HIV-negative male couples' attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement

One efficacious strategy to help prevent HIV is oral pre-exposure prophylaxis (PrEP), a daily regimen of antiretroviral treatment taken by HIV-negative individuals. Two of the recommendations of Centers for Disease Control and Prevention (CDC) guidelines for PrEP pertain to being in a relationship (i.e., male couples). 

Despite the recognition of how primary partners in male couples' relationships shape HIV risk and CDC's PrEP guidelines, there is a paucity of data that examine HIV-negative male couples' attitudes toward PrEP use and using PrEP with a sexual agreement. A sexual agreement is an explicit agreement made between two individuals about what sex and other related behaviors may occur within and outside of their relationship. In this qualitative study, we examine HIV-negative male couples' attitudes toward PrEP use and whether they thought PrEP could be integrated into a sexual agreement. 

Data for this study are drawn from couple-level interviews conducted in 2014 with 29 HIV-negative male couples who had a sexual agreement and were from Atlanta or Detroit. Both passive (e.g., flyers) and active (e.g., targeted Facebook advertisements) recruitment methods were used; the sample was stratified by agreement type. Thematic analysis was applied to identify the following themes regarding HIV-negative male couples' attitudes toward PrEP use: 

1. PrEP and condom use; 
2. concerns about PrEP (e.g., effectiveness, side effects, and promoting sexually risky behavior); and 
3. accessibility of PrEP. 

Some thought PrEP could be a part of couples' agreement because it could help reduce sexual anxiety and sexual risk, and would help keep the couple safe. Others described PrEP use with an agreement as something for "others". Some were also concerned that incorporating PrEP could usurp the need for a sexual agreement in a couples' relationship. 

These themes highlight the need to improve informational messaging and promotion efforts about PrEP among HIV-negative male couples who may benefit from using it.

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By:  Mitchell JW1, Lee JY1, Woodyatt C2, Bauermeister J3, Sullivan P2, Stephenson R4.

• 1 Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
• 2 Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.
• 3 Department of Health Behavior and Health Education, School of Public Health, and The Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , MI , USA.
• 4 Department of Health Behavior and Biological Sciences, School of Nursing, and The Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , MI , USA.
• AIDS Care. 2016 Apr 7:1-6. 

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Perceived Challenges and Rewards of Forming a Sexual Agreement among HIV-Negative Male Couples

Sexual agreements, explicit mutual understandings made between two partners about which sexual and related behaviors they agree to engage in within and/or outside of their relationship, are common among male couples. However, little is known about the perceived rewards and challenges partnered men face in the process of forming a sexual agreement. Such knowledge may be useful for the development of future HIV preventive and sexual health programs that encourage male couples to establish a sexual agreement in their relationship. 

By using qualitative dyadic data from a sample of 29 self-reported concordant HIV-negative male couples who had a sexual agreement, the present qualitative study sought to assess partnered men's perceived rewards and challenges of forming a sexual agreement in their relationship and examine whether both men in the couple concurred about their perceived rewards and challenges of forming a sexual agreement. Themes for perceived rewards were:

1. being honest, 
2. improving communication, 
3. increasing understanding about expectations and permitted behaviors, 
4. enhancing intimacy and relational bond, and 
5. building trust. 

Themes for perceived challenges were: 

1. stigma about having an open agreement; 
2. awkwardness about the topic and talking about it; 
3. jealousy; and 
4. no perceived challenges. 

Few couples had both partners concur about their perceived rewards or challenges toward establishing a sexual agreement. The variety of perceived rewards and challenges highlight the need for tailoring given that a variety of factors may influence partnered men's establishment of a sexual agreement in their relationship.

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By:  Mitchell JW1, Lee JY2, Woodyatt C3, Bauermeister J4, Sullivan P3, Stephenson R5.

• 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA. jwm35@med.miami.edu.
• 2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
• 3Rollins School of Public Health, Emory University, Atlanta, GA, USA.
• 4Department of Health Behavior and Health Education, School of Public Health, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
• 5Department of Health Behavior and Biological Sciences, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA. 
• Arch Sex Behav. 2016 Mar 10. 

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Relationship Power, Sociodemographics, and Their Relative Influence on Sexual Agreements among Gay Male Couples

Men who have sex with men (MSM) in primary relationships engage in condomless sex both within and outside their relationships and a majority of HIV transmission risk may actually occur within primary relationships. Sexual agreements regarding non-monogamy are a critical component to understanding HIV prevention in male couples. Relationship factors have been associated with how sexual agreements function and power is one dyadic construct likely to affect couple's maintenance of non-monogamy agreements.

Multilevel modeling was used in a cross-sectional study of gay male couples (N = 566 couples) to examine associations between partners' demographic characteristics traditionally used to define relationship power, a scale of decision-making power, and outcomes related to sexual agreements, including investment, agreement breaks, and break disclosure. 

Results indicated that decision-making power relative to one's partner was not associated with any agreement outcome, contrary to hypotheses. However, controlling for decision-making power, demographic bases of power were variably associated with sexual agreements' functioning. 

• Younger partners were less invested in and more frequently broke their agreements. 
• Lower-earning partners broke their agreements more frequently, but also disclosed breaks more often. 
• White men in white-minority relationships broke their agreement more often than their partners. 
• Concordant HIV-positive couples were less invested in their agreements and HIV-positive men disclosed breaks more frequently. 

HIV prevention efforts for same-sex couples must attend to the social, developmental, and cultural influences that affect their agreements around non-monogamy.

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By:  Perry NS1, Huebner DM2, Baucom BR2, Hoff CC3.

• 1Department of Psychology, University of Utah, Room 502, Salt Lake City, UT, 84112, USA.
• 2Department of Psychology, University of Utah, Room 502, Salt Lake City, UT, 84112, USA.
• 3Center for Research on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA.

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Sexual Agreements and Perception of HIV Prevalence among an Online Sample of Partnered Men Who Have Sex with Men

Stemming from recent evidence that between one- and two-thirds of new HIV transmissions among men who have sex with men (MSM) occur within main partnerships, research and programmatic efforts have begun to recognize the role of the male-male dyad in shaping HIV risk. Central to this new focus has been studies detailing the presence of sexual agreements, which provide guidelines governing permissions around sex with partners outside of the relationship. Using a Facebook-recruited sample of US-partnered MSM (n = 454), this study examines the associations between reporting of sexual agreements and perceptions of HIV prevalence among male sex partners, friends, and local and national MSM populations. 

Men who perceived that 10-20% and >20% of their male sex partners were HIV positive (had significantly higher odds of reporting having an open agreement with their current main partner than men who perceived that less than 10 % of their male sex partners were HIV positive. Partnered men with open sexual agreements may have more sexual partners than those who report monogamy, possibly leading to heightened perceptions of HIV risk, which may result in reporting of perceptions of greater local HIV prevalence. 

Additionally, men who have made agreements with their partners may have done so due to concerns about HIV risks, and may also be more aware of increased risks of HIV infection, or may have greater knowledge of HIV prevalence through discussions of serostatus with sex partners. 

Attention is needed to develop prevention efforts, such as toolkits and resources that enable men to form sexual agreements that are based on comprehensive knowledge of the potential risks for acquisition of HIV.

Via: http://ht.ly/SgxSC 

By: Stephenson R1, White D, Mitchell JW.
1Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA