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.
KeywordsPre-exposure prophylaxis Men who have sex with men Same-sex couples HIV-prevention Sexual agreement Sero-status
The authors acknowledge the contributions of the We Test Project Team, particularly Patrick Sullivan, Robert Stephenson, Mark Pawson, Andrew Cortopassi, Ruben Jimenez, Chris Hietikko, Chloe Mirzayi and Scott Jones. We also thank Rich Jenkins for his support of the project as well as CHEST staff, recruiters, interns, and our participants who volunteered their time.
The We Test study was funded by a grant from the National Institute on Drug Abuse (R34 DA036419; PI Starks). Data analysis was supported by a grant from the National Institute on Drug Abuse (R34 DA043422; PI Starks).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants
All procedures were reviewed and approved by the IRB of Hunter College, CUNY.
All participants were provided written consent information. The consent form was reviewed, and written documentation of consent was obtained individually, and privately, from each member of the couple.
- Centers for Disease Control and Prevention. (2015a) Daily pill can prevent HIV. Retrieved from https://www.cdc.gov/vitalsigns/hivprep/index.html. Last accessed August, 2017.
- Centers for Disease Control and Prevention. (2015b). HIV surveillance report, 2015. Volume 27. Retrieved from: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf. Last accessed August, 2017.
- Centers for Disease Control and Prevention. (2015c). HIV treatment as prevention. Retrieved from https://www.cdc.gov/hiv/risk/art/. Last accessed August, 2017.
- Centers for Disease Control and Prevention. (2017). Pre-exposure prophylaxis (PrEP). Retrieved from https://www.cdc.gov/hiv/risk/prep/index.html. Last accessed August, 2017.
- Eaton, L. A., Driffin, D. D., Bauermeister, J., Smith, H., & Conway-Washington, C. (2015). Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care and STDs, 29, 423–429.CrossRefPubMedPubMedCentralGoogle Scholar
- Gomez, A. M., Beougher, S. C., Chakravarty, D., Neilands, T. B., Mandic, C. G., Darbes, L. A., & Hoff, C. C. (2012). Relationship dynamics as predictors of broken agreements about outside sexual partners: Implications for HIV prevention among gay couples. AIDS and Behavior, 16, 1584–1588.CrossRefPubMedGoogle Scholar
- John, S.A., Starks, T.J., Rendina, H.J., Grov, C. & Parsons, J.T. (2018). 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. AIDS and Behavior, 22(4), 1239–1252.CrossRefPubMedGoogle Scholar
- Mimiaga, M. J., Closson, E. F., Kothary, V., & Mitty, J. A. (2014). Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. Archives of Sexual Behavior, 43, 99–106.CrossRefPubMedPubMedCentralGoogle Scholar
- Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., & Gomez, C. A. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19, S13–S25.CrossRefPubMedGoogle Scholar
- Rosenberg, E. S., Sullivan, P. S., Dinenno, E. A., Salazar, L. F., & Sanchez, T. H. (2011). Number of casual male sexual partners and associated factors among men who have sex with men: Results from the National HIV Behavioral Surveillance system. BMC Public Health, 11, 189.CrossRefPubMedPubMedCentralGoogle Scholar
- Spencer, L., Ritchie, J., Ormston, R., O’Conner, W., & Barnard, M. (2014). Analysis: Principles and processes. In J. Ritchie, J. Lewis, C. M. Nicholls, & R. Ormston (Eds.), Qualitative research practice (2nd ed., pp. 269–293). Thousand Oaks, CA: SAGE Publications Inc. Google Scholar
- Stephenson, R. B., Grabbe, K. L., Sidibe, T., McWilliams, A., & Sullivan, P. S. (2016). Technical assistance needs for successful implementation of couples HIV testing and counseling (CHTC) intervention for male couples at US HIV testing sites. AIDS and Behavior, 20, 841–847.CrossRefPubMedGoogle Scholar
- Sullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J. L., Dasgupta, S.,. .. Stephenson, R. B. (2014). Safety and acceptability of couples HIV testing and counseling for US men who have sex with men: A randomized prevention study. Journal of the International Association of Physicians in AIDS Care, 13, 135–144.CrossRefGoogle Scholar
- U.S. Food and Drug Administration. (2012). FDA approves first medication to reduce HIV risk. Retrieved from https://aidsinfo.nih.gov/news/1254/fda-approves-first-drug-for-reducing-the-risk-of-sexually-acquired-hiv-infection. Last accessed April, 2018.
- World Health Organization (WHO). (2012). Guidance on couples HIV testing and counseling including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/44646/9789241501972_eng.pdf;jsessionid=1413226F2BD66E85309C8944895997C8?sequence=1. Last accessed August, 2017.