Closeness Discrepancies and Intimacy Interference: Motivations for HIV Prevention Behavior in Primary Romantic Relationships

Closeness Discrepancies and Relationship Quality in German Partnered Women and Men

The construct of inclusion of other in the self has been established as one of the most influential measures for relationship closeness in romantic relationships. It is regularly associated with relational well-being, sexual satisfaction, as well as mental health. However, the degree of closeness one desires in the present relationship is person-specific and can differ from the closeness one actually experiences. Exploring these discrepancies, the present study focused on the association between not enough closeness and too much closeness and relationship characteristics, parenting, and extradyadic sexual activity. Data from a population-based sample of 3,161 men and women from the German Health and Sexuality Survey were analyzed using structural equation modeling. Our results confirm closeness discrepancies as prevalent relationship phenomena, while identifying feelings of not enough closeness as much more problematic for the relationship.

Closeness Discrepancies in Couple Relationships: A Dyadic Response Surface Analysis

Individuals can differ in the degree of closeness they desire in their romantic relationships: Some people may perceive their current level of closeness as just right, whereas others may feel not close enough or too close to their partners (referred to as negative and positive closeness discrepancy, respectively). This study (N = 1,177 individuals from 748 couples) examined the implications of closeness discrepancies for subjective relationship quality (SRQ) using dyadic response surface analysis. The analyses found evidence for linear, but not broad, closeness discrepancy effects: SRQ was lower for individuals reporting more negative closeness discrepancies and, independent of this actor effect, for individuals with partners who reported more negative closeness discrepancies. These results suggest that low levels of closeness paired with a strong desire for closeness can impair both partners' relational well-being.

A Dyadic Analysis Exploring the Mediating Role of Relationship Quality on Discrimination and HIV/STI Risk Among Young Black and Latino Expecting Couples

Encounters with discrimination are a normative experience for many Black and Latino adolescents and young adults (AYAs); these experiences may be even more common for expecting AYAs. While the harmful effects of discriminatory experiences on mental and physical health have been well explored, relatively little is known regarding the impact of discrimination on relationship quality and sexual health-specifically HIV/STI risk.Using the Actor Partner Interdependence Model, we examined both actor and partner effects of discrimination on relationship quality and willingness to be non-monogamous in a sample of 259 pregnant adolescent and young adult couples. There was a significant indirect actor effect, such that one's own discrimination was associated with a decrease in their own relationship quality which, in turn, was associated with their own greater willingness to be non-monogamous. The partner effect for the association of one's partner's discrimination on one's own relationship quality was not significant. Findings highlight the need for more attention to the implications of discrimination on relational and sexual health.

Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP

Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.

Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women

Introduction

There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW).

Methods

We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs.

Results

Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners.

Conclusions

Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.

Partners' Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners' agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners' consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B = 0.23; p = .001) and the number of other COVID-19 prevention behaviors engaged in (B = 0.17; p = .003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B = 0.40; p = .029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

Perceived facilitators of decision-making and usage of biomedical HIV prevention strategies: findings from an online, qualitative study with same-gender male couples in the United States

The early stages of gay and bisexual men's relationships are a critical period for communicating about HIV prevention strategies. This study sought to: (1) explore facilitators to decision-making to use prevention strategies and (2) describe the prevention strategies being used by same-gender male couples in new relationships. Individual interviews were conducted with 76 partnered men, representing 37 couples and 2 individuals. Couples had been together for one year or less, and varied by U.S. geographical region of residence and HIV serostatus: 8 seroconcordant positive, 17 seroconcordant negative, and 13 serodiscordant couples. Two overarching qualitative themes emerged: (1) communication and (2) information and resources. Notably, few couples had both partners mention the same facilitator. The most commonly used HIV prevention strategies were treatment as prevention for partners in seroconcordant positive and serodiscordant couple relationships, and HIV/STI testing for partners of seroconcordant negative couples. Compared to the other two couple groups, fewer seroconcrdant negative couples were aware of each other's use of strategies. Study findings suggest these facilitators are important to include in future interventions. Efforts are also needed to improve within-dyad awareness about which strategies partners are using and how they may best support one another toward their sexual health goals.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.

Development and Psychometric Evaluation of the PrEP Sexual Expectancies (PSEXS) Scale

The goal of this study was to develop and evaluate psychometric properties of the PrEP Sexual Expectancies Scale (PSEXS). The PSEXS represents a range of expectations for how PrEP use will affect one's sexual experience. The scale was developed to understand perceived reinforcements of PrEP use among men who have sex with men (MSM), including sexual risk-taking. The study builds upon Expectancy Theory to develop a measure of sex-related PrEP expectancies with a representative sample of 1155 MSM participants from Ukraine and 408 MSM participants from the U.S. Expectancy items represented two domains: increased sexual risk-taking and enhancement of sexual experience. Confirmatory analyses showed that a two-factor model provided a good fit to the data. The PSEXS scale had a high internal reliability in both samples (Ukraine α = 0.88, U.S. α = 0.83), and the identified factor structure explains a large amount of variance in both samples. Recent studies suggest that expectations of intimacy and better sexual experience can be a significant deciding factor for PrEP uptake. The PSEXS provides researchers with a useful measure for examining MSM's expectancy beliefs about the impact of PrEP use on their sexual life.

Perspectives from Young Partnered Gay, Bisexual, and Other Men Who Have Sex with Men on the Adaptation of Couples HIV Testing and Counseling (CHTC)

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.

Interpartner Concordance on Relationship Quality and Sexually Transmitted Infections Among Young Pregnant and Parenting Couples

BACKGROUND

This study examined agreement between partners on perceptions of relationship quality and its impact on later (sexually transmitted infection [STI]) diagnosis in a sample of pregnant (adolescents and young adults [AYAs]) couples.

METHODS

Two hundred ninety-six AYA couples completed structured surveys on relationship quality (satisfaction, cohesion, consensus, affectional expression) and STI diagnosis. An actor-partner interdependence model was used to assess actor effects (whether an individual's perceived relationship quality influenced their getting STI), partner effects (whether a partner's perceived relationship quality influenced the individual getting an STI), and interactive effects (whether an individual's perceived relationship quality interacted with a partner's perceived relationship quality and influenced in the individual getting an STI).

RESULTS

No significant actor or partner effects were observed for positive STI screen. However, there was a significant interaction between actor and partner satisfaction (B = -0.47, exp(B) = 0.63 [95% confidence interval, 0.43-0.93], P = 0.020). When actor satisfaction was high, greater partner satisfaction was associated with lower odds of a positive STI screen at 12 months. A significant interaction between actor and partner affectional expression was also found (B = -4.40, exp(B) = 0.01 [95% confidence interval, 0.00-0.87], P = 0.043). When partner affectional expression was high, greater actor affectional expression was associated with lower odds of a positive STI screen at 12 months.

CONCLUSIONS

Findings suggest that concordant reports of relationship satisfaction and affectional expression are protective against future STI risk. Strengthening romantic relationships may be a promising strategy for preventing STIs in pregnant/parenting AYA couples.

Inclusion of Other in the Self and Couple's Sexuality: A Scoping Review

To better understand the effect relationship closeness has on couple's sexuality a scoping review was conducted, that focused on the inclusion of other in the self scale (IOS). Authors reviewed quantitative journal articles published between 2000 and 2020 by searching PsychInfo, Medline, and PubMed, resulting in 24 studies. Results suggest positive associations between IOS and sexual well-being, functioning, desire, frequency and satisfaction, and negatively related to sexual distress. Also, the benefits of positive sexual experiences expand well beyond the sexual domain onto different personal and relational factors of health and well-being. Sampling designs considerably limit the generalizability of results.

Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men

A significant proportion of new HIV infections among gay, bisexual, and other men who have sex with men (MSM) occur within primary relationships. Although PrEP use continues to increase, there is a need to better understand the factors that contribute to PrEP decision-making within primary relationships. We qualitatively examined how relationship context influences perceptions of PrEP and decisions to initiate and discontinue PrEP among young Black MSM to provide a nuanced understanding of PrEP use within relationships. Between late 2017 and mid-2018, we conducted 10 focus groups with young Black MSM (n = 80) in Milwaukee, WI, Minneapolis, MN, Kansas City, KS, and Detroit, MI. We used inductive thematic analysis to examine how young Black MSM make decisions about PrEP use within the context of primary relationships. We identified three primary themes: (1) perceptions of PrEP as an indication of distrust and infidelity, (2) perceptions of PrEP use as necessary, even in primary relationships, and (3) the influence of partners on PrEP. Our results demonstrate the considerable variation in how young Black MSM view PrEP within primary relationships and the influence of primary partners in PrEP use decisions. The dynamics between two or more individuals can shape an individual's conceptualizations of and decisions around PrEP use, and these may be key drivers of racial disparities in HIV and PrEP use.

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

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.