Skip to main content

Advertisement

Log in

Partner Support and Communication for Pre-exposure Prophylaxis (PrEP) Use Among Male Couples

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Between one to two-thirds of HIV infections among gay, bisexual, and other men who have sex with men are from primary partners, and there has been increased research attention focused on strategies to increase PrEP adoption among male couples. While there is evidence that partner support is a strong correlate of pre-exposure prophylaxis (PrEP) adoption, there has been a lack of attention on PrEP communication dynamics among male couples. In this paper, we build upon this literature through analysis of dyadic data from a large cross-sectional survey of 543 concordant sero-negative and serodiscordant male couples to examine individual and relationship factors associated with reports of partner communication around PrEP, comfort in discussing PrEP, and perceived partner-level support for PrEP use. PrEP use was relatively low (16.2%), and although 87.5% of men reported their partners would support their PrEP use, only 26.3% had talked to their partner recently about PrEP. PrEP communication and perceived support for PrEP were significantly negatively associated with PrEP stigma and stigma based on sexuality (i.e., internalized homophobia and enacted external stigma based on sexuality), while men with sexual agreements were more comfortable talking about PrEP with their partner. There is a need to adapt current interventions, or develop new dyadic interventions, that provide opportunities for male couples to talk and learn about PrEP together, as a potential pathway to engage them toward PrEP use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Bazzi, A. R., Fergus, K. B., Stephenson, R., Finneran, C. A., Coffey-Esquivel, J., Hidalgo, M. A., Hoehnle, S., Sullivan, P. S., Garofalo, R., & Mimiaga, M. J. (2016). A dyadic behavioral intervention to optimize same sex male couples’ engagement across the HIV care continuum: Development of and protocol for an innovative couples-based approach (partner steps). JMIR Research Protocols, 5(3), e168. https://doi.org/10.2196/resprot.6271

    Article  PubMed  PubMed Central  Google Scholar 

  • Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine, 158(16), 1789–1795. https://doi.org/10.1001/archinte.158.16.1789

    Article  PubMed  Google Scholar 

  • Carey, M. P., & Schroder, K. E. (2002). Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Education and Prevention, 14(2), 172–182.

    Article  Google Scholar 

  • Carpenter, J., Andrykowski, M., Wilson, J., Hall, L., Rayens, M. K., Sachs, B., & Cunningham, L. (1998). Psychometrics for two short forms of the center for epidemiologic studies-depression scale. Issues in Mental Health Nursing, 19(5), 481–494. https://doi.org/10.1080/016128498248917

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2020). Estimated HIV incidence and prevalence in the United States, 2014–2018. HIV Surveillance Supplemental Report 2020;25(No. 1). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2020. Accessed June 2020.

  • Christensen, A. (1987). Detection of conflict patterns in couples. In K. Hahlweg & M. J. Goldstein (Eds.), Understanding major mental disorder: The contribution of family interaction research (pp. 250–265). Family Process Press.

    Google Scholar 

  • Christensen, A. (1988). Dysfunctional interaction patterns in couples. In P. Noller & M. A. Fitzpatrick (Eds.), Perspectives on marital interaction (pp. 31–52). Multilingual Matters.

    Google Scholar 

  • Christensen, A., & Sullaway, M. (1984). Communication patterns questionnaire. Unpublished manuscript, University of California, Los Angeles.

  • Cook, W. L., & Kenny, D. A. (2005). The actor-partner interdependence model: A model of bidirectional effects in developmental studies. International Journal of Behavioral Development, 29(2), 101–109. https://doi.org/10.1080/01650250444000405

    Article  Google Scholar 

  • Cuervo, M., & Whyte, J. (2015). The effect of relationship characteristics on HIV risk behaviors and prevention strategies in young gay and bisexual men. Journal of the Association of Nurses in AIDS Care, 26(4), 399–410. https://doi.org/10.1016/j.jana.2015.03.003

    Article  Google Scholar 

  • Eaton, L. A., Kalichman, S. C., Price, D., Finneran, S., Allen, A., & Maksut, J. (2017). Stigma and conspiracy beliefs related to Pre-exposure Prophylaxis (PrEP) and interest in using PrEP among black and white men and transgender women who have sex with men. AIDS and Behavior, 21(5), 1236–1246. https://doi.org/10.1007/s10461-017-1690-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Finlayson, T., Cha, S., Xia, M., Trujillo, L., Denson, D., Prejean, J., Kanny, D., Wejnert, C., Abrego, M., Al-Tayyib, A., Anderson, B., & National HIV Behavioral Surveillance Study Group. (2019). Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men—20 urban areas, 2014 and 2017. MMWR Morbidity and Mortality Weekly Report, 68(27), 597–603. https://doi.org/10.15585/mmwr.mm6827a1

    Article  PubMed  PubMed Central  Google Scholar 

  • Flores, D. D., Meanley, S. P., Wood, S. M., & Bauermeister, J. A. (2020). Family characteristics in sex communication and social support: implications for emerging adult men who have sex with men’s PrEP engagement. Archives of Sexual Behavior, 49(6), 2145–2153. https://doi.org/10.1007/s10508-020-01648-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., Malotte, C. K., & Stoner, B. P. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92(3), 378–381.

    Article  Google Scholar 

  • Gamarel, K. E., Darbes, L. A., Hightow-Weidman, L., Sullivan, P., & Stephenson, R. (2019). The development and testing of a relationship skills intervention to improve hiv prevention uptake among young gay, bisexual, and other men who have sex with men and their primary partners (We Prevent): Protocol for a randomized controlled trial. JMIR Research Protocols, 8(1), e10370. https://doi.org/10.2196/10370

    Article  PubMed  PubMed Central  Google Scholar 

  • Gamarel, K. E., & Golub, S. A. (2015). Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Annals of Behavioral Medicine, 49(2), 177–186. https://doi.org/10.1007/s12160-014-9646-3

    Article  PubMed  Google Scholar 

  • Gamarel, K. E., & Golub, S. A. (2020). 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. Annals of Behavioral Medicine, 54(4), 237–248. https://doi.org/10.1093/abm/kaz043

    Article  PubMed  Google Scholar 

  • Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., Sanchez, J., Grinsztejn, B., Koblin, B. A., Mayer, K. H., & Buchbinder, S. P. (2012). What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE, 7(11), e50522. https://doi.org/10.1371/journal.pone.0050522

    Article  PubMed  PubMed Central  Google Scholar 

  • Hernandez-Romieu, A. C., Sullivan, P. S., Sanchez, T. H., Kelley, C. F., Peterson, J. L., Del Rio, C., Salazar, L. F., Frew, P. M., & Rosenberg, E. S. (2014). The comparability of men who have sex with men recruited from venue-time-space sampling and facebook: A cohort study. JMIR Research Protocols, 3(3), e37. https://doi.org/10.2196/resprot.3342

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoff, C. C., & Beougher, S. C. (2010). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39(3), 774–787. https://doi.org/10.1007/s10508-008-9393-2

    Article  PubMed  Google Scholar 

  • Hoff, C. C., Beougher, S. C., Chakravarty, D., Darbes, L. A., & Neilands, T. B. (2010). Relationship characteristics and motivations behind agreements among gay male couples: Differences by agreement type and couple serostatus. AIDS Care, 22(7), 827–835. https://doi.org/10.1080/09540120903443384

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoff, C. C., Chakravarty, D., Bircher, A. E., Campbell, C. K., Grisham, K., Neilands, T. B., Wilson, P. A., & Dworkin, S. (2015). Attitudes towards PrEP and anticipated condom use among concordant HIV-negative and HIV-discordant male couples. AIDS Patient Care and STDs, 29(7), 408–417. https://doi.org/10.1089/apc.2014.0315

    Article  PubMed  PubMed Central  Google Scholar 

  • Holt, M., Lea, T., Bear, B., Halliday, D., Ellard, J., Murphy, D., Kolstee, J., & de Wit, J. (2019). Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: Implications for further implementation from a diffusion of innovations perspective. AIDS and Behavior, 23(7), 1939–1950. https://doi.org/10.1007/s10461-018-2368-y

    Article  PubMed  Google Scholar 

  • Kahle, E. M., Sharma, A., Sullivan, S., & Stephenson, R. (2020). The influence of relationship dynamics and sexual agreements on perceived partner support and benefit of PrEP use among same-sex male couples in the U.S. AIDS and Behavior, 24(7), 2169–2177. https://doi.org/10.1007/s10461-020-02782-9

    Article  PubMed  PubMed Central  Google Scholar 

  • Khanna, A. S., Michaels, S., Skaathun, B., Morgan, E., Green, K., Young, L., & Schneider, J. A. (2016). Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men. JAMA Internal Medicine, 176, 1–136. https://doi.org/10.1001/jamainternmed.2015.6536

    Article  Google Scholar 

  • Koblin, B. A., Mansergh, G., Frye, V., Van Tieu, H., Hoover, D. R., Bonner, S., Flores, S. A., Hudson, S. M., Colfax, G. N., & Project MIX Study Team. (2011). Condom-use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX. Journal of Acquired Immune Deficiency Syndromes, 58(3), 319–327. https://doi.org/10.1097/QAI.0b013e31822b76d2

    Article  PubMed  Google Scholar 

  • Kuhns, L. M., Hotton, A. L., Schneider, J., Garofalo, R., & Fujimoto, K. (2017). Use of Pre-exposure Prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS and Behavior, 21(5), 1376–1382. https://doi.org/10.1007/s10461-017-1739-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Larzelere, R. E., & Huston, T. L. (1980). The dyadic trust scale: Toward understanding interpersonal trust in close relationships. Journal of Marriage and the Family, 42, 595–604.

    Article  Google Scholar 

  • Linley, L., Johnson, A. S., Song, R., Wu, B., Hu, S., Gant, Z., Green, T.A., Gunnels, B., Hall, H.I., Hernandez, A., & Friend, M. (2020). Estimated HIV incidence and prevalence in the United States, 2014–2018.

  • Macapagal, K., Feinstein, B. A., Puckett, J. A., & Newcomb, M. E. (2019). Improving young male couples’ sexual and relationship health in the 2GETHER Program: Intervention techniques, environments of care, and societal considerations. Cognitive and Behavioral Practice, 26(2), 254–269. https://doi.org/10.1016/j.cbpra.2018.07.004

    Article  PubMed  Google Scholar 

  • Malone, J., Syvertsen, J. L., Johnson, B. E., Mimiaga, M. J., Mayer, K. H., & Bazzi, A. R. (2018). Negotiating sexual safety in the era of biomedical HIV prevention: Relationship dynamics among male couples using pre-exposure prophylaxis. Culture, Health & Sexuality, 20(6), 658–672. https://doi.org/10.1080/13691058.2017.1368711

    Article  Google 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(1), 99–106. https://doi.org/10.1007/s10508-013-0208-8

    Article  PubMed  PubMed Central  Google Scholar 

  • Mitchell, J. W. (2014). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51(3), 316–328. https://doi.org/10.1080/00224499.2012.727915

    Article  PubMed  Google Scholar 

  • Mitchell, J. W., Chavanduka, T. M. D., Sullivan, S., & Stephenson, R. (2020a). Recommendations from a descriptive evaluation to improve screening procedures for web-based studies with couples: Cross-sectional study. JMIR Public Health and Surveillance, 6(2), e15079. https://doi.org/10.2196/15079

    Article  PubMed  PubMed Central  Google Scholar 

  • Mitchell, J. W., Lee, J.-Y., Woodyatt, C., Bauermeister, J., Sullivan, P., & Stephenson, R. (2016). HIV-negative male couples’ attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement. AIDS Care, 28(8), 994–999. https://doi.org/10.1080/09540121.2016.1168911

    Article  PubMed  PubMed Central  Google Scholar 

  • Mitchell, J. W., Lee, J.-Y., Wu, Y., Sullivan, P. S., & Stephenson, R. (2020b). Feasibility and acceptability of an electronic health HIV prevention toolkit intervention with concordant HIV-negative, same-sex male couples on sexual agreement outcomes: Pilot randomized controlled trial. JMIR Formative Research, 4(2), e16807. https://doi.org/10.2196/16807

    Article  PubMed  PubMed Central  Google Scholar 

  • Mitchell, J. W., & Petroll, A. E. (2012). Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases, 39(11), 871–876. https://doi.org/10.1097/olq.0b013e3182649135

    Article  PubMed  PubMed Central  Google Scholar 

  • Mitchell, J. W., & Stephenson, R. (2015). HIV-negative partnered men’s willingness to use pre-exposure prophylaxis and associated factors among an internet sample of U.S. HIV-negative and HIV-discordant male couples. LGBT Health, 2(1), 35–40. https://doi.org/10.1089/lgbt.2014.0092

    Article  PubMed  PubMed Central  Google Scholar 

  • Napper, L. E., Fisher, D. G., & Reynolds, G. L. (2012). Development of the perceived risk of HIV scale. AIDS and Behavior, 16(4), 1075–1083. https://doi.org/10.1007/s10461-011-0003-2

    Article  PubMed  Google Scholar 

  • Pantalone, D. W., Holloway, I. W., Goldblatt, A. E. A., Gorman, K. R., Herbitter, C., & Grov, C. (2020). The impact of pre-exposure prophylaxis on sexual communication and sexual behavior of urban gay and bisexual men. Archives of Sexual Behavior, 49(1), 147–160. https://doi.org/10.1007/s10508-019-01478-z

    Article  PubMed  Google Scholar 

  • Patel, V. V., Ginsburg, Z., Golub, S. A., Horvath, K. J., Rios, N., Mayer, K. H., Kim, R. S., & Arnsten, J. H. (2018). Empowering with PrEP (E-PrEP), a peer-led social media-based intervention to facilitate HIV preexposure prophylaxis adoption among young Black and Latinx gay and bisexual men: Protocol for a cluster randomized controlled trial. JMIR Research Protocols, 7(8), e11375. https://doi.org/10.2196/11375

    Article  PubMed  PubMed Central  Google Scholar 

  • Pulsipher, C. A., Montoya, J. A., Plant, A., Curtis, P., Holloway, I., & Leibowitz, A. A. (2016). Addressing PrEP disparities among young gay and bisexual men in California. California HIV/AIDS Research Program. Retrieved March, 12, 2018.

  • Quinn, K. G., Zarwell, M., John, S. A., Christenson, E., & Walsh, J. L. (2020). Perceptions of PrEP use within primary relationships among young Black gay, bisexual, and other men who have sex with men. Archives of Sexual Behavior, 49(6), 2117–2128. https://doi.org/10.1007/s10508-020-01683-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Rios-Spicer, R., Darbes, L., Hoff, C., Sullivan, P. S., & Stephenson, R. (2019). Sexual agreements: A scoping review of measurement, prevalence and links to health outcomes. AIDS and Behavior, 23(1), 259–271. https://doi.org/10.1007/s10461-018-2212-4

    Article  PubMed  Google Scholar 

  • Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption—II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

    Article  PubMed  Google Scholar 

  • Smith, D. K., Van Handel, M., & Grey, J. (2018). Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Annals of Epidemiology, 28(12), 850-857.e859. https://doi.org/10.1016/j.annepidem.2018.05.003

    Article  PubMed  Google Scholar 

  • Smith, D. K., Van Handel, M., Wolitski, R. J., Stryker, J. E., Irene Hall, H., Prejean, J., Koenig, L. J., & Valleroy, L. A. (2015). Vital signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR. Morbidity and Mortality Weekly Report, 64(46), 1291–1295. https://doi.org/10.15585/mmwr.mm6446a4

    Article  PubMed  Google Scholar 

  • Smolenski, D. J., Diamond, P. M., Ross, M. W., & Rosser, B. R. S. (2010). Revision, criterion validity, and multigroup assessment of the Reactions to Homosexuality Scale. Journal of Personality Assessment, 92(6), 568–576. https://doi.org/10.1080/00223891.2010.513300

    Article  PubMed  PubMed Central  Google Scholar 

  • Spieldenner, A. (2016). PrEP whores and HIV prevention: The queer communication of HIV pre-exposure prophylaxis (PrEP). Journal of Homosexuality, 63(12), 1685–1697. https://doi.org/10.1080/00918369.2016.1158012

    Article  PubMed  Google Scholar 

  • Starks, T. J., Doyle, K. M., Shalhav, O., John, S. A., & Parsons, J. T. (2019). An examination of gay couples’ motivations to use (or forego) pre-exposure prophylaxis expressed during couples HIV testing and counseling (CHTC) sessions. Prevention Science, 20(1), 157–167. https://doi.org/10.1007/s11121-018-0892-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Stephenson, R., Chavanduka, T. M. D., Sullivan, S., & Mitchell, J. W. (2020). Correlates of successful enrollment of same-sex male couples into a web-based HIV prevention research study: Cross-sectional study. JMIR Public Health and Surveillance, 6(1), e15078. https://doi.org/10.2196/15078

    Article  PubMed  PubMed Central  Google Scholar 

  • Stephenson, R., Freeland, R., Sullivan, S. P., Riley, E., Johnson, B. A., Mitchell, J., McFarland, D., & Sullivan, P. S. (2017). Home-based HIV testing and counseling for male couples (Project Nexus): A protocol for a randomized controlled trial. JMIR Research Protocols, 6(5), e101. https://doi.org/10.2196/resprot.7341

    Article  PubMed  PubMed Central  Google Scholar 

  • Stephenson, R., White, D., Darbes, L., Hoff, C., & Sullivan, P. (2015). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior, 19(3), 553–560. https://doi.org/10.1007/s10461-014-0862-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Sullivan, P. S., Carballo-Diéguez, A., Coates, T., Goodreau, S. M., McGowan, I., Sanders, E. J., Smith, A., Goswami, P., & Sanchez, J. (2012). Successes and challenges of HIV prevention in men who have sex with men. The Lancet, 380(9839), 388–399. https://doi.org/10.1016/s0140-6736(12)60955-6

    Article  Google Scholar 

  • Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23(9), 1153–1162. https://doi.org/10.1097/QAD.0b013e32832baa34

    Article  PubMed  Google Scholar 

  • Sullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J., Dasgupta, S., O’Hara, B., Scales, L., Salazar, L. F., Wingood, G., DiClemente, R., & Stephenson, R. (2014). Safety and acceptability of couples HIV testing and counseling for US men who have sex with men. Journal of the International Association of Providers of AIDS Care, 13(2), 135–144. https://doi.org/10.1177/2325957413500534

    Article  Google Scholar 

  • Szymanski, D. M. (2006). Does internalized heterosexism moderate the link between heterosexist events and lesbians’ psychological distress? Sex Roles, 54(3–4), 227–234. https://doi.org/10.1007/s11199-006-9340-4

    Article  Google Scholar 

  • WHO. (2016). Global health sector strategy on HIV 2016–2021 (p. 60). World Health Organization.

    Google Scholar 

  • Young, L. E., Schumm, P., Alon, L., Bouris, A., Ferreira, M., Hill, B., Khanna, A. S., Valente, T. W., & Schneider, J. A. (2018). PrEP Chicago: A randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clinical Trials, 15(1), 44–52. https://doi.org/10.1177/1740774517730012

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rob Stephenson.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stephenson, R., Chavanduka, T.M.D., Sullivan, S. et al. Partner Support and Communication for Pre-exposure Prophylaxis (PrEP) Use Among Male Couples. Arch Sex Behav 51, 2549–2562 (2022). https://doi.org/10.1007/s10508-021-02118-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-021-02118-1

Keywords

Navigation