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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 2024:10.1007/s10508-024-02915-4. [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] [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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Fu R, Hou J, Gu Y, Yu NX. Do Couple-Based Interventions Show Larger Effects in Promoting HIV Preventive Behaviors than Individualized Interventions in Couples? A Systematic Review and Meta-analysis of 11 Randomized Controlled Trials. AIDS Behav 2023; 27:314-334. [PMID: 35838860 DOI: 10.1007/s10461-022-03768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
This systematic review and meta-analysis aims to compare the effects of couple-based prevention interventions against individual-level interventions on HIV prevention in randomized controlled trials (RCTs), identify potential moderators, and assess study quality. Eleven RCTs were included, comprising 3933 couples in the intervention group and 7125 individuals in the individual control group, predominantly in heterosexual couples from the USA and Africa. Couple-based interventions had a more significant effect in promoting condom use and HIV testing. Education levels of high school or above, residence in low- and middle-income countries, and intervention design incorporating HIV counseling and testing were associated with higher odds of condom use. The quality assessment analysis identified methodological and theoretical heterogeneity factors. Evidence of couple-based HIV prevention RCTs among men who have sex with men, injecting drug users, sex workers, and transgender women warrant further investigation. Recommendations are made to improve the quality and replicability of future intervention studies.
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Affiliation(s)
- Rong Fu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China.
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Liboro RM, Yates TC, Bell S, Ranuschio B, Da Silva G, Fehr C, Ibañez-Carrasco F, Shuper PA. Protective Factors That Foster Resilience to HIV/AIDS: Insights and Lived Experiences of Older Gay, Bisexual, and Other Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168548. [PMID: 34444297 PMCID: PMC8394869 DOI: 10.3390/ijerph18168548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS based on the insights and lived experiences of racially and ethnically diverse, older gbMSM. Applying a community-based participatory research approach that included the meaningful involvement of older gbMSM living with HIV/AIDS in different roles (i.e., advisory committee member, collaborator, peer researcher, and participant), the study recruited and included forty-one older gbMSM living with HIV/AIDS from Ontario, Canada, in confidential, semi-structured interviews. Utilizing thematic analysis, we identified three major themes from the participant interviews as factors that fostered the resilience of older gbMSM to HIV/AIDS and helped to address HIV/AIDS health disparities: (1) established protective factors, (2) behavioral protective factors, and (3) controversial protective factors. This paper argues for the importance of valuing and capitalizing on these protective factors in the conceptualization and development of interventions, services, and programs that are dedicated to fostering resilience to HIV/AIDS.
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Affiliation(s)
- Renato M. Liboro
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
- Correspondence:
| | | | - Sherry Bell
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
| | - Brandon Ranuschio
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
| | - George Da Silva
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
| | - Charles Fehr
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
| | | | - Paul A. Shuper
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
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Walsh AR, Stephenson R. Assessing the Reliability of Self-Reported Sexual Behavior Among Male Couples. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1067-1086. [PMID: 33564980 DOI: 10.1007/s10508-020-01857-x] [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: 01/16/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 06/12/2023]
Abstract
Coupled gay, bisexual, and other men who have sex with men (GBMSM) are at particularly high risk for HIV, and a clear understanding of behavioral risk is key to effective interventions. Accurate behavioral self-reports are a crucial component of valid sexual health research, yet reliability of these data remains understudied. This study aimed to quantify and identify predictors of dyadic discordance in reported 3-month anal intercourse (AI) occurrence and frequency. Using cross-sectional data from 407 male couples in the U.S. (2016-2017), we calculated proportional dyadic concordance and used dyad-level logistic and linear regression to identify demographic, behavioral, and relationship traits associated with the odds of discordant frequency reports and the relative difference between discordant partner reports. Couples had high levels of concordant reports of 3-month anal AI occurrence (97%) but low interpartner agreement in reported frequency (37%). After adjustment, the odds of discordance were significantly associated with dyadic employment and differences on the Communal Coping to Reduce HIV Threat Scale (CCS) (p < .05). Among frequency-discordant couples, the mean relative difference between partner reports was 52.80% ± 35.91% (M ± SD). After adjustment, relative differences between partners' reported AI frequencies were positively associated with interpartner differences in CCS (p < .05). These results indicate that among GBMSM couples in committed partnerships, self-reported sexual behavior data may be impacted by granularity, recall, and relationship characteristics. Further research in this area is warranted to better understand measurement error in self-reported sexual activity data.
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Affiliation(s)
- Alison R Walsh
- Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls St., Ann Arbor, MI, 48109, USA.
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls St., Ann Arbor, MI, 48109, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
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