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AIDS and Behavior

, Volume 21, Issue 8, pp 2464–2478 | Cite as

Integrating HIV Prevention and Relationship Education for Young Same-Sex Male Couples: A Pilot Trial of the 2GETHER Intervention

  • Michael E. NewcombEmail author
  • Kathryn R. Macapagal
  • Brian A. Feinstein
  • Emily Bettin
  • Gregory Swann
  • Sarah W. Whitton
Original Article

Abstract

Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.

Keywords

HIV/AIDS Relationship education Couples Young men who have sex with men 

Notes

Acknowledgements

This research was supported by a grant from the Sexualities Project at Northwestern (PI: M. Newcomb). Michael Newcomb’s time was also supported in part by a grant from the National Institute on Drug Abuse (DP2DA042417; PI: M. Newcomb). We would like to acknowledge the various individuals who served as facilitators for this project (in addition to the authors): Ryan Coventry, David Drustrup, John Frank, Kelsey Howard, Darnell Motley, Jae A. Puckett, and Tyson Reuter. We would also like to acknowledge Samuel McMillen and Brian Mustanski for their support. Finally, we would like to thank the couples that participated in this study for their time.

Compliance with Ethical Standards

Conflict of interest

The authors do not have any conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Participants provided their consent/assent to participate in the study.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance—Men Who Have Sex with Men. 2016.Google Scholar
  2. 2.
    Goodreau SM, Carnegie NB, Vittinghoff E, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7:e50522.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23:1153–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Safren SA, Blashill AJ, O’Cleirigh CM. Promoting the sexual health of MSM in the context of comorbid mental health problems. AIDS Behav. 2011;15(Suppl 1):S30–4.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rowniak S. Safe sex fatigue, treatment optimism, and serosorting: new challenges to HIV prevention among men who have sex with men. J Assoc Nurses AIDS Care. 2009;20:31–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Greene GJ, Fisher KA, Kuper L, Andrews R, Mustanski B. “Is this normal? Is this not normal? There’s no set example”: sexual health intervention preferences of LGBT youth in romantic relationships. Sex Res Social Policy. 2015;12:1–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30:597–605.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Newcomb ME, Ryan DT, Garofalo R, Mustanski B. The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Arch Sex Behav. 2014;43:61–72.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Perez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the P18 Study. AIDS Educ Prev. 2015;27:112–25.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Greene GJ, Andrews R, Kuper L, Mustanski B. Intimacy, monogamy, and condom problems drive unprotected sex among young men in serious relationships with other men: a mixed methods dyadic study. Arch Sex Behav. 2014;43:73–87.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mitchell JW, Petroll AE. Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sex Transm Dis. 2012;39:871–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chakravarty D, Hoff CC, Neilands TB, Darbes LA. Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS Behav. 2012;16:1944–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Centers for Disease Control and Prevention. HIV among gay and bisexual men: CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention, 2015.Google Scholar
  14. 14.
    Mustanski B, Newcomb M, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–53.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bingham TA, Harawa NT, Johnson DF, et al. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men’s Survey, Los Angeles, 1999-2000. AIDS Educ Prev. 2003;15:39–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Mustanski B, Newcomb ME. Older sexual partners may contribute to racial disparities in HIV among young men who have sex with men. J Adolesc Health. 2013;52:666–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Newcomb ME, Mustanski B. Developmental change in the relationship between alcohol and drug use before sex and sexual risk behavior in young men who have sex with men. AIDS Behav. 2014;18:1981–90.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16:1394–410.CrossRefPubMedGoogle Scholar
  19. 19.
    Grov C, Starks TJ, Rendina HJ, Parsons J. Rules about casual sex partners, relationship satisfaction, and HIV risk in partnered gay and bisexual men. J Sex Marital Ther. 2014;40:105–22.CrossRefPubMedGoogle Scholar
  20. 20.
    Hoff CC, Beougher SC. Sexual agreements among gay male couples. Arch Sex Behav. 2010;39:774–87.CrossRefPubMedGoogle Scholar
  21. 21.
    Hoff CC, Beougher SC, Chakravarty D, Darbes LA, Neilands TB. Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus. AIDS Care. 2010;22:827–35.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Mitchell JW. Characteristics and allowed behaviors of gay male couples’ sexual agreements. J Sex Res. 2014;51:316–28.CrossRefPubMedGoogle Scholar
  23. 23.
    Parsons JT, Starks TJ. Drug use and sexual arrangements among gay couples: frequency, interdependence, and associations with sexual risk. Arch Sex Behav. 2014;43:89–98.CrossRefPubMedGoogle Scholar
  24. 24.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012;7:99–105.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Newcomb ME, Mongrella MC, Weis B, McMillen SJ, Mustanski B. Partner disclosure of PrEP use and undetectable viral load on geosocial networking apps: frequency of disclosure and decisions about condomless sex. J Acquir Immune Defic Syndr. 2016;71:200–6.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93:963–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jiwatram-Negron T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav. 2014;18:1864–87.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Macapagal K, Greene GJ, Rivera Z, Mustanski B. “The best is always yet to come”: relationship stages and processes among young LGBT couples. J Fam Psychol. 2015;29:309–20.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Wagenaar BH, Christiansen-Lindquist L, Khosropour C, et al. Willingness of US men who have sex with men (MSM) to participate in Couples HIV Voluntary Counseling and Testing (CVCT). PLoS ONE. 2012;7:e42953.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sullivan PS, Stephenson R, Grazter B, et al. Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: an application of the ADAPT-ITT framework. Springerplus. 2014;3:249.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Allen S, Meinzen-Derr J, Kautzman M, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17:733–40.CrossRefPubMedGoogle Scholar
  33. 33.
    World Health Organization. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples. Geneva: WHO; 2012.Google Scholar
  34. 34.
    Purcell DW, Mizuno Y, Smith DK, et al. Incorporating couples-based approaches into HIV prevention for gay and bisexual men: opportunities and challenges. Arch Sex Behav. 2014;43:35–46.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Markman HJ, Rhoades GK. Relationship education research: current status and future directions. J Marital Fam Ther. 2012;38:169–200.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Hawkins AJ, Blanchard VL, Baldwin SA, Fawcett EB. Does marriage and relationship education work? A meta-analytic study. J Consult Clin Psychol. 2008;76:723–34.CrossRefPubMedGoogle Scholar
  37. 37.
    Buzzella BA, Whitton SW, Tompson MC. The initial evaluation of a relationship education program for male same-sex couples. Couple Family Psychol. 2012;14:306–22.CrossRefGoogle Scholar
  38. 38.
    Whitton SW, Weitbrecht EM, Kuryluk AD, Hutsell DW. A randomized waitlist-controlled trial of culturally sensitive relationship education for male same-sex couples. J Fam Psychol. 2016;30:763–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Lewis MA, Butterfield RM. Social control in marital relationships: effect of one’s partner on health behaviors. J Appl Soc Psychol. 2007;37:298–319.CrossRefGoogle Scholar
  40. 40.
    Waite LJ, Gallagher M. The case for marriage: why married people are happier, healthier, and better off financially. New York: Doubleday; 2000.Google Scholar
  41. 41.
    Talley AE, Hughes TL, Aranda F, Birkett M, Marshal MP. Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. Am J Public Health. 2014;104:295–303.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Bostwick WB, Meyer I, Aranda F, et al. Mental health and suicidality among racially/ethnically diverse sexual minority youths. Am J Public Health. 2014;104:1129–36.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–74.CrossRefPubMedGoogle Scholar
  44. 44.
    Misovich SJ, Fisher JD, Fisher WA. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1:72–107.CrossRefGoogle Scholar
  45. 45.
    Macapagal K, Greene GJ, Andrews R, Mustanski B. Evaluating the Relationship-Oriented Information, Motivation, and Behavioral Skills Model of HIV preventive behaviors in young men who have sex with men. AIDS Educ Prev. 2016;28:165–79.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Karney BR, Bradbury TN. The longitudinal course of marital quality and stability: a review of theory, method, and research. Psychol Bull. 1995;118:3–34.CrossRefPubMedGoogle Scholar
  47. 47.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Safren S, Otto MW, Worth JL. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Pract. 1999;6:332–41.CrossRefGoogle Scholar
  49. 49.
    Smith NG, Hart TA, Moody C, et al. Project PRIDE: a cognitive-behavioral group intervention to reduce HIV risk behaviors among HIV-negative young gay and bisexual men. Cogn Behav Pract. 2016;23:398–411.CrossRefGoogle Scholar
  50. 50.
    Yadavaia JE, Hayes SC, Vilardaga R. Using acceptance and commitment therapy to increase self-compassion: a randomized controlled trial. J Context Behav Sci. 2014;3:248–57.CrossRefGoogle Scholar
  51. 51.
    Mustanski B, Starks T, Newcomb ME. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43:21–33.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Misovich SJ, Fisher WA, Fisher JD. A measure of AIDS prevention information, motivation, behavioral skills, and behavior. In: Davis C, Yarber R, Bauserman R, et al., editors. Handbook of sexuality-related measures. Thousand Oaks, CA: SAGE; 1998. p. 328–37.Google Scholar
  53. 53.
    Janulis P, Newcomb ME, Sullivan P, Mustanski B. Evaluating HIV knowledge questionnaires among men who have sex with men: a multi-study item response theory analysis. Arch Sex Behav. In press.Google Scholar
  54. 54.
    Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38:15–28.CrossRefGoogle Scholar
  55. 55.
    Choi SW, Schalet B, Cook KF, Cella D. Establishing a common metric for depressive symptoms: linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychol Assess. 2014;26:513–27.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Pilkonis PA, Choi SW, Reise SP, et al. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(R)): depression, anxiety, and anger. Assessment. 2011;18:263–83.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88:791–804.CrossRefPubMedGoogle Scholar
  58. 58.
    Levesque RJR. The romantic experience of adolescents satisfying love relationships. J Youth Adolesc. 1992;22:219–51.CrossRefGoogle Scholar
  59. 59.
    Newcomb ME, Birkett M, Corliss HL, Mustanski B. Sexual orientation, gender, and racial differences in illicit drug use in a sample of US high school students. Am J Public Health. 2014;104:304–10.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Michael E. Newcomb
    • 1
    • 2
    Email author
  • Kathryn R. Macapagal
    • 1
    • 2
  • Brian A. Feinstein
    • 1
    • 2
  • Emily Bettin
    • 1
    • 2
  • Gregory Swann
    • 1
    • 2
  • Sarah W. Whitton
    • 3
  1. 1.Institute for Sexual and Gender Minority Health and WellbeingNorthwestern UniversityChicagoUSA
  2. 2.Department of Medical Social Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Department of PsychologyUniversity of CincinnatiCincinnatiUSA

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