Abstract
Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples’ attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples’ attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were “somewhat” to “very likely” to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Appleby, P. R., Miller, L. C., & Rothspan, S. (1999). The paradox of trust for male couples: When risking is a part of loving. Personal Relationships, 6, 81–93.
Blais, M. (2006). Vulnerability to HIV among regular male partners and the social coding of intimacy in modern societies. Culture, Health, & Sexuality, 8, 31–44.
Burton, J., Darbes, L. A., & Operario, D. (2010). Couples-focused behavioral interventions for prevention of HIV: Systematic review of the state of evidence. AIDS and Behavior, 14, 1–10.
Catania, J. A., Gibson, D. R., Chitwood, D. D., & Coates, T. J. (1990). Methodological problems in AIDS behavioral research: Influences on measurement error and participation bias in studies of sexual behavior. Psychological Bulletin, 108, 339–362.
Centers for Disease Control and Prevention (CDC). (2012). HIV incidence. Accessed from http://www.cdc.gov/hiv/topics/surveillance/incidence.htm. Accessed 23 May 2013.
Chakravarty, C., Hoff, C. C., Neilands, T. B., & Darbes, L. A. (2012). Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS and Behavior, 16, 1944–1948.
Christensen, A., & Shenk, J. L. (1991). Communication, conflict, and psychological distance in non-distressed, clinic, and divorcing couples. Journal of Consulting and Clinical Psychology, 59, 458–463.
Coates, T. J. (2008). What is to be done? AIDS, 22, 1079–1080.
Darbes, L. A., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Hoff, C. C. (2012). Partner provided social support influences choice of risk reduction strategies in gay male couples. AIDS and Behavior, 16, 159–167.
Davidovich, U., de Wit, J. B. F., Albrecht, N., Geskus, R., Stroebe, W., & Coutinho, R. (2001). Increase in the share of steady partners as a source of HIV infection: A 17-year study of seroconversion among gay men. AIDS, 15, 1303–1308.
Davidovich, U., de Wit, J. B. F., & Stroebe, W. (2000). Assessing sexual risk behavior of young gay men in primary relationships: The incorporation of negotiated safety and negotiated safety compliance. AIDS, 14, 701–706.
Davidovich, U., de Wit, J. B. F., & Stroebe, W. (2004). Behavioral and cognitive barriers to safer sex between men in steady relationships: Implications for prevention strategies. AIDS Education and Prevention, 16, 304–314.
Davidovich, U., de Wit, J. B. F., & Stroebe, W. (2006). Relationship characteristics and risk of HIV infection: Rusbult’s investment model and sexual risk behavior of gay men in steady relationships. Journal of Applied Social Psychology, 36, 22–40.
de Vroome, E. M. M., Stroebe, W., Sandfort, T. G. M., de Wit, J. B. F., & Van Griensven, G. J. P. (2000). Safer sex in social context: Individualistic and relational determinants of AIDS-preventive behavior among gay men. Journal of Applied Social Psychology, 30, 2322–2340.
El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Hunt, T., & Remien, R. H. (2010). Couples-based HIV prevention in the United States: Advantages, gaps and future directions. Journal of Acquired Immune Deficiency Syndrome, 55, S98–S101.
Elford, J., Bolding, G., Maguire, M., & Sherr, L. (1999). Sexual risk behaviour among gay men in a relationship. AIDS, 13, 1407–1411.
Gass, K., Hoff, C. C., Stephenson, R., & Sullivan, P. S. (2012). Sexual agreements in the partnerships of Internet-using men who have sex with men. AIDS Care, 24, 1255–1263.
Gomez, A. M., Beougher, S. C., Chakravarty, D., Neilands, T. B., Mandic, C. G., Darbes, L. A., et al. (2012). Relationship dynamics as predictors of broken sexual agreements about outside sexual partners: Implications for HIV prevention among gay couples. AIDS and Behavior, 16, 1584–1585.
Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., Sanchez, J., Grinsztejn, B., … Buchbinder, S. P. (2012). What drives the US and Peruvian epidemics in men who have sex with men (MSM)? PLoS One, 7(11), e50522.
Grossman, C. I., Forsyth, A., Purcell, D. W., Allison, S., Toledo, C., & Gordon, C. M. (2011). Advancing novel HIV prevention intervention research with MSM—Meeting report. Public Health Reports, 126, 472–479.
Hageman, K. H., Tichacek, A., & Allen, S. (2009). Couples voluntary counseling and testing. In K. H. Mayer & H. F. Pizer (Eds.), HIV prevention: A comprehensive approach (pp. 240–266). London: Academic Press.
Herbst, J. H., Beeker, C., Mathew, A., McNally, T., Passin, W. F., Kay, L. S., … Task Force on Community Preventive Services. (2007). The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men. American Journal of Preventive Medicine, 32, 38–67.
Hoff, C. C., & Beougher, S. C. (2008). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39, 774–787.
Hoff, C. C., Chakravarty, D., Beougher, S. C., Darbes, L. A., Dadasovich, R., & Neilands, T. B. (2009). Serostatus differences and agreements about sex with outside partners among gay male couples. AIDS Education and Prevention, 21, 25–38.
Kenny, D., Kashy, D., & Cook, W. (2006). Dyadic data analysis. New York: Guilford Press.
Kippax, S., Slavin, S., Ellard, J., Hendry, O., Richters, J., Grulich, A., et al. (2003). Seroconversion in context. AIDS Care, 15, 839–852.
McLean, J., Boulton, M., Brookes, M., Lakhani, D., Fitzpatrick, R., Dawson, J., … Hart, G. (1994). Regular partners and risky behaviour: Why do gay men have unprotected intercourse? AIDS Care, 6, 331–341.
McNeal, J. L. (1997). The association of idealization and intimacy factors with condom use in gay male couples. Journal of Clinical Psychology in Medical Settings, 4, 437–451.
Mitchell, J. W. (2013). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research,. doi:10.1080/00224499.2012.727915.
Mitchell, J. W., Champeau, D., & Harvey, S. M. (2012a). Actor–partner effects of demographic and relationship factors associated with HIV risk within gay male couples. Archives of Sexual Behavior, 42, 1337–1345.
Mitchell, J. W., Harvey, S. M., Champeau, D., Moskowitz, D. A., & Seal, D. W. (2012b). Relationship factors associated with gay male couples’ concordance on aspects of their sexual agreements: Establishment, type, and adherence. AIDS and Behavior, 16, 1560–1569.
Mitchell, J. W., Harvey, S. M., Champeau, D., & Seal, D. W. (2012c). Relationship factors associated with HIV risk among a sample of gay male couples. AIDS and Behavior, 16, 404–411.
Mitchell, J. W., & Petroll, A. E. (2012a). Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases, 39, 871–876.
Mitchell, J. W., & Petroll, A. E. (2012b). HIV testing rates and factors associated with recent HIV testing among male couples. Sexually Transmitted Diseases, 39, 379–381.
Mitchell, J. W., & Petroll, A. E. (2012c). Factors associated with men in HIV-negative gay couples who practiced UAI within and outside of their relationship. AIDS and Behavior, 17, 1329–1337.
Neilands, T. B., Chakravarty, D., Darbes, L. A., Beougher, S. C., & Hoff, C. C. (2009). Development and validation of the Sexual Agreement Investment scale. Journal of Sex Research, 47, 24–37.
Office of National AIDS Policy. (2010). National HIV/AIDS Strategy for the United States. http://www.whitehouse.gov/administration/eop/onap/nhas. Accessed 23 May 2013.
Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and longitudinal modeling using Stata. College Station, TX: Stata Press.
Rempel, J. K., Holmes, J. G., & Zanna, M. P. (1985). Trust in close relationships. Journal of Personality and Social Psychology, 49, 95–112.
Rusbult, C. E., Martz, J. M., & Agnew, C. A. (1998). The Investment Model scale: Measuring commitment level, satisfaction level, quality of alternatives, and investment size. Personal Relationships, 5, 357–391.
Stephenson, R., Rentsch, C., Sullivan, P., McAdams-Mahmoud, A., Jobson, G., Struthers, H., et al. (2012). Attitudes toward couples-based HIV counseling and testing among MSM in Cape Town, South Africa. AIDS and Behavior, 17, S43–S50.
Stephenson, R., Sullivan, P. S., Salazar, L. F., Gratzer, B., Allen, S., & Seelbach, E. (2011). Attitudes toward couples-based HIV testing among MSM in three US cities. AIDS and Behavior, 15, S80–S87.
Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23, 1153–1162.
Wagenaar, B. H., Christiansen-Lindquist, L., Khosropour, C., Salazar, L. F., Benbow, N., Prachand, N., … Sullivan, P. S. (2012). Willingness of US men who have sex with men (MSM) to participate in couples HIV voluntary counseling and testing (CVCT). PLoS One, 7, e42953.
Worth, H., Reid, A., & McMillan, K. (2002). Somewhere over the rainbow: Love, trust in monogamy in gay relationships. Journal of Sociology, 38, 237–253.
Xiridou, M., Geskus, R., de Wit, J., Coutinho, R., & Kretzschmar, M. (2003). The contribution of steady and causal partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS, 17, 1029–1038.
Acknowledgments
Data collected for this article was supported by the center (P30-MH52776) and NRSA (T32-MH19985) grants from the National Institute of Mental Health. Special thanks are extended to the participants for their time and effort.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mitchell, J.W. Gay Male Couples’ Attitudes Toward Using Couples-Based Voluntary HIV Counseling and Testing. Arch Sex Behav 43, 161–171 (2014). https://doi.org/10.1007/s10508-013-0211-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-013-0211-0