An estimated one- to two-thirds of incident HIV infections among U.S. men who have sex with men (MSM) occur within the context of a primary relationship. The existing, yet limited, literature on sexual risk behavior among same-sex couples suggests that MSM with main partners are more often to report having lower perceived HIV risk, higher unrecognized HIV infection, and increased frequency of condomless anal intercourse with their primary partner. Furthermore, numerous studies document the strong relationship between polydrug use and binge drinking with HIV infection among MSM. However, more research is needed that identifies how individual- and relationship-level factors are related to polydrug use and binge drinking in the context of same-sex male relationships. We used baseline data collected as part of a prospective randomized controlled trial of 160 same-sex male couples (total N = 320 individuals). In 2015, recruitment commenced in three U.S. cities: Atlanta, GA, Boston, MA, and Chicago, IL. Participants completed a self-report assessment using an audio-computer-assisted self-interview system during their baseline enrollment visit. We collected information on participants’ sociodemographic characteristics, drug and alcohol use, individual- and relationship-level variables of interest, as well as relationship quality. Multinomial logistic regression models were fit for three different categories of polydrug use and of binge drinking for which (1) both partners exhibited the behavior, (2) only the respondent exhibited the behavior, or (3) only the partner exhibited the behavior. Participants’ age ranged from 18 to 69 (M = 35.9). The sample majority (77.5%) was White (248/320), with 12.2% Black (39/320) and 10.3% Multiracial (33/320); 68.4% had completed a college degree; and 9.6% were unemployed. A high proportion (62.2%) reported any drug use, including marijuana; 45% reported using drugs other than marijuana; and 18.1% reported polydrug use. Overall, 22.2% reported current binge drinking. Age discordance and being in a long-term relationship (6 or more years) were associated with a decreased odds of polydrug use among couples; being in an interracial dyad, recent history of arrest, living with HIV, and self-reported clinically significant depressive symptoms were associated with an increased odds of polydrug use. Additionally, being the older partner and reporting higher levels of internalized homophobia decreased odds for binge drinking, while recent history of arrest, living with HIV, and feeling more loved in their relationship were associated with an increased odds of binge drinking. Findings have implications for developing interventions to reduce substance use and promote health among same-sex male couples. Future research would benefit by using longitudinal study designs to understand the individual-, relationship-, and structural-level factors that potentiate polydrug use and binge drinking among same-sex male couples.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Amadio, D. M., & Chung, Y. B. (2004). Internalized homophobia and substance use among lesbian, gay, and bisexual persons. Journal of Gay and Lesbian Social Services, 17, 83–101.
Baiocco, R., D’Alessio, M., & Laghi, F. (2010). Binge drinking among gay, and lesbian youths: The role of internalized sexual stigma, self-disclosure, and individuals’ sense of connectedness to the gay community. Addictive Behaviors, 35, 896–899.
Baliunas, D., Rehm, J., Irving, H., & Shuper, P. (2010). Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. International Journal of Public Health, 55(3), 159–166.
Baral, S., Logie, C. H., Grosso, A., Wirtz, A. L., & Beyrer, C. (2013). Modified social ecological model: A tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health, 13(1), 482. https://doi.org/10.1186/1471-2458-13-482.
Blashil, A. B., Gordon, J. R., Mimiaga, M. J., & Safren, S. A. (2014). HIV/AIDS and depression. In S. Richards & M. O’Hara (Eds.), The Oxford handbook of depression and comorbidity (pp. 382–397). New York: Oxford University Press.
Brady, S., & Busse, W. J. (1994). The Gay Identity Questionnaire: A brief measure of homosexual identity formation. Journal of Homosexuality, 26, 1–22.
Bronfenbrenner, U. (1989). Ecological systems theory. In R. Vasta (Ed.), Annals of child development (Vol. 6, pp. 187–249). London: Jessica Kingsley Publishers.
Carpenter, J., Andrykowski, M., Wilson, J., Hall, L., Kay Rayens, M., Sachs, B., & Cunningham, L. (1998). Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues in Mental Health Nursing, 19, 481–494.
Carpenter, K. M., Fowler, J. M., Maxwell, G. L., & Andersen, B. L. (2010). Direct and buffering effects of social support among gynecologic cancer survivors. Annals of Behavioral Medicine, 39, 79–90.
Centers for Disease Control and Prevention. (2016). HIV in the United States: At a glance. Atlanta, GA: U.S. Department of Health and Human Services. https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 7 Oct 2018.
Darbes, L. A., Chakravarty, D., Neilands, T. B., Beougher, S. C., & Hoff, C. C. (2014). Sexual risk for HIV among gay male couples: A longitudinal study of the impact of relationship dynamics. Archives of Sexual Behavior, 43, 47–60.
Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., … Wilkins, E. (2014). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: Results from the cross-sectional ASTRA study. Lancet HIV, 1(1), e22–e31.
Duncan, D. T., Goedel, W. C., Stults, C. B., Brady, W. J., Brooks, F. A., Blakely, J. S., & Hagen, D. (2018). A study of intimate partner violence, substance abuse, and sexual risk behaviors among gay, bisexual, and other men who have sex with men in a sample of geosocial-networking smartphone application users. American Journal of Men’s Health, 12, 292–301. https://doi.org/10.1177/1557988316631964.
Fernández, M. I., Bowen, G. S., Varga, L. M., Collazo, J. B., Hernandez, N., Perrino, T., & Rehbein, A. (2005). High rates of club drug use and risky sexual practices among Hispanic men who have sex with men in Miami, Florida. Substance Use and Misuse, 40(9–10), 1347–1362.
Finneran, C., & Stephenson, R. (2014). Antecedents of intimate partner violence among gay and bisexual men. Violence and Victims, 29(3), 422–435.
Fleming, C. B., White, H. R., & Catalano, R. F. (2010). Romantic relationships and substance use in early adulthood: An examination of the influences of relationship type, partner substance use, and relationship quality. Journal of Health and Social Behavior, 51, 153–167.
Gallagher, K. M., Sullivan, P. S., Lansky, A., & Onorato, I. M. (2007). Behavioral surveillance among people at risk for HIV infection in the US: The National HIV Behavioral Surveillance System. Public Health Reports, 122(Suppl. 1), 32–38.
Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Jerome, R. C., Rogers, M., & Schillinger, J. (2008). Methamphetamine and poly-substance use among gym-attending men who have sex with men in New York City. Annals of Behavioral Medicine, 35(1), 41–48.
Halkitis, P. N., Palamar, J. J., & Mukherjee, P. P. (2007). Poly-club-drug use among gay and bisexual men: A longitudinal analysis. Drug and Alcohol Dependence, 89(2), 153–160.
Heavey, C. L., Larson, B. M., Zumtobel, D. C., & Christensen, A. (1996). The Communication Patterns Questionnaire: The reliability and validity of a Constructive Communication subscale. Journal of Marriage and Family, 58(3), 796–800. https://doi.org/10.2307/353737.
Hess, K. L., Chavez, P. R., Kanny, D., DiNenno, E., Lansky, A., Paz-Bailey, G., & NHBS Study Group. (2015). Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities. Drug and Alcohol Dependence, 147, 46–52.
Hoff, C. C., Cambell, C. K., Chakravarty, D., & Darbes, L. A. (2016). Relationship-based predictors of sexual risk for HIV among MSM couples: A systemic review of the literature. AIDS and Behavior, 20, 2873–2892. https://doi.org/10.1007/s10461-016-1350-9.
Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179–193.
Larzelere, R. E., & Huston, T. L. (1980). The Dyadic Trust Scale: Toward understanding interpersonal trust in close relationships. Journal of Marriage and Family, 42(3), 595–604. https://doi.org/10.2307/351903.
Lemieux, R., & Hale, J. L. (1999). Intimacy, passion, and commitment in young romantic relationships: Successfully measuring the triangular theory of love. Psychological Reports, 85, 497–503.
Martinez, O., Muñoz-Laboy, M., Levine, E. C., Starks, T., Dolezal, C., Dodge, B., … Fernandez, M. I. (2017). Relationship factors associated with sexual risk behavior and high-risk alcohol consumption among Latino men who have sex with men: Challenges and opportunities to intervene on HIV risk. Archives of Sexual Behavior, 46(4), 987–999.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.
Mimiaga, M. J., Biello, K. B., Robertson, A. M., Oldenburg, C. E., Rosenberger, J. G., O’Cleirigh, C., … Safren, S. A. (2015a). High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Archives of Sexual Behavior, 44(7), 1869–1878.
Mimiaga, M. J., O’Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., … Mayer, K. H. (2015b). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 68(3), 329–336. https://doi.org/10.1097/QAI.0000000000000475.
Mimiaga, M. J., Reisner, S. L., Fontaine, Y. M., Bland, S. E., Driscoll, M. A., Isenberg, D., … Mayer, K. H. (2010). Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM. Drug and Alcohol Dependence, 110(1–2), 30–37.
Mimiaga, M. J., Reisner, S. L., Vanderwarker, R., Gaucher, M. J., O’Connor, C. A., Medeiros, M. S., & Safren, S. A. (2008). Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing Department of Public Health mobile van services: Implications for intervention development. AIDS Patient Care and STDs, 22(9), 745–751.
Mitchell, J. (2014). Between and within couple-level factors associated with gay male couples’ investment in a sexual agreement. AIDS and Behavior, 18, 1454–1465.
Mitchell, J. W. (2015). Relationship characteristics differ based on use of substances with sex among an urban internet sample of HIV-Sdant and HIV-positive male couples. Journal of Urban Health, 92, 136–150.
Mitchell, J. W. (2016a). Differences in gay male couples’ use of drugs and alcohol with sex by relationship HIV status. American Journal of Men’s Health, 10, 262–269.
Mitchell, J. W. (2016b). Differences in relationship characteristics between HIV-negative male couples who used and did not use substances with sex. AIDS and Behavior, 20, 667–678.
Mitchell, J. W., Pan, Y., & Feaster, D. (2016). Actor-partner effects of male couples substance use with sex and engagement in condomless anal sex. AIDS and Behavior, 20, 2904–2913.
Mor, Z., Davidovich, U., McFarlane, M., Feldshtein, G., & Chemtob, D. (2008). Gay men who engage in substance use and sexual risk behaviour: A dual-risk group with unique characteristics. International Journal of STD and AIDS, 19(10), 698–703.
Mustanski, B., Newcomb, M. E., & Clerkin, E. M. (2011). Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychology, 30(5), 597–605. https://doi.org/10.1037/a0023858.
Newcomb, M. E., Ryan, D. T., Garofalo, R., & Mustanski, B. (2014). The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Archives of Sexual Behavior, 43(1), 61–72.
Ostrow, D. G., Plankey, M. W., Cox, C., Li, X., Shoptaw, S., Jacobson, L. P., & Stall, R. C. (2009). Specific sex-drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. Journal of Acquired Immune Deficiency Syndromes, 51(3), 349–355.
Parsons, J. T., & Starks, T. J. (2014). Drug use and sexual arrangements among gay couples: Frequency, interdependence, and associations with sexual risk. Archives of Sexual Behavior, 43, 89–98.
Parsons, J. T., Starks, T. J., DuBois, S., Grov, C., & Golub, S. A. (2013). Alternatives to monogamy among gay male couples in a community survey: Implications for mental health and sexual risk. Archives of Sexual Behavior, 42(2), 303–312.
Patterson, T. L., Semple, S. J., Zians, J. K., & Strathdee, S. A. (2005). Methamphetamine-using HIV-positive men who have sex with men: Correlates of poly-drug use. Journal of Urban Health, 82(1), i120–i126.
Peacock, E., Andrinopoulos, K., & Hembling, J. (2015). Binge drinking among men who have sex with men and transgender women in San Salvador: Correlates and sexual health implications. Journal of Urban Health, 92, 701–716.
Ross, M. W., Rosser, B. S., Bauer, G. R., Bockting, W. O., Robinson, B. B. E., Rugg, D. L., & Coleman, E. (2001). Drug use, unsafe sexual behavior, and internalized homonegativity in men who have sex with men. AIDS and Behavior, 5, 97–103.
Rowe, C., Liou, T., Vittinghoff, E., Coffin, P. O., & Santos, G. M. (2016). Binge drinking concurrent with anal intercourse and condom use among men who have sex with men. AIDS Care, 28(12), 1566–1570.
Salazar, L. F., Stephenson, R. B., Sullivan, P. S., & Tarver, R. (2013). Development and validation of HIV-related dyadic measures for men who have sex with men. Journal of Sex Research, 50, 164–177.
Santos, G. M., Jin, H., & Raymond, H. F. (2015). Pervasive heavy alcohol use and correlates of increasing levels of binge drinking among men who have sex with men, San Francisco, 2011. Journal of Urban Health, 92, 687–700.
Shuper, P. A., Neuman, M., Kanteres, F., Baliunas, D., Joharchi, N., & Rehm, J. (2010). Causal considerations on alcohol and HIV/AIDS: A systematic review. Alcohol and Alcoholism, 45(2), 159–166.
Skeer, M. R., Mimiaga, M. J., Mayer, K. H., O’Cleirigh, C., Covahey, C., & Safren, S. A. (2012). Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS and Behavior, 16(3), 676–689.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, 38(1), 15–28. https://doi.org/10.2307/350547.
Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., … Catania, J. A. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96(11), 1589–1601.
Stephenson, R., & Finneran, C. (2013). The IPV-GBM scale: A new scale to measure intimate partner violence among gay and bisexual men. PLoS ONE, 8, e62592.
Stephenson, R., Sato, K., & Finneran, C. (2013). Dyadic, partner and social network influences on intimate partner violence among male-male couples. Western Journal of Emergency Medicine, 14(4), 316–323.
Stephenson, R., Suarez, N. A., Garofalo, R., Hidalgo, M. A., Hoehnle, S., Thai, J., … Sullivan, P. (2017). Project Stronger Together: Protocol to test a dyadic intervention to improve engagement in HIV care among sero-discordant male couples in three US cities. JMIR Research Protocols, 6(8), e170. https://doi.org/10.2196/resprot.7884.
Stephenson, R., White, D., Darbes, L., Hoff, C., & Sullivan, P. (2015a). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior, 19(30), 530–560.
Stephenson, R., White, D., & Mitchell, J. W. (2015b). Sexual agreements and perception of HIV prevalence among an online sample of partnered men who have sex with men. Archives of Sexual Behavior, 44, 1813–1819.
Stults, C. B., Javdani, S., Greenbaum, C. A., Kapadia, F., & Halkitis, P. N. (2016). Intimate partner violence and sex among young men who have sex with me. Journal of Adolescent Health, 58, 215–222.
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.
Wen, X. J., Balluz, L., & Town, M. (2012). Prevalence of HIV risk behaviors between binge drinkers and non-binge drinkers aged 18-to 64-years in US, 2008. Journal of Community Health, 37(1), 72–79.
Wong, C. F., Kipke, M. D., & Weiss, G. (2008). Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men. Addictive Behaviors, 33, 1012–1020.
Woolf, S. E., & Maisto, S. A. (2009). Alcohol use and risk of HIV infection among men who have sex with men. AIDS and Behavior, 13(4), 757–782.
Wu, E., El-Bassel, N., McVinney, L. D., Hess, L., Fopeano, M. V., Hwang, H. G., … Mansergh, G. (2015). The association between substance use and intimate partner violence within Black male same-sex relationships. Journal of Interpersonal Violence, 30(5), 762–781.
Yu, G., Wall, M. M., Chiasson, M. A., & Hirshfield, S. (2015). Complex drug use patterns and associated HIV transmission risk behaviors in an Internet sample of U.S. men who have sex with men. Archives of Sexual Behavior, 44, 421–428.
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD075655 (MPIs: Drs. Garofalo, Mimiaga, Stephenson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review boards of The Fenway Institute, Boston, MA, Brown University, Providence, RI, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL and Emory University, and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Mimiaga, M.J., Suarez, N., Garofalo, R. et al. Relationship Dynamics in the Context of Binge Drinking and Polydrug Use Among Same-Sex Male Couples in Atlanta, Boston, and Chicago. Arch Sex Behav 48, 1171–1184 (2019). https://doi.org/10.1007/s10508-018-1324-2
- Same-sex male couples
- Polydrug use
- Binge drinking
- Sexual orientation