Employer-sponsored health insurance and labor market outcomes for men in same-sex couples: Evidence from the advent of pre-exposure prophylaxis

In the United States, the cost of providing employer-sponsored health insurance (ESI) varies for employers based on the medical expenditures of their employees, a practice known as "experience rating". Experience rating increases the cost of employing workers who have greater medical expenditures, one example being men in same-sex couples. To study whether ESI affects labor market outcomes for men in same-sex couples, I use the 2012 advent of Pre-Exposure Prophylaxis (PrEP), a $24,000 per year drug that effectively prevents Human Immunodeficiency Virus (HIV) acquisition. Using American Community Survey data and a difference-in-difference empirical approach - comparing post-PrEP changes in earnings among men who have ESI - I find that annual earnings for men in same-sex couples decline by $2,650 (approximately 3.9%) relative to comparable men after PrEP becomes available. For those who are most likely to be taking Truvada (the brand name for PrEP), such as young men and white men, effects on earnings are considerably larger. I also observe a 3.7 percentage point (4.6%) decline in ESI prevalence and a 0.8 percentage point (10.7%) increase in part-time employment among men in same-sex couples. Event studies provide support for a causal interpretation for my findings. My estimates are also robust to placebo analyses, various specification permutations, and a range of sensitivity checks.

Cohabitation and Marriage Among Same-Sex Couples in the 2019 ACS and CPS: A Research Note

Since the 2015 U.S. Supreme Court ruling that marriages of same-sex couples are legal in all states in the union, federal surveys have adapted to the shifting legal climate and included new measures that more directly identify same-sex and different-sex cohabiting and married couples. In this research note comparing the largest and most recent federal surveys-the 2019 American Community Survey and Current Population Survey-we find consistent levels of cohabitation and marriage across surveys. While the vast majority (90%) of different-sex couples were married, we report a more even split in cohabitation and marriage among same-sex couples. Our evaluation of sociodemographic characteristics of married and cohabiting couples indicates that differences were less prominent among same-sex couples than among different-sex couples, suggesting weaker sociodemographic selection into marriage among the former. However, factors affecting same-sex and different-sex couples' decisions to live together and marry may differ because of legal and social climates that still present unique obstacles for same-sex couples. Researchers need to acknowledge these differences in assessments of the implications of marriage for health and well-being.

A dyadic examination of alcohol use and intimate partner aggression among women in same-sex relationships

Despite considerable evidence linking alcohol use and intimate partner aggression among mixed-sex couples, scant research has examined this association in same-sex couples using a dyadic framework. The aim of the present study was to examine associations between one's own and their partner's alcohol use (i.e., drinks per week, hazardous alcohol use) and intimate partner aggression (physical, psychological) perpetration while accounting for the interdependence among partners in alcohol use. Participants were 326 women (M_age = 27.57, SD = 3.65) from 163 female-female couples who independently completed measures of drinks per week, hazardous alcohol use, psychological intimate partner aggression victimization and perpetration, and physical intimate partner aggression victimization and perpetration. Actor-partner interdependence structural equation models found that (1) actor drinks per week were positively associated with one's own physical assault perpetration (2) actor hazardous alcohol use was positively associated with one's own physical assault and psychological aggression perpetration and (3) partner drinks per week and hazardous alcohol use were positively associated with actor's psychological aggression perpetration. No other significant effects were detected. Collectively, findings highlight the nuanced relationship between alcohol use and intimate partner aggression among same-sex female couples and suggest that one's own alcohol use is associated with intimate partner psychological and physical aggression perpetration. In contrast, the only partner effect was partner's alcohol use in association with actor's psychological aggression perpetration. These findings differ from prior research with heterosexual couples and underscore the need for future research with same-sex couples rather than attempts to generalize findings across populations.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

OBJECTIVES

We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHODS

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001).

DISCUSSION

The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

Biomedical HIV Prevention among Gay Male Couples: A Qualitative Study of Motivations and Concerns

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly efficacious biomedical prevention strategies, which significantly reduce the risk of HIV transmission. Yet, partnered sexual minority men (SMM) continue to exhibit poorer uptake rates especially those in a non-monogamous or serodiscordant relationship for whom PrEP is recommended. The purpose of the study was to identify factors that may facilitate or impede the uptake of PrEP or PEP among partnered SMM. This qualitative study conducted semi-structured interviews with 10 sexual minority male couples recruited from the New York City metropolitan area. Thematic analysis identified relationship-specific and structural-level factors, which influence motivation and willingness for biomedical prevention uptake. Specifically, results highlighted the tension between relationship functioning and HIV prevention. In addition, stigma and access to knowledgeable health care providers diminished interest in biomedical prevention. Findings suggest a need for interventions that frame biomedical prevention in ways that minimize social perceptions of mistrust between partners and improve access.

Academic Achievement of Children in Same- and Different-Sex-Parented Families: A Population-Level Analysis of Linked Administrative Data From the Netherlands

Although numerous studies have examined how children raised in same-sex-parented families fare relative to children in different-sex-parented families, this body of work suffers from major methodological shortcomings. By leveraging linked administrative data from several population registers from the Netherlands covering the 2006-2018 period (n = 1,454,577), we overcome most methodological limitations affecting earlier research. The unique features of the data include complete population coverage, reliable identification of same-sex-parented families, a large number of children in same-sex-parented families (n = 3,006), multiple objective and verifiable educational outcomes, and detailed measures of family dynamics over children's entire life courses. The results indicate that children in same-sex-parented families outperform children in different-sex-parented families on multiple indicators of academic performance, including standardized tests scores, high school graduation rates, and college enrollment. Such advantages extend to both male and female children, and are more pronounced among children in female than male same-sex-parented families. These findings challenge deficit models of same-sex parenting.

Romantic relationships and sexual minority health: A review and description of the Dyadic Health Model

A large body of literature has documented the health promotive effects of healthy committed relationships on the health and wellbeing of heterosexual people in different-sex relationships, including observational and longitudinal studies, couple-based intervention development and evaluation efforts, and articulation of theoretical frameworks. A much smaller but growing field of research has observed that same-sex relationships have similar effects on health outcomes but that these couples face unique stressors that may impact relationship functioning and health. Further, extant theoretical frameworks do not sufficiently address the multiple pathways by which psychosocial vulnerabilities and stressors impact same-sex relationship functioning, engagement in health-related risk behaviors, and the mental and physical health of sexual minorities in relationships. The purpose of this manuscript is to: a) review the existing literature on relationship functioning and health among sexual minorities, including both observational and intervention studies; and b) present an integrated model of relationship functioning and health for same-sex couples that can be used as a basis for further studies on sexual minority dyads, as well as the development of novel couple-based interventions to optimize the health promoting effects of relationships.

Predictors of disordered weight loss behaviors among same-sex and opposite-sex romantic partners

Although the majority of adults will attempt to lose weight at some point in their lives, most weight loss behaviors are ineffective and potentially harmful. Further, weight loss behaviors often closely resemble disordered eating, and include behaviors such as fasting and purging. The current study examined potential predictors of disordered approaches to weight loss in the context of same-sex and opposite-sex romantic partnerships by investigating participants' (n = 500, M_age = 29.62 years) BMI, body image, self-esteem, relationship quality and disordered weight loss behaviors. We conducted analyses using Actor Partner Interdependence Models, which revealed that the greatest predictors of participating in disordered weight loss behavior were body dissatisfaction and having a male partner. These findings suggest that it is not sexuality, per se, that places individuals at risk for disordered weight loss behavior, but perhaps the value placed on thinness as defined by particular gender and cultural groups.

A Dyadic Perspective on Sexual Agreements Among Same-Sex Male Couples in the United States

Sexual agreements are an important HIV risk reduction strategy enacted by men in male-male partnerships. Greater levels of relationship quality have been associated with sexual agreement formation and adherence. However, current evidence supporting the associations between relationship quality and sexual agreements for male dyads is based primarily on the responses of just one partner. Understanding that relationship quality and decisions about sexual agreements are inherently influenced by both partners, the present analysis uses dyadic-level data to examine the sexual agreements among 199 HIV serodiscordant and seroconcordant male dyads (n = 398 individuals). Specifically, the analysis examines measures of love, trust, and conflict style as they relate to (1) the type of agreement established, (2) concordance in agreement reporting, (3) satisfaction with the agreement, and (4) broken agreements. A discrepancy in love between partners was associated with the type of agreement established, whether they reported the same agreement type, and whether one of the partners reported a broken agreement, but it was not associated with either partner's satisfaction with the agreement. A discrepancy in trust was associated with agreement concordance and agreement breaks, but it was not associated with the type of agreement established or satisfaction with the agreement. Lastly, a discrepancy in conflict style was associated with each of the agreement outcomes. Future research and intervention efforts should focus on understanding the behavioral and communication skills necessary for couples to make successful sexual agreements.

Cumulative live birth rates following insemination with donor spermatozoa in single women, same-sex couples and heterosexual patients

RESEARCH QUESTION

What is the cumulative live birth rate (LBR) following donor intrauterine insemination (IUI-D) treatment in a large, retrospective, single-centre cohort of single women, same-sex couples and heterosexual patients?

DESIGN

Outcomes from 8922 treatments performed in 3333 consecutive women (45% single, 43% from same-sex and 12% from heterosexual couples) were analysed in a 13-year retrospective study from a private, HFEA-regulated UK centre between January 2004 and December 2016.

RESULTS

A total of 795 live births resulted in an overall delivery rate of 8.9% per cycle, including 24 (3%) twins. Age-specific crude and expected cumulative LBR calculated in four age groups (<35, 35-37, 38-39 and 40-42 years) were 29, 23, 21, 12% and 66, 49, 54, 28%, respectively. A plateau was reached after six cycles, beyond which there were few additional live births. There was no significant difference in cumulative LBR between single women and same-sex couples. In a multivariate analysis, female age (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.90-0.93; P < 0.0001), previous live birth following IUI-D (aOR 2.15; 95% CI 1.69-2.73; P < 0.0001) and mild stimulation (aOR 1.27; 95% CI 1.09-1.48; P = 0.02) had a significant effect on outcome, but relationship status or cycle rank did not.

CONCLUSIONS

These results indicate there is little benefit performing more than six cycles of IUI-D in all women up to 40 years old, including those from same-sex relationships, while only three attempts seem reasonable in those aged 40-42 years. These results do not reflect current clinical guidelines in the UK. The authors found that consecutive IUI cycles, especially with mild stimulation, were an efficient treatment in all indications.

Same-Sex Couples' Shared Time in the United States

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time that same-sex couples and different-sex couples spend together; for parents, the time they spend together with children; and for both parents and nonparents, the time they spend together with no one else present and the time they spend with others (excluding children). After we control for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity.

An Examination of Gay Couples' Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions

While many gay couples perceive themselves to have little risk for HIV transmission, research estimates that 35-68% of new HIV infections are transmitted within main partnerships. Pre-exposure prophylaxis (PrEP) is recommended for those partnered gay and bisexual men (GBM) who engage in sex outside their primary relationship or who have an HIV-positive partner. There is reason to believe that couples' sero-status and sexual agreement will shape perceptions of PrEP's personal relevance among gay couples. The current study examined motivations for and ambivalence towards PrEP uptake reported in a sample of 67 gay couples during completion of a brief CDC-recommended prevention intervention: Couples HIV Testing and Counseling. Findings suggest that all types of couples identified some circumstances in which they would consider PrEP; however, PrEP messaging should be crafted to avoid undermining current prevention strategies or threatening the trust and legitimacy of the relationship.

Same-Sex Parents and Children's School Progress: An Association That Disappeared Over Time

Research is divided as to whether children living in same-sex parent families achieve different outcomes compared with their peers. In this article, we improve on earlier estimates of such differences and subsequently study whether and why the association between parental union sex composition and children's school progress changed over time. Data from the American Community Survey waves 2008-2015 (N = 1,952,490 including 7,792 children living with a same-sex couple) indicate that children living with same-sex couples were historically more likely to be behind in school but that this association disappeared over time. Changes in socioeconomic characteristics of same-sex couples played a minor role. In 2008, it was only in areas with unfavorable laws and attitudes toward same-sex couples that children living with same-sex couples were more likely to be behind in school. This was especially the case for adopted children. In more recent periods, no effect of parental union sex composition on school progress is observed within any area or among any group studied. Based on where and when these changes took place, it is suggested that changing attitudes toward same-sex couples might have played an important role in equalizing school progress across groups.

Sexual orientation-related stigma and relationship functioning among female same-sex couples

This article discusses how sexual orientation-based stigma serves to undermine functioning in female same-sex relationships. We particularly focus on the unique roles of interpersonal stigma (e.g., victimization, microaggressions) and structural stigma (e.g., institutional forms of discrimination), highlighting critical limitations and gaps in this literature and offering suggestions for future studies. We also discuss the need for future work on sexual orientation-related stigma and relationship functioning to consider the unique experiences of bisexual women, intersecting identities, and couple-level perspectives on stigma.

The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples

Young MSM are at increased risk for HIV, especially in the context of serious relationships, but there is a lack of couples-based HIV prevention for this population. The 2GETHER intervention-an HIV prevention and relationship education program for young male couples-demonstrated promising effects in a pilot trial. However, there is evidence that internalized stigma (IS) can influence treatment outcomes among MSM. The current study examined the influence of IS on the efficacy of the 2GETHER intervention among 57 young male couples. The intervention led to decreases in percentage of condomless anal sex partners and increases in subjective norms regarding HIV prevention for those with low/average IS, but not high IS. The intervention also led to increases in motivation to get tested with one's partner and decreases in alcohol consumption for those with high IS, but not low/average IS. In contrast, IS did not moderate intervention effects on other motivational constructs, dyadic adjustment, or alcohol problems. In sum, IS influences the extent to which young male couples benefit from HIV prevention and relationship education depending on the outcome. Research is needed to understand how IS influences treatment outcomes.

Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men

An estimated 35-68% of new HIV infections among gay, bisexual, and other men who have sex with men (GBM) are transmitted through main partnerships. Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV seroconversion, yet PrEP uptake has been modest. PrEP-naïve GBM with HIV-negative, PrEP-naïve main partners enrolled in One Thousand Strong (n = 409), a U.S. national cohort of GBM, were asked about (1) the importance of partner PrEP use and (2) their willingness to convince their partner to initiate PrEP. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP. Personal PrEP uptake willingness and intentions were the strongest indicators of partner PrEP outcomes. Being in a monogamish relationship arrangement (as compared to a monogamous arrangement) and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP.

Sexuality Within Female Same-Gender Couples: Definitions of Sex, Sexual Frequency Norms, and Factors Associated with Sexual Satisfaction

Despite a growing number of female same-gender (FSG) relationships, couples-based research and interventions have focused primarily on mixed-gender couples. Consequently, research has applied a heteronormative lens to understanding some relationship factors, including sexuality. The current study sought to provide descriptive data regarding frequency and conceptualizations of sex across partners in FSG relationships, as well as to analyze how relationship factors are associated with sexual satisfaction in this population. Participants (N = 206) were 103 adult FSG couples who had been together for at least 2 months. Individuals provided self-report data on how they conceptualized sex, and actor-partner models were utilized to assess relationship factors associated with sexual satisfaction. Findings indicated that women in FSG relationships hold broad definitions of sex, with the majority of behaviors conceptualized as sex, including acts that involved partnered genital touching. In dyadic actor-partner models, sexual satisfaction was predicted by several factors including sexual frequency, emotional intimacy, and sexual intimacy. Unexpectedly, higher desired sexual frequency was associated with lower sexual satisfaction; however, this finding only emerged after controlling for actual sexual frequency, suggesting that discrepancies between desired and actual sex frequency may be important for FSG couples. Implications for clinical practice with FSG couples are explored, including a strength-based focus on broad conceptualizations of sex within this population and targeting relationship factors associated with sexual satisfaction.

Committed, Unmarried Same-Sex Couples and their Social Networks in the United States: Relationships and Discursive Strategies

This study examines two aspects of the experiences that committed, unmarried same-sex couples have with social network members (friends and family members). The study examines how remaining unmarried affected the couples' relationships with social network members and the discursive strategies couples use when discussing their relationship with social network members. Twenty-seven committed, unmarried U.S. same-sex couples were interviewed. Couples described two challenges in their relationships with social network members as a result of not marrying: others perceived their commitment level as lessened because they did not marry, and others supported their relationship less because they did not marry. Couples used four discursive strategies to establish and maintain their family identity when interacting with social network members. Couples' relational experiences and discursive strategies were consistent with previous descriptions of discourse-dependent families.

"We are Two of the Lucky Ones": Experiences with Marriage and Wellbeing for Same-Sex Couples

Happy marriages provide protective health benefits, and social support is a key factor in this association. However, previous research indicates one of the greatest differences between same- and different-sex couples is less social support for same-sex couples. Our goal was to examine the extent to which formal markers of couple status (e.g., marriage) impact wellbeing among same-sex married partners. Using a mixed-methods approach, data were collected from 218 primarily White gay and lesbian individuals in the Midwest. Quantitative analysis revealed individuals in a prior formal union with a different-sex partner reported the lowest levels of sexuality specific social support and acceptance. Qualitative analysis revealed four primary impacts of marriage on support from family, friends, and co-workers: no change, increased support, decreased support, and a synthesis of mixed support. Three mechanisms prompting change in the family were identified and are presented.

Does "body talk" improve body satisfaction among same-sex couples?

Research suggests the important role of romantic partners in shaping how individuals feel about their bodies (e.g., Markey & Markey, 2013, 2014), but the processes that result in changes in body satisfaction within relationships have rarely been examined. To investigate how partners may potentially affect body image, 72 lesbian couples and 72 gay male couples (total N=288) completed body image assessments on their own and with the help of their partners. Multilevel modeling revealed that both men and women reported an improvement in body satisfaction after talking with their partners while completing the body image assessment together. Improvement in body satisfaction appeared to result from participants' reconsideration of their body ideals, not their appraisal of their current bodies. Implications of these findings for improving body image in the context of relationships are discussed.

Gender Roles, Comparative Advantages and the Life Course: The Division of Domestic Labor in Same-Sex and Different-Sex Couples

Lesbian and gay couples by definition cannot establish sex-specific divisions of domestic tasks, at least not literally. Previous research has shown that high levels of equality characterize domestic work arrangements in same-sex couples. This study scrutinizes explanations for this. The theoretical background stems from family economics, from the theory of relative resources and from gender role and life-course considerations. The empirical analysis is based upon the Generations and Gender Survey from Austria, Belgium, France, the Netherlands, Norway, Sweden and Australia. Results show that same-sex partners engage in more tasks equally, that their housework-sharing pattern is less segregated and that the partners' workload is more equally balanced. Comparative advantages, life-course differences and gender roles contribute to the explanation of higher levels of equality in same-sex compared to different-sex relationships.

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general-and the field of Couple and Family Therapy in particular-have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle-class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners' complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists' and clients' multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners' multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.

Parents of children conceived through assisted conception

Parental responsibility allows parents to exercise rights over their children and to make decisions on behalf of the child that are in the best interests of the welfare of the child. It is a crucial part of being a parent. In recognition of the changing demographic of the family resulting in more cohabiting couples and step families the law relating to parental responsibility was changed in 2003 and 2005. With the development of more effective assisted conception techniques and increased use of 'do-it-yourself ' insemination using semen purchased over the Internet it was necessary to amend the rules relating to parenthood as a result of assisted conception. This article considers the amendments relating to the recognition of parenthood introduced by the Human Fertilisation and Embryology Act 2008.

Earnings Equality and Relationship Stability for Same-Sex and Heterosexual Couples

This paper examines a topic of continuing interest for demographers and sociologists of the family: which factors promote relationship stability among couples. Two competing theories have been highly debated to explain how relative earnings relate to relationship quality and stability. The neoclassical economic theory posits that specialization of home and work duties leads to stability because partners fill complementary roles. Gender scholars propose an alternative explanation, suggesting that when couples violate the traditional male breadwinner model, they experience relationship strain and are more likely to experience a breakup. Using the new How Couples Meet and Stay Together (HCMST) dataset, this paper offers a unique perspective on the debate, by comparing same-sex couples to heterosexual couples. The paper presents three sets of analyses to determine how relative earnings relate to relationship stability. The first analysis employs discrete-time event history models to assess the likelihood of breakup for both heterosexual and same-sex cohabiting couples. Next, the paper presents results predicting self-reported relationship quality among married and cohabiting couples. The final analysis focuses on non-cohabiting couples from Wave I of the HCMST survey and examines the likelihood of entering cohabitation in subsequent survey waves. Results demonstrate that the economic or specialization model does not hold in same-sex relationships, suggesting that the effect of earnings equality is dependent upon gender norms in heterosexual relationships. When earnings power is disentangled from gender, as is the case of same-sex couples, equality in earnings promotes stability.