The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples

  • Brian A. Feinstein
  • Emily Bettin
  • Gregory Swann
  • Kathryn Macapagal
  • Sarah W. Whitton
  • Michael E. Newcomb
Original Paper


Young MSM are at increased risk for HIV, especially in the context of serious relationships, but there is a lack of couples-based HIV prevention for this population. The 2GETHER intervention—an HIV prevention and relationship education program for young male couples—demonstrated promising effects in a pilot trial. However, there is evidence that internalized stigma (IS) can influence treatment outcomes among MSM. The current study examined the influence of IS on the efficacy of the 2GETHER intervention among 57 young male couples. The intervention led to decreases in percentage of condomless anal sex partners and increases in subjective norms regarding HIV prevention for those with low/average IS, but not high IS. The intervention also led to increases in motivation to get tested with one’s partner and decreases in alcohol consumption for those with high IS, but not low/average IS. In contrast, IS did not moderate intervention effects on other motivational constructs, dyadic adjustment, or alcohol problems. In sum, IS influences the extent to which young male couples benefit from HIV prevention and relationship education depending on the outcome. Research is needed to understand how IS influences treatment outcomes.


Internalized stigma HIV prevention Relationship education Same-sex couples Young men who have sex with men 



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.


This study was funded by a grant from the Sexualities Project at Northwestern (PI: Newcomb). Brian Feinstein was supported by a grant from the National Institute on Drug Abuse (F32DA042708; PI: Feinstein). Michael Newcomb was supported in part by a grant from the National Institute on Drug Abuse (DP2DA042417; PI: Newcomb). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Compliance with Ethical Standards

Conflict of interest

Brian A. Feinstein declares that he has no conflict of interest. Emily Bettin declares that she has no conflict of interest. Gregory Swann declares that he has no conflict of interest. Kathryn Macapagal declares that she has no conflict of interest. Sarah W. Whitton declares that she has no conflict of interest. Michael E. Newcomb declares that he has no conflict of interest.

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute for Sexual and Gender Minority Health and WellbeingNorthwestern UniversityChicagoUSA
  2. 2.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of PsychologyUniversity of CincinnatiCincinnatiUSA

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