, Montreal, QC
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48
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Mitchell JW, Sophus AI, Petroll AE. HIV-Negative Partnered Men's Willingness to Use Non-Occupational Post-Exposure Prophylaxis and Associated Factors in a U.S. Sample of HIV-Negative and HIV-Discordant Male Couples. LGBT Health 2015; 3:146-52. [PMID: 26789400 DOI: 10.1089/lgbt.2015.0065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Non-occupational post-exposure prophylaxis (nPEP) is an underutilized biomedical option for HIV prevention. Few studies have assessed male couples' knowledge of and willingness to use nPEP. METHODS Cross-sectional dyadic data from 275 HIV-negative and 58 HIV-discordant male couples were used to describe HIV-negative, partnered men's awareness and willingness to use nPEP, and factors associated with their willingness to use nPEP. Data were analyzed with the use of multivariate multilevel modeling. RESULTS Less than a third of the men were aware of nPEP, yet 73% were very-to-extremely likely to use nPEP. Partnered men's willingness to use nPEP was positively associated with having an individual income less than $30,000 USD and serosorting within the relationship. Willingness to use nPEP was negatively associated with greater age difference between primary partners and with higher scores on measures of couples' investment in their relationship. CONCLUSION Efforts should be made to increase male couples' awareness of nPEP and how to access nPEP. Uptake of nPEP has the potential to help avert new HIV infections among male couples.
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Affiliation(s)
- Jason W Mitchell
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Amber I Sophus
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Andrew E Petroll
- 2 Division of Infectious Diseases, Center for AIDS Intervention Research , Medical College of Wisconsin, Milwaukee, Wisconsin
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49
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Stephenson R, White D, Mitchell JW. Sexual agreements and perception of HIV prevalence among an online sample of partnered men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1813-9. [PMID: 26048482 DOI: 10.1007/s10508-015-0532-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 05/22/2023]
Abstract
Stemming from recent evidence that between one- and two-thirds of new HIV transmissions among men who have sex with men (MSM) occur within main partnerships, research and programmatic efforts have begun to recognize the role of the male-male dyad in shaping HIV risk. Central to this new focus has been studies detailing the presence of sexual agreements, which provide guidelines governing permissions around sex with partners outside of the relationship. Using a Facebook-recruited sample of US-partnered MSM (n = 454), this study examines the associations between reporting of sexual agreements and perceptions of HIV prevalence among male sex partners, friends, and local and national MSM populations. Men who perceived that 10-20 % (OR 6.18, 95 % CI 1.28-29.77) and >20 % of their male sex partners were HIV positive (OR 2.68, 95 % CI 1.02-7.08) had significantly higher odds of reporting having an open agreement with their current main partner than men who perceived that less than 10 % of their male sex partners were HIV positive. Partnered men with open sexual agreements may have more sexual partners than those who report monogamy, possibly leading to heightened perceptions of HIV risk, which may result in reporting of perceptions of greater local HIV prevalence. Additionally, men who have made agreements with their partners may have done so due to concerns about HIV risks, and may also be more aware of increased risks of HIV infection, or may have greater knowledge of HIV prevalence through discussions of serostatus with sex partners. Attention is needed to develop prevention efforts, such as toolkits and resources that enable men to form sexual agreements that are based on comprehensive knowledge of the potential risks for acquisition of HIV.
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Affiliation(s)
- Rob Stephenson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA,
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50
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Starks TJ, Newcomb ME, Mustanski B. A longitudinal study of interpersonal relationships among lesbian, gay, and bisexual adolescents and young adults: mediational pathways from attachment to romantic relationship quality. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1821-1831. [PMID: 26108898 PMCID: PMC4831206 DOI: 10.1007/s10508-015-0492-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/16/2015] [Accepted: 01/17/2015] [Indexed: 06/01/2023]
Abstract
The current study examined the potential for mental health to mediate associations between earlier attachment to parents and peers and later relationship adjustment during adolescence and young adulthood in a sample of sexual minority youth. Secondarily, the study examined associations between peer and parental attachment and relationship/dating milestones. Participants included 219 lesbian, gay, and bisexual youth who participated in six waves of data collection over 3.5 years. Parental attachment was associated with an older age of dating initiation, while peer attachment was associated with longer relationship length. Both peer and parental attachment were significantly associated with mental health in later adolescence and young adulthood. Mental health mediated the association between peer attachment and main partner relationship quality. While the total indirect effect of parental attachment on main partner relationship quality was statistically significant, specific indirect effects were not. Implications for the application of attachment theory and integration of interpersonal factors into mental health intervention with sexual minority youth are discussed.
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Affiliation(s)
- Tyrel J Starks
- Center for HIV/AIDS Educational Studies and Training, 142 W 36th St. 9th Floor, New York, NY, 10018, USA,
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