Main Partner Relationships and the HIV Care Cascade: Examining the Predictive Utility of Sexual Agreements, Partner Concordance, and Drug Use Among Sexual Minority Men Living With HIV in the USA.

BACKGROUND: The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. PURPOSE: This study evaluated associations between relational covariates (relationship status, sexual agreements, and seroconcordance) and HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load (VL) testing, and VL detectability) above and beyond cannabis and stimulant drug use. METHODS: Adult SMM (n = 36,874) living with HIV in the USA were recruited between November 1, 2017 and March 15, 2020 through social networking applications. They completed a cross-sectional survey online. RESULTS: Nonmonogamous SMM with serodiscordant partners were most likely to have an ART prescription. Those with seroconcordant partners (regardless of sexual agreements) were least likely to be adherent. While relational covariates were not associated with VL testing, SMM in nonmonogamous relationships with serodiscordant partners were significantly more likely to have an undetectable VL. Those in monogamous relationships with seroconcordant partners were significantly less likely to have an undetectable VL. CONCLUSIONS: SMM with seroconcordant partners and monogamous sexual agreements may experience diminished interpersonal motivation for HIV care engagement. HIV care cascade retention messages that emphasize the prevention of onward transmission may have limited relevance for these SMM. Novel intervention strategies are needed to enhance HIV care outcomes in this population, ideally ones that incorporate attention to drug use.

The majority of people living with HIV in the USA are sexual minority men (SMM). Whereas substantial work has examined HIV prevention in male couples, relatively little has examined relationship factors associated with HIV care outcomes. This study examined whether relationship status, main partner serostatus (seroconcordant vs. serodiscordant), and sexual agreements (monogamous vs. nonmonogamous) were associated with HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load testing, and viral load detectability) above and beyond cannabis and stimulant drug use. We surveyed adult SMM (n = 36,874) living with HIV in the USA between November 2017 and March 2020. Across outcomes where significant between-group differences were observed, results generally indicated partnered SMM with serodiscordant partners­particularly those in nonmonogamous relationships­were more likely to be retained in the HIV care cascade; meanwhile, SMM with seroconcordant partners­particularly those in monogamous relationships­were most vulnerable to attrition in the HIV care cascade. Given this pattern of findings, it is conceivable that efforts to motivate linkage and retention along the HIV care cascade have emphasized the prevention of onward transmission while failing to capitalize on or acknowledge health enhancement as an additional (and coequal) source of motivation.

Client Responses to Video-Based Communication Skills Training Involving PrEP for HIV: Tailoring an Individual Sexual Health Intervention for Sexual Minority Men in Relationships.

For many partnered sexual minority men (SMM), PrEP decisions are shaped by their relationships. Recent innovations in HIV risk reduction interventions tailored for partnered SMM include the integration of video-based communication skill building. The purpose of the current study was to examine the responses of 37 SMM in relationships with cismale partners to understand how actual or anticipated conversations between partners may influence PrEP decision making. Results suggested an individual intervention has the ability to elicit detailed content about interactions between partners. When SMM anticipated being in agreement with their partner about PrEP, they described few challenges to discussing HIV prevention. In contrast, when SMM anticipated relationship-related concerns about PrEP, they also anticipated conversations with their partner would be challenging and likely to involve conflict. This often-diminished SMM's motivation to engage partners and develop shared HIV-prevention goals. These SMM may benefit from integrated communications skills building to overcome challenges and work collaboratively with partners around PrEP use.

PrEP Demonstration Project Showed Superior Adherence with Tenofovir Alafenamide/Emtricitabine Compared to Tenofovir Disoproxil Fumarate/Emtricitabine in a Sample of Partnered Sexual Minority Men.

Sexual minority men (SMM) remain at high risk of HIV infection in the United States, and for those in relationships, dyadic functioning may contextualize prevention decisions. Pre-exposure prophylaxis (PrEP) for HIV prevention was previously limited to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) until the FDA approved tenofovir alafenamide/FTC (TAF/FTC) for PrEP in 2019. Data regarding substance use, sexual behavior, holding an active PrEP prescription, and type of PrEP regimen (TDF/FTC versus TAF/FTC) were analyzed from a sample of 421 partnered SMM. The majority of the sample on PrEP reported a TDF/FTC prescription as opposed to TAF/FTC. However, SMM reported significantly better adherence to TAF/FTC than TDF/FTC in multivariable models. Novelty of TAF/FTC, treatment fatigue with TDF/FTC, and/or a belief in TAF/FTC's superior efficacy and mitigated side effects may be plausible contributing factors. More studies using objective adherence metrics and surveys are needed.

RESUMEN: Los hombres de minorías sexuales (SMM, por sus siglas en inglés) permanecen en alto riesgo de infección por VIH en los Estados Unidos y, para quienes están en una relación romántico, el funcionamiento diádico puede contextualizar las decisiones de prevención del VIH. La profilaxis previa a la exposición (PrEP) para la prevención del VIH se limitaba a tenofovir disoproxil fumarato / emtricitabina (TDF / FTC) hasta que la FDA aprobó tenofovir alafenamida / FTC (TAF / FTC) para PrEP en 2019. Datos sobre el uso de sustancias, comportamientos sexuales, teniendo una prescripción de PrEP activa, y el tipo de régimen de PrEP (TDF / FTC versus TAF / FTC) se analizaron de una muestra de 421 SMM asociados. La mayoría de la muestra que toma PrEP indicó teniendo una prescripción de TDF / FTC en lugar de TAF / FTC. Sin embargo, comparando la adherencia auto-informada, SMM indica mejor adherencia a TAF / FTC que TDF / FTC en modelos multivariables. La novedad de TAF / FTC, la fatiga del tratamiento con TDF / FTC y/o la creencia en la eficacia superior de TAF / FTC y los efectos secundarios mitigados pueden contribuir a la mejor adherencia a TAF / FTC. Se necesitan más estudios que utilicen métricas y encuestas de adherencia objetivas.

Developmental Barriers to Couples' HIV Testing and Counseling Among Adolescent Sexual Minority Males: A Dyadic Socio-ecological Perspective.

Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data from 28 ASMM recruited in 4 urban centers in the USA during the formative stage of Adolescent Trials Network study ATN-156. Participants were cis-male, HIV-negative, and in a relationship with a similarly-aged cis-male partner. Thematic analysis indicated low and high levels of commitment were barriers to CHTC. Concerns about caregiver attitudes towards HIV testing were salient. Adolescents' perception of structural barriers highlighted reliance on caregiver resources, which limited access to sexual health services. Prevention programming must address structural barriers to access encountered by adolescents. ASMM in relationships may benefit from programming that includes options for individual and dyadic participation.

Population-Specific Correlates of Sexual Arrangements and Communication in a National Sample of Latinx Sexual Minority Men.

While the literature on sexual arrangements has expanded considerably, less is known about sexual arrangements among ethnically diverse populations, particularly Latinx sexual minority men (LSMM). Relationship research may overlook culturally salient correlates (e.g., ideals of masculinity or immigration-related factors) of sexual arrangements. The current study explored relationship-related factors (i.e., sexual arrangements, sexual communication, and relationship functioning) as well as Latino-specific factors, including dominant cultural views of masculinity (machismo/caballerismo) and immigration among partnered LSMM. Participants were recruited nationwide through social media and geo-location dating apps. All participants were aged 18 or older, cisgender male, lived in the U.S., including Puerto Rico, were able to read in either English or Spanish, and indicated they were currently in a relationship with a cismale partner. Multinomial regression was used to calculate the odds of being in an open or monogamish arrangement relative to a monogamous arrangement. Multivariable linear regression analysis was conducted to examine factors related to sexual communication. Language spoken with partner, adherence to more general heteronormative beliefs (genderism), and substance use were associated with specific sexual arrangement groups. The findings also suggested that birthplace, language spoken with partner variables, and machismo were associated with specific sexual arrangements and with sexual communication. This study highlights that factors associated with sexual arrangements and sexual communication may be population specific. The current study points to a complex interplay between culturally relevant ideals of masculinity and sexual arrangements as well as sexual communication among partnered Latinx sexual minority men.

Collective Sex and Committed Relationships: A Qualitative Exploration of Relationship Desires Among Gay Men Who Attend Sex Clubs.

Studies have documented gay men's engagement in collective sex (e.g., group sex in public or commercial environments) but little attention has been paid to these men's relationship desires or agreements. We report on qualitative interviews with 20 gay men who attended private sex clubs in New York City, asking how participants navigated sometimes conflicting desires for collective sex and committed relationships. Participants felt that collective sex was either a) incompatible with relationships, which should be monogamous; b) complementary to a primary non-monogamous relationship; or c) at least as important as relationships. Gay men attending sex clubs attribute different value to collective sex and to committed relationships, and experience different challenges in satisfying their desires for intimacy. Resources could help gay men navigating these apparently conflicting desires and making suitable choices regarding their relationships and/or sexual agreements.

Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach.

Introduction: The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined. Methods: The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021. Results: The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma. Conclusions: Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex. Policy Implications: Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.

Day-level associations between drug use and sexual behavior in male couples: Actor partner interdependence modeling of timeline follow-back data.

BACKGROUND: Both marijuana and other illicit drugs (e.g., cocaine/crack, methamphetamines, ecstasy, gamma-hydroxybuterate, and ketamine) have been linked to the occurrence of condomless anal sex (CAS) with casual partners among sexual minority men (SMM) and these associations largely generalize to partnered SMM. Software advances now permit testing the day-level correspondence between participants' sexual behavior and their own drug use (actor effects) as well as their partners' (partner-effects). METHODS: Participants comprised 50 couples (100 individuals) recruited in the New York City metro area. All were 18 or older and identified as cis male. In each couple, at least one partner was 18-29 years old, HIV-negative, reported recent (past 30 day) drug use and recent (past 30 day) CAS with a casual partner or CAS with a non-monogamous or sero-discordant main partner at screening. RESULTS: Marijuana was associated with CAS between main partners on days both partners reported its use. A similar pattern was observed for other illicit drugs. Respondents were more likely to report CAS with casual partners on days CAS between main partners occurred. Both marijuana and other illicit drugs were associated with increased likelihood of CAS with casual partners on days a main partner did not use drugs. These associations were attenuated on days where partners reported the use of different drugs. CONCLUSIONS: The co-occurrence of CAS with main and casual partners maximizes shared sexual risk. Results support the continued emphasis on dyadic HIV prevention interventions and the development of theoretically-based interventions that may address drug use by both partners in the relationship.

HIV Conspiracy Theory Belief or Institutional Mistrust? A Call for Disentangling Key Concepts.

Researchers studying the mental health implications of HIV continue to conflate institutional mistrust (i.e., medical and/or governmental) with HIV conspiracy theory belief despite a multitude of existing scales that measure both independently. Although this conflation is made frequently, measuring for HIV conspiracy theory belief in select (largely black) populations while choosing to forgo a scale for the assessment of institutional mistrust is likewise a fairly common practice. Therefore, research done on the prevalence of HIV conspiracy theories in black populations ought to be scrutinized for bias. By doing so, the differences and similarities of these phenomena would be clarified and perhaps the way could be paved for a new HIV conspiracy theory belief scale that factors in the Internet's profound effect on conspiracy theory dissemination while ensuring the ethical practice of HIV-related research in the future.

Self-efficacy, social distancing, and essential worker status dynamics among SGM people.

As of October 2020, the COVID-19 pandemic has accounted for over 210,000 deaths in the U.S. Sexual and gender minority populations are more likely to work in essential industries while bearing a disproportionate burden of the virus. Constructs consistent with Protection Motivation Theory (perceived severity, vulnerability, self-efficacy, and response efficacy) were measured using an abridged version of Kleczkowski et al.'s 4-factor Protection Motivation Theory Psychological Measures to examine social distancing behaviors of these populations. 32.6% of the sample were essential workers. Greater self-efficacy predicted stricter social distancing behaviors. Non-essential and unemployed worker statuses were associated with increased odds of stricter social distancing behaviors relative to essential worker status. Essential worker status predicted lower self-efficacy. The indirect effect of essential worker status on social distancing through self-efficacy was significant. Findings suggest that interventions that encourage social distancing through enhanced self-efficacy may optimize health for sexual and gender minority essential workers.

Evaluating the impact of COVID-19: A cohort comparison study of drug use and risky sexual behavior among sexual minority men in the U.S.A.

BACKGROUND: Sexual minority men who use drugs have high sexual HIV transmission risk. Sexual interactions may also increase COVID-19 risk.This study compared marijuana use, other illegal drugs use (i.e. cocaine/crack, methamphetamine, MDMA/ecstasy, GHB, and ketamine) and sexual behavior with casual partners among sexual minority cismen active on social networking and dating applications before and during the COVID-19 epidemic. METHODS: This cohort-control study compared 455 adult respondents (surveyed May 6th to 17th, 2020) and a matched sample selected from 65,707 respondents surveyed pre-COVID. Participants were recruited on social networking and dating applications and completed surveys online. RESULTS: The proportion reporting marijuana use declined significantly in the COVID cohort (34.5 % versus 45.7 % pre-COVID,p < .001) as did their illegal drug use (11.0 % versus 22.9 % pre-COVID, p < .001). While the number of casual partners per month was stable, the proportion reporting condomless anal sex with casual partners declined significantly during COVID (26.4 % versus 71.6 % pre-COVID, p < .001). The effect of illegal drug use (excluding marijuana) on number of casual partners per month (aRR = 1.45 pre-COVID versus 2.84, p < .01) and odds of condomless anal sex (aOR = 2.00 pre-COVID versus 5.22, p = .04) were significantly greater in the COVID cohort. CONCLUSIONS: While the proportion of participants reporting drug use and condomless anal sex with casual partners declined in the COVID cohort, the association between drug use and sexual behavior was magnified. Sexual minority men who use drugs are significantly more likely to engage in sexual behaviors that place them at risk for HIV and COVID-19 transmission.