AIDS and Behavior

, Volume 15, Supplement 1, pp 80–87 | Cite as

Attitudes Towards Couples-Based HIV Testing Among MSM in Three US Cities

  • Rob StephensonEmail author
  • Patrick S. Sullivan
  • Laura F. Salazar
  • Beau Gratzer
  • Susan Allen
  • Erick Seelbach
Original Paper


Couples-based voluntary HIV counseling and testing (CVCT)—in which couples receive counseling and their HIV test results together—has been shown to be an effective strategy among heterosexual sero-discordant couples in Africa for reducing HIV transmission by initiating behavioral change. This study examined attitudes towards CVCT among men who have sex with men (MSM) in three US cities. Four focus group discussions (FGD) were held with MSM in Atlanta, Chicago, and Seattle. Although initially hesitant, participants reported an overwhelming acceptance of CVCT. CVCT was seen as a sign of commitment within a relationship and was reported to be more appropriate for men in longer-term relationships. CVCT was also seen as providing a forum for the discussion of risk-taking within the relationship. Our results suggest that there may be a demand for CVCT among MSM in the United States, but some modifications to the existing African CVCT protocol may be needed.


MSM Couples HIV testing 



This research was supported by the Emory Center for AIDS Research (P30 AI050409), National Institute for Mental Health (1R34MH086331), and NIMH RO1 667667, Fogarty AIDS International Training and Research Program FIC 2D43 TW001042.


  1. 1.
    Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al. Estimation of HIV incidence in the United States. J Am Med Assoc. 2008;300(5):520–9.CrossRefGoogle Scholar
  2. 2.
    Sullivan PS, Salazar LF, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among venue-attending men who have sex with men in the 5 US cities. AIDS. 2009;23(9):1153–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Gates GJ. Same-sex couples and the gay, lesbian, bisexual population: new estimates from the American Community Survey [online report]. 2006. Available at: Accessed May 2010.
  4. 4.
    Centers for Disease Control and Prevention. HIV Testing Survey, 2002. Atlanta: US. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004. p. 1–28. HIV/AIDS Special Surveillance Report 5. 2004. Available at
  5. 5.
    Centers for Disease Control and Prevention. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five US cities, June 2004–April 2005. MMWR. 2005;52(24):597–601.Google Scholar
  6. 6.
    Koblin BA, Chesney MA, Husnik MJ, Bozeman S, Celum CL, Buchbinder S, et al. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE study. Am J Public Health. 2003;93(6):926–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Stall RD, Hays RB, Waldo CR, Ekstrand M, Mc-Farland W. The gay ‘90s: a review of research in the 1990s on sexual behavior and HIV risk among men who have sex with men. AIDS. 2000;14(suppl 3):S101–14.PubMedGoogle Scholar
  8. 8.
    Imrie J, Stephenson JM, Cowan FM, et al. A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial. BMJ. 2001;322:1451–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Elford J, Hart G. If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM? AIDS Educ Prev. 2003;15(4):294–308.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89(9):1397–405.PubMedCrossRefGoogle Scholar
  11. 11.
    Kalichman Sc, Jeffrey A, Rompa D. Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychol. 1997;16(4):369–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Allen S, Serufilira A, Bogaerts J, Van de Perre P, Nsengumuremyi F, Lindan C, et al. Confidential HIV testing and condom promotion in Africa. Impact on HIV and gonorrhea rates. JAMA. 1992;268(23):3338–43.PubMedCrossRefGoogle Scholar
  13. 13.
    Chomba C, Allen S, Kaweka W, Tichacek A, Cox G, Shutes E, et al. Evolution of couples’ voluntary counseling and testing for HIV in Lusaka, Zambia. J AIDS. 2008;47(1):108–15.Google Scholar
  14. 14.
    Farquhar C, Kiarie JN, Richardson BA, Kabura M, Francis J, Nduati R, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. Epidemiol Soc Sci. 2004;37(5):1620–6.Google Scholar
  15. 15.
    Guthrie BL, de Bruyn G, Farquhar C. HIV 1 discordant couples in sub-Saharan Africa: explanations and implications for high rates of discordancy. Curr HIV Res. 2007;5(4):416–29.PubMedCrossRefGoogle Scholar
  16. 16.
    Painter TM. Voluntary counseling and testing for couples: a high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa. Soc Sci Med. 2001;53(11):1397–411.PubMedCrossRefGoogle Scholar
  17. 17.
    Dunkle K, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. Estimating the proportion of new heterosexually transmitted HIV infections that occur within married/cohabiting couples in urban Zambia and Rwanda. Lancet. 2008;371:2183–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Hageman KH, Tichacek A, Allen S. Couples voluntary counseling and testing. In: Mayer KH, Pizer HF, editors. HIV prevention: a comprehensive approach. London: Academic Press; 2009.Google Scholar
  19. 19.
    Morgan DL. Focus groups. Annu Rev Soc. 1996;22:129–52.CrossRefGoogle Scholar
  20. 20.
    NUD*IST. QSR International: Accessed May 2010.
  21. 21.
    Peterman TA, Todd KA, Mupanduki I. Opportunities for targeting publicly funded human immunodeficiency virus counseling and testing. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12:69–74.PubMedGoogle Scholar
  22. 22.
    Spielberg F, Kurth A, Gorbach PM, Goldbaum G. Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations. AIDS Educ Prev. 2001;13(6):524–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Allen S, Tice J, Van de Pere P, Serufilira A, Hudes E, Nsengumuremyi F, Bohaerts J, et al. Effect of serotesting with counseling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 2001;304:1605–9.CrossRefGoogle Scholar
  24. 24.
    Roth DL, Stewart KE, Clay OJ, van der Straten A, Karita E, Allen S. Sexual practices of HIV discordant and concordant couples in Rwanda: effects of a testing and counseling programme for men. Int J STD AIDS. 2003;12:181–8.CrossRefGoogle Scholar
  25. 25.
    Allen A, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17:733–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Gorbach PM, Holmes KK. Transmission of STIs/HIV at the partnership level: Beyond individual-level analyses. J Urban Health Bull NY Acad Med. 2003;80(3):iii15–25.Google Scholar
  27. 27.
    Theodore PS, Duran REF, Antoni M, Fernandez MI. Intimacy and sexual behavior among HIV-positive men who have sex with men in primary relationships. AIDS Behav. 2004;8(3):321–31.PubMedCrossRefGoogle Scholar
  28. 28.
    Marks G, Crepaz N, Senterfitt JW, Janssen R. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States Implications for HIV prevention programs. J AIDS. 2005;39(4):446–53.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Rob Stephenson
    • 1
    Email author
  • Patrick S. Sullivan
    • 2
  • Laura F. Salazar
    • 3
  • Beau Gratzer
    • 4
  • Susan Allen
    • 5
  • Erick Seelbach
    • 6
  1. 1.Hubert Department of Global HealthRollins School of Public HealthEmory, AtlantaUSA
  2. 2.Department of EpidemiologyRollins School of Public HealthEmory, AtlantaUSA
  3. 3.Department of Behavioral Science & Health EducationRollins School of Public HealthEmory, AtlantaUSA
  4. 4.Howard Brown Health Center and School of Public HealthUniversity of Illinois at ChicagoChicagoUSA
  5. 5.Zambia-Emory HIV Research Group, Department of PathologySchool of Medicine, Emory UniversityAtlantaUSA
  6. 6.Lifelong AIDS AllianceSeattleUSA

Personalised recommendations