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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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2
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Starks TJ, Stewart JL, Gupta SK, Hillesheim JR, Cain D. A Qualitative Analysis of Shared Values and Motivation for Change Expressed by Sexual Minority Men in Relationships: Use of the Personal Values Card Sort Activity During Motivational Interviewing Sessions Addressing Drug Use and Sexual Health. AIDS Behav 2024:10.1007/s10461-024-04392-1. [PMID: 38850332 DOI: 10.1007/s10461-024-04392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
The development of tailored interventions that address drug use and sexual risk taking among sexual minority men (SMM) in relationships has garnered increasing interest over the past 20 years. Motivational interviewing (MI) has demonstrated promise in both individual and couples-based applications. The Personal Values Card Sort activity is commonly employed in these interventions; however, relatively little is known about the content of client responses evoked by this intervention task. This study examined how SMM in relationships characterize their values; how their relationship partners influence value attainment; and how they situated drug use and sexual risk taking in the context of their values and primary relationships. A qualitative analysis of intervention transcripts from sessions with 47 SMM aged 18 to 34 was conducted. All respondents were HIV negative and indicated recent (past 30 days) drug use and sexual risk behavior. Participants' high priority values reflected a focus on clarifying personal identity and interpersonal relationships. Values manifested as realized, aspirational, or transformed. Participants described their partners as supporting goal attainment and as a companion with whom they cope with goal-related stressors. Consistent with interdependence theory, participants' responses indicated consideration of their partner and relationship when these aligned with and supported goal-attainment. Conversely, when partners were described as a barrier to realizing their values, participants characterized their relationship as being of lower quality. Implications of this content for the activation of motivation for health behavior are discussed with specific emphasis on applications with SMM in relationships.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Graduate Program in Health Psychology and Clinical Practice, Graduate Center, City University of New York, New York, NY, USA.
| | - J L Stewart
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sugandha K Gupta
- Department of Psychiatry and Human Behavior, the Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph R Hillesheim
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
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3
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Hillesheim JR, Starks TJ. Drug use and condomless sex among sexual minority men in relationships: Whether relationship quality is a risk or protective factor depends upon what they believe their partners do. Soc Sci Med 2024; 351:116941. [PMID: 38749254 DOI: 10.1016/j.socscimed.2024.116941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 06/17/2024]
Abstract
Sexual minority male (SMM) couples tend toward behavioral similarity around cannabis use, illicit drug use, and sex with casual partners. Similarity in these behaviors may contextualize associations with relationship quality. This study tested the hypotheses that perceptions of partner (cannabis and illicit) drug use and sexual behavior would predict personal drug use and sexual behavior as well as moderate the association between relationship quality and these health outcomes. Recruitment via social networking applications yielded a sample of 5511 cisgender SMM aged 18-85 (M = 38.21, SD = 12.16) who were in a relationship with an adult cisgender male main partner. Respondents completed an online survey assessing their own cannabis use, illicit drug use, and condomless anal sex (CAS) with casual partners during the past 30 days as well as their belief about their partner's engagement in these behaviors. Three subscales of the Perceived Relationship Quality Components (PRQC) scale assessed relationship quality. Across the observed range of PRQC scores participants who reported their partner used cannabis, used other illicit drugs, and had recent CAS with a casual partner were more likely to report engaging in these activities themselves. Among participants who indicated their partner did not engage in these activities, relationship quality was negatively associated with personal cannabis use (OR = 0.985, p < 0.001), illicit drug use (OR = 0.973, p < 0.001), and CAS with casual partners (OR = 0.979, p < 0.001); meanwhile, among those who reported their partner engaged in these behaviors - relationship quality was positively associated with the odds of these behaviors (OR = 1.018, p < 0.001; OR = 1.015, p < 0.001; OR = 1.019, p = 0.015 for cannabis, illicit drug use and CAS with casual partners respectively). These findings suggest that perceptions of a partner's behavior contextualize associations between relationship quality and personal behavioral risk. Results emphasize the importance of integrating components that support relationship quality into behavioral health interventions for SMM couples and SMM in relationships.
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Affiliation(s)
- Joseph R Hillesheim
- 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; Doctoral Program in Health Psychology and Clinical Science, Graduate Center of the City University of New York, New York, NY, USA.
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Starks TJ, Robles G, Dellucci TV, Cain D, D Kyre K, Outlaw AY, Lovejoy TI, Naar S, Ewing SWF. Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components. AIDS Behav 2024:10.1007/s10461-024-04371-6. [PMID: 38801503 DOI: 10.1007/s10461-024-04371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Graduate Program in Health Psychology and Clinical Practice, Graduate Center, City University of New York, New York, NY, USA.
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Trey V Dellucci
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Kory D Kyre
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Angulique Y Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Travis I Lovejoy
- Division of Clinical Psychology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Sylvie Naar
- Center for Translational Behavioral Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
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Ford CA, Boyer CB, Halpern CT, Katzman DK, Ross DA, Berg TD, Santo TD. The Distinguished Dozen: 2023 Journal of Adolescent Health Articles Making Distinguished Contributions to Adolescent and Young Adult Health. J Adolesc Health 2024; 74:211-215. [PMID: 38237973 DOI: 10.1016/j.jadohealth.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | | | | | | | | | - Tor D Berg
- Managing Editor, San Francisco, California
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