1
|
Newcomb ME, Swann G, Macapagal K, Sarno E, Whitton SW, Mustanski B. Biomedical and behavioral outcomes of 2GETHER: A randomized controlled trial of a telehealth HIV prevention program for young male couples. J Consult Clin Psychol 2023; 91:505-520. [PMID: 37141032 PMCID: PMC10729837 DOI: 10.1037/ccp0000823] [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: 05/05/2023]
Abstract
OBJECTIVE This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing risk for HIV. METHOD We conducted a comparative effectiveness randomized controlled trial of 2GETHER, a five-session hybrid group- and couple-based intervention delivered via videoconference, relative to a single-session HIV testing and risk reduction counseling protocol delivered to couples. We randomized 200 young male couples (N = 400) to 2GETHER or control from 2018 to 2020. Primary biomedical (i.e., rectal Chlamydia and Gonorrhea infection) and behavioral outcomes (i.e., condomless anal sex [CAS]) were measured at 12-months postintervention. Secondary outcomes were other HIV prevention and risk behaviors, relationship quality, and substance use. Multilevel regression was used to model intervention outcomes to account for clustering within couples. Postintervention change over time was modeled as a latent linear growth curve at the within-persons level. RESULTS We observed significant intervention effects on primary biomedical and behavioral HIV risk outcomes. Participants in 2GETHER had significantly lower odds of rectal STIs at 12-months relative to control. We also observed significantly steeper declines in the number of CAS partners and acts from baseline to 12-month follow-up in 2GETHER relative to control. Few differences were observed for secondary relationship and HIV-related outcomes. CONCLUSIONS 2GETHER is an efficacious intervention that has a significant impact on both biomedical and behavioral HIV prevention outcomes among male couples. Couple-based HIV prevention programs enhanced with evidence-based relationship education may effectively reduce the most proximal predictors of HIV infection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elissa Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah W. Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
2
|
Stephenson R, Chavanduka TMD, Sullivan S, Mitchell JW. Partner Support and Communication for Pre-exposure Prophylaxis (PrEP) Use Among Male Couples. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2549-2562. [PMID: 34799830 DOI: 10.1007/s10508-021-02118-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Between one to two-thirds of HIV infections among gay, bisexual, and other men who have sex with men are from primary partners, and there has been increased research attention focused on strategies to increase PrEP adoption among male couples. While there is evidence that partner support is a strong correlate of pre-exposure prophylaxis (PrEP) adoption, there has been a lack of attention on PrEP communication dynamics among male couples. In this paper, we build upon this literature through analysis of dyadic data from a large cross-sectional survey of 543 concordant sero-negative and serodiscordant male couples to examine individual and relationship factors associated with reports of partner communication around PrEP, comfort in discussing PrEP, and perceived partner-level support for PrEP use. PrEP use was relatively low (16.2%), and although 87.5% of men reported their partners would support their PrEP use, only 26.3% had talked to their partner recently about PrEP. PrEP communication and perceived support for PrEP were significantly negatively associated with PrEP stigma and stigma based on sexuality (i.e., internalized homophobia and enacted external stigma based on sexuality), while men with sexual agreements were more comfortable talking about PrEP with their partner. There is a need to adapt current interventions, or develop new dyadic interventions, that provide opportunities for male couples to talk and learn about PrEP together, as a potential pathway to engage them toward PrEP use.
Collapse
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.
| | - Tanaka M D Chavanduka
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, 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
| | - Jason W Mitchell
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| |
Collapse
|
3
|
Pre-Exposure Prophylaxis Stigma and Beliefs in the Efficacy of Pre-Exposure Prophylaxis: An Analysis of a Cross-Sectional Survey of Male Couples in the United States. J Assoc Nurses AIDS Care 2021; 33:406-420. [PMID: 34812796 DOI: 10.1097/jnc.0000000000000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Increasing the use of pre-exposure prophylaxis (PrEP) among male couples is critical to the success of the United States' Ending the HIV Epidemic campaign. By leveraging dyadic data from a larger cross-sectional study of male couples, the present analysis examined individual, partner, and relationship characteristics associated with PrEP stigma and perceived efficacy of PrEP. Actor-Partner Independence Models were fit separately for both outcomes. Individual and partner risk behaviors, including substance use, binge drinking, and higher number of condomless casual sex partners, were associated with lower levels of both PrEP stigma and belief in the efficacy of PrEP. Networks that supported PrEP use were associated with decreased PrEP stigma and increased belief in PrEP efficacy. Stigma-informed PrEP interventions for couples should be considered foundational to the success of the United States' Ending the HIV Epidemic campaign.
Collapse
|
4
|
Godfrey LM, Whitton SW, Dyar C, Newcomb ME, Mustanski B. Sexual Agreements Among Young Sexual and Gender Minorities Assigned Male at Birth: Associations with Relationship Quality and Break-Up. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1035-1045. [PMID: 32691255 PMCID: PMC7855777 DOI: 10.1007/s10508-020-01781-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2020] [Accepted: 06/20/2020] [Indexed: 05/08/2023]
Abstract
Previous studies have shown that sexual non-monogamy is not associated with lower relationship satisfaction among adult male same-sex couples and may therefore be a viable alternative to monogamy. However, sexual minority men with non-monogamous agreements have reported lower commitment and trust in their relationships than those with monogamous agreements-potentially raising their risk of break-up. In this study, we investigated whether sexual agreements (monogamous, non-monogamous, or no sexual agreement) were associated with relationship quality and rates of break-up over 1 year in a sample of 338 young sexual and gender minorities assigned male at birth (SGM-AMAB). Participants reported their sexual agreement and indices of relationship quality (satisfaction, trust, and commitment) at baseline, as well as their relationship status (intact or broken up) at 6- and 12-month follow-up. Results showed no significant differences by sexual agreement in concurrent trust, but participants with monogamous agreements reported higher satisfaction and commitment than those with non-monogamous agreements or no sexual agreement. Despite these significant differences in relationship quality, there were no significant differences in rates of break-up at 6- or 12-month follow-up across the sexual agreement types. However, having a monogamous agreement was indirectly associated with lower rates of break-up through relationship commitment. Although results were mixed, findings provide some preliminary support that young SGM-AMAB in relationships with monogamous agreements may have higher satisfaction and commitment at early relationship stages, and that monogamous agreements may be a protective factor against break-up over 1 year through the mechanism of relationship commitment.
Collapse
Affiliation(s)
- Lisa M Godfrey
- Department of Psychology, University of Cincinnati, Mail Center 0376, Cincinnati, OH, 45221-0376, USA.
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Mail Center 0376, Cincinnati, OH, 45221-0376, USA
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Mónaco E, de la Barrera U, Montoya-Castilla I. The Effectiveness of EMOVERE: An Emotional Education Program for Young Couples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1677. [PMID: 33572448 PMCID: PMC7916226 DOI: 10.3390/ijerph18041677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Our aim was to assess the effectiveness of EMOVERE, a psychoeducational and experiential program to increase emotion regulation in couples. Forty-four young couples (n = 88) aged between 18 and 36 years old participated in the study (53.4% women; M = 24.18; SD = 4.34). Twenty-two couples belonged to the experimental group (received the intervention) and 22 to the control group (received no intervention). The intervention program consisted of seven two-hour sessions over a month, in groups of four to five couples. The variables studied were sociodemographic characteristics, emotional intelligence (TMMS-24), emotional inter-regulation with the partner (SIERC), attachment (ECR-S) and satisfaction with the relationship (RAS). The proposed design was quasi-experimental, with two randomized groups (experimental and control group) and longitudinal data from two occasions. SPSS version 24.0 was used to perform analysis of variance (MANOVA and MANCOVA), multiple hierarchical regression and reliable change index. PROCESS was also used for moderation analyses. The results indicate that the program is effective in increasing emotional self-regulation and emotion regulation with the partner, as well as reducing couples' avoidance of intimacy. Age, relationship duration and previous relationship satisfaction moderate the effectiveness of the program. The importance of continuing this research line to address well-being of young populations is discussed.
Collapse
Affiliation(s)
| | | | - Inmaculada Montoya-Castilla
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, 46010 Valencia, Spain; (E.M.); (U.d.l.B.)
| |
Collapse
|
6
|
Westmoreland DA, D’Angelo A, Nash D, Grov C. Individual and Partner Characteristics Associated With Intentions to Use PrEP Among Partnered Men, Trans Men, and Trans Women in Sero-Concordant and -Discordant Relationships in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:367-377. [PMID: 33112677 PMCID: PMC7597370 DOI: 10.1521/aeap.2020.32.5.367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite proven effectiveness in reducing HIV transmission, pre-exposure prophylaxis (PrEP) use remains low among those who meet the recommended CDC guidance for PrEP use. Data are from a U.S. national cohort of men and trans persons who have sex with men (2017-2018). Logistic regression analyses were used to determine individual and partner factors associated with intentions to use PrEP among non-PrEP-using participants reporting a main partner (n = 1,671). Prior PrEP use among participants (14.2%) and their partners (7.7%) was low. Participants' prior PrEP use and main partner's HIV-positive status were both positively associated with intentions to use PrEP. HIV prevention interventions incorporating main partners may be effective in increasing PrEP use.
Collapse
Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Alexa D’Angelo
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| |
Collapse
|
7
|
Newcomb ME, Sarno EL, Bettin E, Carey J, Ciolino JD, Hill R, Garcia CP, Macapagal K, Mustanski B, Swann G, Whitton SW. Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER. JMIR Res Protoc 2020; 9:e15883. [PMID: 32012111 PMCID: PMC7011124 DOI: 10.2196/15883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/12/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID) DERR1-10.2196/15883
Collapse
Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Elissa L Sarno
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Emily Bettin
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - James Carey
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Ricky Hill
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Christopher P Garcia
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Gregory Swann
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
8
|
Robles G, Dellucci TV, Stratton MJ, Jimenez RH, Starks TJ. The Utility of Index Case Recruitment for Establishing Couples' Eligibility: An Examination of Consistency in Reporting the Drug Use of a Primary Partner Among Sexual Minority Male Couples. ACTA ACUST UNITED AC 2019; 8:221-232. [PMID: 32395393 DOI: 10.1037/cfp0000128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sexual minority men are disproportionately impacted by substance use, which is associated with greater HIV transmission behaviors. Novel approaches to drug use prevention and treatment are needed. Couple-based approaches have garnered significant attention. The recruitment of couples into substance use interventions has proven challenging. We evaluate an index-case approach to screening participants in couples' research. Seventy index cases, aged 18-29, and their main partner (140 individuals), were recruited. At screening, index participants reported their drug use and their partners' drug use for the previous 30 days. At baseline, both partners reported their drug use over the past 30 days. Individuals' self-reports and perceptions of their partner's concurrency were compared within couples using the κ (Kappa) coefficient. We found high levels of personal predictive accuracy from screening to baseline for cannabis (κ = .81, p < .01) and cocaine/crack (κ = .70, p < .01). Predictive accuracy of index case reporting of their partner's drug use behavior were moderately high among cocaine/crack use (κ = .68, p < .01) and MDMA/GHB/Ketamine (κ = .56, p < .01). Perceived partner similarity for recent drug use was also high for all drugs, with the highest levels among cocaine/crack (κ =.82) and prescription drugs (κ =.81). This study demonstrates that index partners report drug use with differing levels of agreement between drug types. Index recruitment has advantages in determining drug use-related eligibility requirements. Discrepancies in reporting were more frequently false positives, which reduces the risk of screening out potentially eligible couples.
Collapse
Affiliation(s)
- Gabriel Robles
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
| | - Mark J Stratton
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA.,Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
| |
Collapse
|
9
|
Sloan CA, Shipherd JC. An Ethical Imperative: Effectively Reducing SGM Disparities Utilizing a Multi-Level Intervention Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|