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While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data from the baseline of a pilot randomized control trial with 318 YSMM aged 15 to 24 years in the United States who were in relationships with other males to examine the associations between sexual minority-specific stigma and sociodemographic and relationship characteristics and experiences of intimate partner violence (IPV) and sexual IPV in their relationships. Approximately one-in-five participants reported experiencing any form of IPV and 6% reported sexual IPV in their current relationship. Participants who reported sexual minority-specific familial rejection (Adjusted Odds Rato (aOR) = 2.33, 95% confidence interval [CI] [1.03, 5.26], p more...

Sexual satisfaction is an important dimension of relationship quality with implications for sexual and reproductive health (SRH), and HIV prevention, care, and treatment. We developed and validated the Couple Sexual Satisfaction Scale (CSSS) with heterosexual couples in sub-Saharan Africa. Using data from qualitative interviews with 94 partnered women and men in Swaziland and Malawi, we generated a 22-item scale and administered it to 211 couples with at least one partner living with HIV in Malawi. We performed an exploratory factor analysis (EFA) to identify and confirmatory factor analysis (CFA) to test the factor structure. To assess validity, we tested for associations between the CSSS and relationship quality, consistent condom use, and intimate partner violence (IPV) using generalized estimating equations. The EFA yielded two factors, general sexual satisfaction (13-item CSSS-Gen subscale, e.g., "I am satisfied with the sweetness of sex in our relationship") and HIV-specific sexual satisfaction (4-item CSSS-HIV subscale, e.g., "My appetite for sex has gone down due to HIV"), accounting for 78% of the shared variance. The CFA supported the two-factor solution: χ2(118) = 203.60; CFI = 0.909; SRMR = 0.057; RMSEA = 0.058. Participants with higher CSSS-Gen scores reported higher coital frequency and relationship quality (intimacy, trust, unity, equality, relationship satisfaction, commitment, partner social support), and less consistent condom use, physical IPV, and emotional IPV. Participants with higher CSSS-HIV scores reported higher coital frequency and relationship quality (trust, partner support), and less consistent condom use, and sexual IPV. The CSSS demonstrated good psychometric properties and provides new opportunities to study sexual reproductive health and HIV-related health behaviors among couples in sub-Saharan Africa. more...

There is increasing focus in HIV prevention and treatment on couples-based approaches. No systematic review has synthesized prospective behavioral couples-based HIV trials targeting prevention of mother-to-child transmission (PMTCT) outcomes in low- and middle-income countries (LMICs). We systematically reviewed published abstracts and articles reporting prospective comparative evaluations of behavioral couples-based HIV interventions delivered during pregnancy to both members of a self-identified heterosexual couple in LMICs following PRISMA. Citations, abstracts, and full texts were double screened for eligibility. References meeting eligibility criteria underwent double data abstraction, quality appraisal, and qualitative synthesis. We identified 295 unique publications. Of these, 5 randomized trials were deemed eligible and synthesized. Studies were conducted in 3 different African countries using three overarching intervention approaches: home-based; group workshops; and faith-based. Studies included various PMTCT outcome measures. We found evidence that behavioral couples-based approaches around the time of pregnancy can positively affect HIV testing among pregnant women and their male partners, infant HIV prophylaxis use, and HIV-free infant survival. The effects on other PMTCT outcomes were not well supported. There was a low to moderate risk of bias among the included studies. Few couples-based PMTCT interventions have been tested in LMICs. Of the interventions we located, workshops/group education and home-based couple counseling and testing were most commonly used to promote PMTCT. Research is needed on the role of relationship dynamics within such interventions and whether couples-based approaches during pregnancy can extend to health outcomes across the PMTCT continuum of care. more...

Despite the growing body of evidence demonstrating the high prevalence of intimate partner violence (IPV) among male couples and the unique antecedents to IPV that male couples may experience, research efforts have focused almost exclusively on North American populations. Missing from the literature is an understanding of the experience of IPV among male couples in African nations where social norms and legal restrictions around same-sex behavior may be more conservative. This paper presents data from an innovative study of male couples (Together Tomorrow) from two Southern African countries characterized by high prevalence of HIV: Namibia and South Africa. A one-time cross-sectional survey was conducted with 140 partnered MSM (70 couples) in Namibia and 300 partnered MSM (150 couples) in KZN, South Africa, for a total sample size of 440 partnered MSM (220 couples). Surveys measured the recent (12 month) experience of physical, sexual and emotional IPV and the experience of sexuality-related stressors. Reporting of IPV was relatively low: 7.3% reported being the victim of IPV from their male partner in the 12 months prior to the survey, and 10.2% reported participating in bi-directional IPV in their relationship in the previous 12 months. Men who reported different experiences of internalized homophobia and external acts of discrimination were more likely to report IPV and bi-directional IPV. The results offer several potential intervention points to disrupt pathways between stigma and IPV for partnered MSM in South Africa and Namibia, and point to the need for services for this critically overlooked population. more...

We estimated effects of maternal depressive symptoms, utilizing the Patient Health Questionnaire-8 (PHQ-8), on women’s HIV prevention behaviors in Migori County, Kenya. Pregnant women ≥ 18 years old, with gestational age of more...

Growing evidence suggests that intimate partner violence (IPV) is a barrier to engagement in HIV care. Bidirectional IPV—being both a perpetrator and victim—may be the most common pattern of IPV, yet no research has examined its effect on engagement in care, which could identify couples in most need of interventions. Married couples ( N = 211) with at least one partner on antiretroviral therapy were recruited from HIV clinic waiting rooms in Zomba, Malawi. Partners completed separate surveys on physical, sexual, and emotional IPV, medication adherence, and appointment attendance. We created categorical variables indicating no violence, perpetrator-only, victim-only, and bidirectional violence. Generalized estimating equation regression models tested for associations between IPV and engagement in care. The bidirectional pattern represented 25.4%, 35.5%, and 34.0% of all physical, sexual, and emotional IPV. Physical IPV victimization-only (adjusted odds ratio [AOR]: 0.28, 95% confidence interval [CI]: 0.08, 0.92) was associated with lower adherence, but the association was stronger for bidirectional physical IPV (AOR: 0.10, 95% CI: 0.02, 0.51). Bidirectional sexual IPV was also associated with lower adherence (AOR: 0.14, 95% CI: 0.02, 0.80). Bidirectional physical IPV (AOR: 4.04, 94% CI: 1.35, 12.14) and emotional IPV (AOR: 3.78, 95% CI: 1.78, 8.05) were associated with missing 1+ appointment. Interventions to address the health effects of bidirectional IPV, which may be greater than victim-only or perpetrator-only IPV, should intervene with both partners to break cycles of violence. Couple-based interventions may be a viable option by intervening on both partners’ trauma and aggression simultaneously. more...

Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples. more...

Cisgender men partnered with transgender women are an understudied and hard to engage population in HIV prevention efforts. Relationship stigma-the anticipation of negative treatment based on having a relationship with a member of a stigmatized group-has been linked to adverse health behaviors, but it remains unclear whether different sources of relationship stigma (i.e., family, friends, and the general public) are associated with HIV risk behaviors and whether these associations may vary by men's sexual identities (e.g., gay, bisexual, and heterosexual). The current study examined associations between relationship stigma and HIV risk behaviors and whether these associations were moderated by sexual identity. We recruited a convenience sample of 185 cisgender men in primary partnerships with transgender women to participate in a one-time survey. Gay identified men reported greater levels of relationship stigma from the general public compared with heterosexually identified men. In multivariable models, higher levels of relationship stigma from the public were associated with increased odds of engaging in drug use prior to having condomless sex and receiving an STI diagnosis in the last 30days. There were significant interaction effects such that higher levels of relationship stigma from the public were associated with both indicators of HIV risk for gay identified men but not for heterosexually identified men. Findings support the importance of HIV prevention approaches accounting for relationship stigma from the general public and the diverse sexual identities of men partnered with transgender women when seeking to increase linkage to and engagement in HIV prevention services, including biomedical prevention strategies. more...

BACKGROUND: Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC.SETTING: The Vulindlela district of KwaZulu-Natal, South Africa.METHODS: Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior.RESULTS: Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex.CONCLUSIONS: Our intervention improved CHTC uptake-a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV. more...

HIV disproportionately impacts men who have sex with men (MSM) in the USA. Building upon research on relationship constructs unique to MSM couples’ HIV-prevention needs, we developed two new scales measuring sexual agreement self-efficacy (SASE) and importance of sexual agreement communication (ISAC). Following qualitative item development, we used two large independent samples of MSM couples (N1 = 441, N2 = 388) to conduct scale validation. Exploratory factor analyses indicated both SASE and ISAC to be unidimensional with 7 and 5 items (eigenvalues = 5.68 and 3.50), respectively, with strong factor loadings. Confirmatory factor analyses yielded satisfactory model fit for SASE (CFI = 0.99, SRMR = 0.03) and ISAC (CFI = 0.99, SRMR = 0.05). Reliability was high for SASE (ω = 0.92) and ISAC (ω = 0.84). Predictive validity analysis revealed a protective association between higher scores on both scales and the outcomes of sexual risk behavior and agreement breaks. Convergent and discriminant validity analyses demonstrated associations in the expected directions between these scales and multiple measures of relationship quality. Therefore, SASE and ISAC are two brief, valid, and reliable scales that can facilitate more in-depth explorations of sexual agreements in MSM and thereby contribute greatly to improving our understanding of and ability to intervene on sexual agreements to improve health and relationship outcomes. more...

The COVID-19 pandemic has impacted the well-being of people worldwide; however, there has been limited research examining ways in which the pandemic has created changes in relationship quality among young sexual minority men. We analyzed data from a sample of 150 young sexual minority men, aged 15-24 years. In total, 25% reported their relationship quality decreased during the pandemic, 47% reported no change, and 28% reported increased relationship quality due to COVID-19. In multinomial models, intimate partner violence, lower commitment, and spending less time with a partner due to COVID-19 were associated with decreased relationship quality during the pandemic compared to those who reported no change or increased relationship quality due to the pandemic. More efforts are needed to understand and address the impact of COVID-19 on the romantic relationships of young sexual minority men. more...

There has been a growth in research illustrating that gay, bisexual, and other men who have sex with men (GBMSM) experience intimate partner violence (IPV) at rates that are comparable to those among heterosexual women. However, the majority of research on IPV among same-sex male couples has focused on adults, and research on the experience of IPV among younger men (those aged under 18), remains at a nascent stage, despite knowledge that IPV is often common among younger men. This article adds to the growing body of literature on IPV among young GBMSM (YGBMSM) through of an analysis of qualitative data from in-depth interviews (IDI) with GBMSM aged 15–19 ( n = 30) in romantic relationships partnerships. The study sought to explore issues of relationship development, relationship contexts, and understandings of IPV. More than one-half of the sample reported experiencing some form of IPV in their current or past relationships. Participants described a range of experiences of IPV, including physical IPV, emotional IPV, sexual IPV, and controlling behaviors. Emotional IPV in the form of negative comments and controlling behaviors such as jealousy were the most commonly reported forms of violence behaviors. Although few participants reported experiencing physical or sexual IPV, several discussed concerns about giving, and partners’ acknowledging, sexual consent. Antecedents to IPV included wanting or feeling pressured to participate in normative development milestones, short-lived relationships, and societal stigma. Interventions that develop content on IPV and that reflect the lived realities of YGBMSM who are experiencing their first relationships are urgently needed. Study findings also support the need for training teachers, health care providers, and parents to identify signs of IPV and provide them with the knowledge and skills to talk to YGBMSM about relationships and violence to reduce IPV. more...

Introduction Interpersonal support can promote positive outcomes among people living with HIV. In order to develop an acceptable psychoeducational couples-based intervention aimed at strengthening the relationship context and improving HIV outcomes before and after pregnancy, we conducted qualitative interviews with pregnant women living with HIV and their male partners. Methods We interviewed a convenience clinic-based sample of pregnant women living with HIV (n = 30) and male partners (n = 18) in Lusaka, Zambia. Interviews included pile sorting relationship topics in order of perceived priority. Interviews also focused on family health concerns. Interviews were audio-recorded, translated, transcribed, and thematically analyzed. Pile sorting data was analyzed using descriptive statistics. Results All female participants were living with HIV; 61% of the male partners interviewed were additionally living with HIV. The most prioritized relationship topic among both genders was communication between couples. Honesty and respect were important relationship topics but prioritized differently based on gender. Female participants considered emotional and instrumental support from male partners critical for their physical and mental health; men did not prioritize support. Intimate partner violence was discussed often by both genders. Family health priorities included good nutrition during pregnancy, preventing infant HIV infection, safe infant feeding, sexual health, and men's alcohol use. Conclusions A major contribution of this study is a better understanding of the dyad-level factors pregnant women living with HIV and their male partners perceive to be the most important for a healthy, well-functioning relationship. This study additionally identified gaps in antenatal health education and the specific family health issues most prioritized by pregnant women living with HIV and their male partners. The findings of this study will inform the development of an acceptable couples-based intervention with greater likelihood of efficacy in strengthening the relationship context and promoting family health during and after pregnancies that are affected by HIV. more...

There is strong evidence that gay, bisexual and other men who have sex with men (GBMSM) in African countries experience high prevalence of HIV. However, missing from the literature is an understanding of the HIV risk behaviors and prevention needs of partnered GBMSM in African countries. The Together Tomorrow project sampled 440 partnered GBMSM (220 couples) in South Africa and Namibia. Prevalence of HIV was high at 42%, with 33% of men in sero-discordant relationships. Despite high levels of HIV testing in the past 6 months (65%), condom use with main and outside sex partners was low. Men reported low levels of willingness to use pre-exposure prophylaxis (PrEP) (16%). HIV testing in the past 12 months and willingness to use PrEP were significantly associated with recent binge drinking and substance use. Men in sero-discordant relationships, those with sexual agreements and those who had experienced any form of IPV were all less likely to report that they had recently tested for HIV. There is a need to develop interventions that meet the unique needs of African partnered GBMSM and tackle stigma and discrimination as drivers of HIV risk in these settings. more...

IntroductionHIV transmission and acquisition risk among transgender women is particularly high in the context of primary partnerships. This project extends a previous pilot couples-focused HIV intervention programme, which was shown to be feasible, acceptable and promising in reducing sexual risk behaviour among transgender women and their partners. This randomised controlled trial (RCT) tests the efficacy of this culturally sensitive HIV prevention programme for HIV-serodiscordant and HIV-negative seroconcordant transgender women and their partners.Methods and analysisTo finalise the protocol for trial, we used qualitative methods to hone eligibility criteria, refine the intervention and control manuals, and name and brand the intervention (‘It Takes Two’). The RCT investigates the effects of the It Takes Two intervention on Composite Risk for HIV (CR-HIV) among 100 couples. CR-HIV is a binary indicator of couple HIV risk using validated measures of sexual behaviour, pre-exposure prophylaxis use among HIV-negative participants and viral suppression among participants living with HIV. Using a two-arm RCT, we will examine intervention effects on CR-HIV at 12-month follow-up comparing transgender women and their partners randomised to the intervention versus control (HIV prevention information only).Ethics and disseminationThis study has been reviewed and approved by the University of California, San Francisco (19-28624) and the University of Michigan (HUM00147690) Institutional Review Boards. Participants provide informed consent before taking part of the study activities. Results will be published in peer-reviewed journals and presented at scientific conferences. We will make our results available to the community of researchers and general public interested in transgender health to avoid unintentional duplication of research, as well as to others in the health and social services community, including LGBT community-based organisations, AIDS service organisations and other transgender-serving organisations. The full de-identified dataset and codebook will be shared at the University of Michigan Digital Repository.Trial registration numberNCT04067661. more...

Background Rates of sexually transmitted infections and unintended pregnancies are disproportionately high among African American adolescents and young adults (AYA). New media platforms such as social networking sites, microblogs, online video sites, and mobile phone applications may be a promising approach in promoting safe sex and preventing sexually transmitted infections. Objective The purpose of this scoping review was to address promising approaches in new media that may serve as valuable tools in health promotion, prevention, education, and intervention development aimed at African American AYA. Methods An electronic search was conducted using Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health (CINHAL), and PubMed online databases. Concept blocks and MeSH terminology were used to identify articles around African American youth and new media. Results The search yielded 1169 articles, and 16 publications met the criteria. Studies from the review found themes in new media that included feasibility, changing attitudes, and improving knowledge related to sexual health behavior among youth of color. Conclusions New media is a promising and feasible platform for improving the sexual health of African American AYA. Further research is suggested to better understand the benefits of new media as a sexual health promotion tool among this specific population. more...

Background Social media platforms such as Facebook, Instagram, and Twitter, which have millions of users who interact and communicate every day, have been effective in promoting sexual health interventions and in disseminating reproductive health education. They have also been shown to be useful in health promotion and have been used to track several key metrics (eg, comments, posts) among users of all demographics. However, there is a lack of research on the impact and reach of these social media platforms as a community-based tool for disseminating sexual health information and for increasing engagement among Black adolescents and young adults, which is a targeted high-risk population. Objective The purpose of this study was to determine the social media platforms and banner advertisements that affected engagement among Black male adolescents and young adults in participating in web-based health surveys. Methods A web-based survey was conducted from March 2019 to July 2019 to assess sexual health and health behaviors in a convenience sample of Black male adolescents and young adults in the age range of 18-24 years (N=170). Social media metrics from Facebook, Instagram, and Twitter were monitored. This cross-sectional survey comprised several categories, including basic personal information, drug-related risk behaviors, health care, sexual reproductive health questions, attitudes, norms, and perceived control, mental health, violence-related risk behaviors, and social media preferences. Results Social media advertisements on the Black Male Opinion survey reached approximately 146,412 individuals. Our primary finding of the web-based survey engagement was that referral (eg, group chat, indirect social media sharing) led to as the greatest proportion of recruitment, with Twitter and YouTube as the preferred sites to receive sexual health information. Conclusions Recognizing the variety of technologies being used among Black male young adults and adolescents can help the community, researchers, and health care providers understand the web-based engagement of this high-risk population. This information may also promote culturally sensitive, customized marketing on sexual health information for this population. more...

Background HIV-related maternal deaths and HIV infection among infants remain unacceptably high across sub-Saharan Africa despite increased antenatal care attendance and provision of antiretroviral therapy to pregnant women. In the Jamii Bora (“Better Family” in Swahili) Study, we seek to test the efficacy of an interdependence theory-based couple intervention. The intervention reaches pregnant women and male partners through home visits by male-female pairs of lay health workers. The aim is to increase access to home-based couples’ HIV testing and counseling services to improve family health. Methods This is a three-arm randomized control trial among 1080 pregnant women 15 years of age or older, living with their male partners, and who have not undergone couples’ HIV testing and counseling in Kisumu and Migori Counties in Kenya. Couples will be randomized into three groups: home-based couple visits, HIV self-testing kits for couple use, or standard care (male partner clinic invitation letters). Participants will be followed up to 18 months postpartum. The study has three aims: in aim 1, we will determine the effects of the intervention on our primary outcome of couple HIV testing, compared to HIV self-testing kits and standard care; in aim 2, we will examine the intervention impact on HIV prevention behaviors, facility delivery, and postnatal healthcare utilization, as well as secondary health outcomes of maternal viral suppression and HIV-free child survival up to 18 months for couples living with HIV; and in aim 3, we will compare the cost-effectiveness of the home-based couple intervention to the less resource-intensive strategies used in the other two study arms. Assessments with couples are conducted at baseline, late pregnancy, and at months 3, 6, 12, and 18 after birth. Discussion The results from this study will inform decision-makers about the cost-effective strategies to engage pregnant couples in the prevention of mother-to-child transmission and family health, with important downstream benefits for maternal, paternal, and infant health. Trial registration ClinicalTrials.gov NCT03547739. Registered on May 9, 2018 more...

Pregnancy is a time of heightened HIV risk, but also a phase when a couple can prioritize family health. We conducted secondary analysis of a home-based intervention in rural Kenya to explore couple-level adherence to HIV prevention behaviors. The intervention included health education, relationship-building skills, and Couples HIV Testing and Counseling. Pregnant women were randomized to the intervention (n = 64) or standard care (n = 63) along with male partners. Of 96 couples, 82 (85.0%) were followed to 3 months postpartum, when 31.0% of couples reported perfect adherence to HIV prevention. In logistic regression, intervention condition couples had three-fold higher odds of perfect adherence (AOR = 3.07, 95% CI = 1.01–9.32). A structural equation model found the intervention had moderate effects on couple communication, large effects on couple efficacy to take action around HIV, which in turn improved HIV prevention behaviors (CFI = 0.969; TLI = 0.955; RMSEA = 0.049). Strengthening couple communication and efficacy may help prevent the spread of HIV to infants or partners around the time of pregnancy. more...

Alcohol use among HIV-positive individuals in sub-Saharan Africa directly impacts adherence to antiretroviral therapy and HIV outcomes. Few studies have examined approaches to reduce alcohol use among HIV-affected couples, despite evidence that alcohol use is a couple-level concern. We conducted a qualitative study with 23 alcohol-using couples to identify multilevel barriers and facilitators of alcohol use, and potential intervention options with couples. Data were analyzed at individual and dyadic levels using framework analysis. All couples were married and had at least one partner on ART. Men were the primary alcohol drinkers with few women reporting alcohol use. Most women tried to persuade their partners to reduce their alcohol intake and when unsuccessful, enlisted help from relatives and HIV care providers. Effective couple negotiation around men's alcohol use was constrained by negative peer influence and men's desire for friendship to cope with life stressors. Women were primarily concerned about the expense of alcohol and described how alcohol prevented the family from meeting basic needs and investing in the future. Alcohol use was described as a major barrier to ART adherence, but was also viewed as the cause of couple and family violence, extramarital partnerships, food insecurity, and poverty. We conclude that multilevel interventions based on couples' needs and preferences are urgently needed. Couple-based intervention approaches could include provider-led alcohol counseling with couples, alcohol reduction support groups for couples, couples' counseling to bolster couple communication and problem-solving around alcohol, and economic-strengthening interventions for couples. more...

Sexual satisfaction is an important dimension of relationship quality with implications for sexual and reproductive health (SRH), and HIV prevention, care, and treatment. We developed and validated the Couple Sexual Satisfaction Scale (CSSS) with heterosexual couples in sub-Saharan Africa. Using data from qualitative interviews with 94 partnered women and men in Swaziland and Malawi, we generated a 22-item scale and administered it to 211 couples with at least one partner living with HIV in Malawi. We performed an exploratory factor analysis (EFA) to identify and confirmatory factor analysis (CFA) to test the factor structure. To assess validity, we tested for associations between the CSSS and relationship quality, consistent condom use, and intimate partner violence (IPV) using generalized estimating equations. The EFA yielded two factors, general sexual satisfaction (13-item CSSS-Gen subscale, e.g., "I am satisfied with the sweetness of sex in our relationship") and HIV-specific sexual satisfaction (4-item CSSS-HIV subscale, e.g., "My appetite for sex has gone down due to HIV"), accounting for 78% of the shared variance. The CFA supported the two-factor solution: χ more...

Rationale Despite the importance of primary partners for health, little is known about factors that constrain the ability of couples to work collaboratively towards HIV care and treatment (dyadic coordination). This study examined the interplay of marital infidelity, food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral therapy (ART) in Malawi. Methods In 2016, we conducted 80 in-depth interviews with 25 couples with at least one partner on ART. Couples were recruited at two HIV clinics in the Zomba district when attending clinic appointments. Participants were asked about their relationship history, relationship dynamics (love, trust, conflict), experiences with HIV care and treatment, and how partners were involved. Using an innovative analysis approach, we analyzed the data at the couple-level by examining patterns within and between couples. Results Three patterns emerged. For some couples, ART led to positive changes in their relationships after men terminated their extramarital partnerships in exchange for love and support. For other couples with power imbalances and ongoing conflict, men's infidelity continued after ART and negatively affected dyadic coordination. Finally, some couples agreed to remain “faithful”, but could not overcome stressors related to food insecurity, which directly impacted their adherence. Conclusions Couples-based interventions targeting ART adherence should improve relationship quality, while also addressing interpersonal stressors such as marital infidelity and food insecurity. Multi-level interventions that address both dyadic and structural levels may be necessary for couples with severe food insecurity. more...

A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples’ HIV status. more...

Engaging both partners of a pregnant couple can enhance prevention of mother-to-child transmission of HIV and promote family health. We developed and piloted an intervention to promote couple collaboration in health during pregnancy and postpartum in southwestern Kenya. We utilized formative data and stakeholder input to inform development of a home-based couples intervention. Next, we randomized pregnant women to intervention (n = 64) or standard care (n = 63) arms, subsequently contacting their male partners for enrollment. In the intervention arm, lay health workers conducted couple home visits, including health education, couple relationship and communication skills, and offers of couple HIV testing and counseling (CHTC) services. Follow-up questionnaires were conducted 3 months postpartum (n = 114 women, 86 men). Baseline characteristics and health behaviors were examined by study arm using t-tests, chi-square tests, and regression analyses. Of the 127 women randomized, 96 of their partners participated in the study. Of 52 enrolled couples in the intervention arm, 94% completed at least one couple home visit. Over 93% of participants receiving couple home visits were satisfied and no adverse social consequences were reported. At follow-up, intervention couples had a 2.78 relative risk of having participated in CHTC during the study period compared with standard care couples (95% confidence interval: 1.63–4.75), and significant associations were observed in other key perinatal health behaviors. This pilot study revealed that a home-based couples intervention for pregnant women and male partners is acceptable, feasible, and has the potential to enhance CHTC and perinatal health behaviors, leading to improved health outcomes. more...

Despite the important role of social relationships for health and wellbeing, little is known about how primary partners affect adherence to HIV care and treatment. We qualitatively explored how relationship dynamics and partner support influence adherence among couples from KwaZulu-Natal, South Africa. Twenty-four heterosexual couples with at least one HIV-positive partner completed semi-structured interviews on topics including relationship dynamics (intimacy or emotional closeness, communication, violence), experiences with HIV care and treatment and HIV-related social support. The majority of couples were seroconcordant HIV-positive (92%) and both on antiretroviral therapy (ART) (63%). Participants described how primary partners both interfered with and supported adherence. Negative forms of influence included relationship conflict, which resulted in forgetfulness to take pills, and men's attempt to control use of ART. However, participants were more likely to highlight positive forms of influence on adherence, which included social support (instrumental, informational and emotional), intimacy and commitment. The findings also suggest a reciprocal relationship between ART and relationships such that couple ART use may enhance relationship quality. Primary partners are important pillars of support for ART adherence, especially in contexts of high unemployment and poverty. Future interventions that encourage and leverage these supportive relationships could improve ART adherence among heterosexual couples in similar settings. more...

Project Summary The goal of this qualitative study was to generate a better understanding of relationship processes with male partners that affect women’s prevention of mother-to-child HIV transmission (PMTCT)-related health behaviours through a critical examination of gender and power. This study was part of a larger concurrent mixed-methods parent study on the relationship between gender power dynamics within heterosexual couples and women’s PMTCT adherence. From March to August 2014, a cross-sectional survey was administered to 320 postpartum women living with HIV attending well-child paediatric healthcare visits at a large public health centre within a densely populated, low socio-economic neighbourhood of Lusaka. A convenience sub-sample of 32 participants in the parent study was invited to also participate in a semi-structured qualitative interview. The goal of the interviews was to expand on and explain the quantitative survey findings regarding the relationship between gender power dynamics and PMTCT-related health behaviours. Data Overview Participants were recruited during routine paediatric healthcare visits (e.g., child immunisations, height and weight measurements). Women were eligible for participation if they were married or cohabiting with a male partner, HIV-positive, over 18 years of age (legal age to provide consent for research in Zambia), and had a biological child between 3 to 9 months of age. Infant age criteria were meant to capture the essential PMTCT protocols, match the paediatric immunisation schedule, and limit recall bias. Because a major focus of the parent study was on intimate partner violence (IPV), as a safety measure, we excluded any women who were at the clinic with their male partners; only one woman was excluded for this reason. Nurses at the clinic determined eligibility for the parent study using the child’s “Under-Five Card” (i.e., a mother’s copy of her child’s health record that she is required to bring to all healthcare visits) or other available medical records. Eligible women were consented by research staff and received a small travel reimbursement. All survey participants were invited to stay and participate in a semi-structured interview immediately after the survey on the same day in the same location. Interviews were conducted by experienced, trained local Zambian research assistants in the most commonly spoken languages (English, Nyanja, Bemba, Tonga) using a semi-structured interview guide. The interview guide included broad, open-ended questions regarding PMTCT experiences and gender power dynamics. All research assistants had qualitative public health experience and participated in a three-day training. Data analysis and recruitment occurred concurrently and continued until the research team agreed we had achieved theoretical saturation of themes informing how gender power dynamics affect women’s PMTCT-related health behaviours. Throughout data collection, memos were kept in order to create a rich description of the data and to identify any needed changes to the interview guide, as well as establish theoretical saturation. Interviews were audio-recorded, translated and transcribed verbatim into Microsoft Word, and imported into Atlas.ti for analysis. The codebook was developed and applied to the transcripts by the primary investigator (Dr. Hampanda) using a combination of a priori codes from the interview guide and emergent codes. The author began with initial, line-by-line coding of transcripts to identify meanings and assumptions within the data, as well as comparisons between the codes and participants. In the final stages of analysis, focused coding by two of the investigators (Dr. Hampanda and Dr. Mweemba) explored the underlying meanings of the participant narratives and how they add to, form, transform, or reflect gendered social structures and processes in relation to women’s HIV care during and after pregnancy. We applied Fairclough’s method of critical discourse analysis, which emphasises how participant narratives are linked to societal and cultural processes and structures. Our critical discourse analysis interrogated the transcripts by paying attention to issues of explicit and implicit gender power dynamics and how participants navigated these in the context of PMTCT care. A table of excerpts is included with one short excerpt from the interview transcripts for every code used in the qualitative coding. Full transcripts are not shared to conform to assurances made to participants during informed consent. Publicly sharing the full transcripts would violate the agreement to which the participants consented. more...

Male couples in open relationships tend to have as equally fulfilling relationships as monogamous male couples; however, less is known about communication differences between monogamous and open couples. Because couples with open agreements permit sex with outside partners, they must navigate different relationship issues than monogamous couples, and this can translate to differences in communication. We therefore examined differences between cisgender men in monogamous versus open relationships regarding communication about sexual agreements, safety agreements, breaking of sexual and safety agreements, the disclosure of broken sexual and safety agreements, and general relationship communication. Using a sample of 395 couples, we found that while certain aspects of communication are different for monogamous couples compared to open couples, similarities also exist. Specifically, we identified no differences in how explicitly couples discussed their sexual and safety agreements, attitudes toward communication about safety agreements, and mutual avoidance and withholding communication. However, monogamous couples had more positive attitudes toward communication about sexual agreements. The results were mixed on the perceived impact that broken safety agreements had on communication with the primary partner. Our results are interpreted with attention to relationship well-being and implications for safer sex practices. more...

Sexual agreements between same-sex practising men facilitate communication about health promotion activities, including HIV prevention. In African contexts, male couples negotiate their sexual agreements in relation to rigid cultural prescriptions about male power and privilege, intense hostility towards same-sex sexualities and persistent heterogendered socio-cultural norms. Yet the impact of such norms on relationship practices and HIV risk among male couples remains inadequately explored. This qualitative study examined the role of gendered power disparities in establishing sexual agreements among male couples in two Southern African contexts. Eighteen male couples completed in-depth interviews focused on relationship practices, including sexual agreements. The research employed critical social theory to analyse power relations and socio-cultural norms shaping male couples' explicit and implicit sexual agreements, with a focus on implications for HIV risk. The findings outline different types of and motivations for sexual agreements among male couples, including qualified non-monogamy with female partners only. The study illustrates how Southern African male-male sexual practices remain embedded in a cultural context favouring the replication of heteronormative sexual behaviours and relationship practices. These heterogendered norms impact negatively on the process of establishing explicit, mutually agreed-upon sexual agreements, and thus place male couples at increased risk for HIV. more...

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. more...

Introduction We examined the stability of smoking behaviors, and factors associated with persistent smoking in a longitudinal study of HIV-positive gay and bisexual men in primary relationships. Methods A sample of 377 HIV-positive men on antiretroviral therapy and their same-sex partners completed five assessments over two years. Participants completed semi-structured interviews which assessed smoking status, sociodemographic factors, relationship dynamics, and HIV-related disease characteristics. Latent transition analysis estimated the amount of transition in smoking over time. Latent class analysis examined factors associated with smoking status across the study period. Results At baseline, 28.1% ( n = 106) of participants reported current smoking. Over 90% of the HIV-positive men remained in the same smoking category over time (68.4% persistent non-smokers; 24.1% persistent smokers). Men whose partners smoked and men with lower income had higher odds of being persistent smokers, whereas older men and men who identified as Latino race/ethnicity had lower odds of being persistent smokers compared to non-smokers. Conclusions Despite efforts to reduce smoking among people living with HIV (PLWH), a substantial subset of men continued to smoke during their two years in the study. Findings suggest that primary partners who also smoke and low income were the strongest predictors of sustained smoking behaviors among HIV-positive men. Additional research is needed to better understand how to increase motivation and support for smoking cessation among PLWH and their primary partners, while attending to how socioeconomic status may inhibit access to and the sustained impact of existing smoking cessation programs. more...

Alcohol consumption and beliefs about mixing alcohol and ART are associated with decreased adherence to antiretroviral therapy (ART). In this study, we examined how romantic partners influence alcohol and ART use. We conducted semi-structured interviews with 24 HIV-positive individuals and their primary partners (48 individuals) in KwaZulu-Natal, South Africa. Almost 17% of participants spontaneously expressed beliefs that alcohol and ART should not be mixed. Participants who held these beliefs influenced their partners’ behaviors by either discouraging the mixing of alcohol and ART, which sometimes resulted in missed pills when drinking, or by helping partners manage their medications when drinking. Other participants encouraged partners to take ART no matter what. Messages on alcohol and ART may need to be refined for ART patients who cannot abstain from alcohol. Primary partners should be included in these education efforts and their influence could be leveraged to help reduce alcohol consumption and maintain adherence. more...

Introduction HIV prevention interventions targeting couples are efficacious, cost-effective and a key strategy for preventing HIV transmission. Awareness of the full spectrum of relationship types and underlying complexities, as well as available support mechanisms in a given context, are critical to the design of effective couple-based interventions. Objective This paper is based on a sub-analysis of a qualitative research study investigating HIV disclosure dynamics amongst pregnant women living with HIV in Durban, South Africa. The sub-analysis explored the nature of participants' social and relationship contexts and consequences of these dynamics on women's feelings of trust towards partners and perceptions of partner commitment. Methods Between June and August 2008, we conducted in-depth interviews with 62 pregnant women living with HIV and accessing Prevention of Mother-to-Child Transmission (PMTCT) services in Durban, South Africa. Transcripts were coded for emergent themes and categories using a grounded theoretical approach. Results The median age of participants was 26 years (interquartile range: 22–29 years). Three major themes with accompanying sub themes were identified: 1) relationship types (sub themes included unmarried status, minimal cohabitation with partners, presence of concurrent relationships), 2) relationship quality/functioning (sub themes included low trust and expectation of partner commitment, relationship turbulence, and lack of communication/ability to negotiate protective behaviours), and 3) factors underlying the relationship functioning (sub themes included dynamics of concurrent relationships coinciding with concurrent pregnancies, gender roles and unequal relationship power, intimate partner violence or threat thereof, and lack of social support). Conclusions Our research findings indicate a lack of many of the dyadic relationship elements underlying couple-counselling frameworks for successful risk reduction coordination. Understanding sexual behaviour and the accompanying relationship dynamics within different types of partnerships is crucial for the optimal design of couple-based HIV prevention interventions. more...

Accurate beliefs about partners' viral suppression are important for HIV prevention and care. We fit multilevel mixed effects logistic regression models to examine associations between partners' viral suppression beliefs and objective HIV RNA viral load tests, and whether relationship dynamics were associated with accurate viral suppression beliefs over time. Male couples (N=266 couples) with at least one HIV-positive partner on antiretroviral therapy completed five assessments over 2years. Half of the 407 HIV-positive partners were virally suppressed. Of the 40% who had inaccurate viral load beliefs, 80% assumed their partner was suppressed. The odds of having accurate viral load beliefs decreased over time (OR=0.83; p=0.042). Within-couple differences in dyadic adjustment (OR=0.66; p&nbsp more...

BACKGROUND: We sought to understand whether women’s empowerment and male partner engagement were associated with use of antenatal care (ANC). METHODS: Women presenting for ANC in Nyanza province of Kenya during June 2015-May 2016, were approached for participation. A total of 137 pregnant women and 96 male partners completed baseline assessments. Women’s empowerment was measured using the modified Sexual Relationship Power Scale. ANC use measures included timing of the first ANC visit and number of visits. Male engagement was based on whether a husband reported accompanying his wife to one or more antenatal visits during the pregnancy. Multiple linear and logistic regression analyses were used to identify factors independently related to use and timing of ANC. RESULTS: Women with higher mean empowerment scores were likely to have more than one ANC visit in the index pregnancy (Adjusted Odds Ratio (AOR)=2.8, 95% Confidence Interval (CI): 1.1–7.3), but empowerment was not associated with early ANC use. Women who were more empowered were less likely to have a husband who reported attending an ANC visit with his wife (AOR=0.1, 95% CI: 0.03–0.8). CONCLUSIONS: Women’s empowerment is important and may be related to ANC use and engagement of male partners in complex ways. more...

Objective: The HIV literature has largely ignored the importance of alcohol use in the quality of intimate relationships in sub-Saharan Africa (SSA), despite evidence of alcohol’s role in relational behaviors that increase risk for HIV infection and other harms. The present study explored the association of alcohol use with relationship functioning among heterosexual couples from rural South Africa. Method: Dyadic analyses were conducted with 443 sexually active, heterosexual, South African couples (886 individuals) to examine the association between male partners’ alcohol use (abstinent, nonhazardous, and hazardous), and male and female partners’ reports of relationship intimacy, trust, mutually constructive communication, demand/withdraw communication, and satisfaction. Five structural equation models were fit using male partner alcohol use as a predictor of male and female reports of relationship quality. Results: Women with a hazardous-drinking male partner (compared to an abstainer) reported significantly higher levels of intimacy (p Conclusions: Hazardous alcohol use among South African couples is positively correlated with women’s relationship intimacy and maladaptive communication patterns, yet negatively correlated with men’s perceived trust. more...

A sexual agreement is a mutual understanding between two partners regarding sexual and relational behaviors both within and outside of their relationship. Sexual agreements have been central to research and programming efforts around HIV prevention, primarily for male couples. A comprehensive scoping review of the primary literature on sexual agreements, including negotiated safety, was performed to identify what is known about sexual agreements among couples (n = 66). Results indicate a wide range of prevalence of agreements and measurements used to characterize sexual agreements. Findings also report associations between sexual agreements and health and relational outcomes. Several knowledge gaps were identified; specifically, the need to expand sexual agreements research beyond MSM populations and the need to better understand agreement breaks, break disclosure, and how variation in agreement categorization may impact reported prevalence. This review demonstrates the importance of broadening the evidence-base of sexual agreements research and programmatic focus. more...

PURPOSE: Despite indications that lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients have unique needs when seeking healthcare, the experiences of LGBTQ patients in the context of cancer care have not been fully explored. This qualitative study investigated recommendations offered by LGBTQ patients with cancer for improving cancer care. METHODS: 273 LGBTQ people across the United States who had been diagnosed with cancer completed an online survey that included open-ended questions. Using responses to these questions, two researchers independently conducted open coding. A code book was generated collaboratively and the data were coded independently. Codes were clustered and refined and the data were independently re-coded. RESULTS: Five themes emerged. LGBTQ patients with cancer: (1) are affected by providers’ LGBTQ-specific knowledge and skills, assumptions, and mistreatment; (2) negotiate disclosure of identities based on safety of clinical encounters; (3) have differing experiences based on multiple intersecting identities; (4) receive more effective care when members of their support networks are included; and (5) are self-advocates and undergo transformative experiences in the face of morbidity and marginalization. CONCLUSIONS: LGBTQ cancer survivors report challenges accessing competent cancer treatment. To address this, cancer care providers should provide safe clinical encounters, inquire about and respond professionally to patients’ identities and identifiers, include chosen support people, provide care relevant to patients’ gender identities, and address treatments’ effects on sexuality. Training providers about diverse LGBTQ communities and acknowledging the strengths of LGBTQ patients with cancer may improve provider/patient relationships. Provider training could be created based on these principles. more...

Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV-serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and treatment programs in Kenya and other HIV endemic regions of sub-Saharan Africa. more...

Transgender women—individuals assigned a male sex at birth who identify as women, female, or on the male-to-female (MTF) trans feminine spectrum—are at high-risk of HIV worldwide. Prior research has suggested that transgender women more frequently engage in condomless sex with primary cisgender (i.e. non-transgender) male partners compared with casual or paying partners, and that condomless sex in this context might be motivated by relationship dynamics such as trust and intimacy. The current study examined sexual agreement types and motivations as factors thatshape HIV risk behaviors in a community sample of 191 transgender women and their cisgenderprimary male partners who completed a cross-sectional survey. Overall, 40% of couples had monogamous, 15% open, and 45% discrepant sexual agreements (i.e., partners disagreed on their type of agreement). Actor-partner interdependence models (APIM) were fit to examine the influence of sexual agreement type and motivations on extra-dyadic HIV risk (i.e., condomless sex with outside partners) and intra-dyadic HIV serodiscordant risk (i.e., condomless sex with serodiscordant primary partners). Formale partners, extra-dyadic risk was associated with their own and their partners' sexual agreement motives, and male partners who engaged in extra-dyadic HIV risk had an increased odds of engaging in HIV serodiscordant intra-dyadic risk. Study findings supportinclusion ofthe male partners of transgender women into HIV prevention efforts. Future research is warranted to explore the interpersonal and social contexts of sexual agreement types and motivations in relationships between transgender women and their male partners to develop interventions that meet their unique HIV prevention needs. more...

BACKGROUND Young gay, bisexual, and other men who have sex with men (YMSM) continue to be the group most heavily impacted by HIV in the United States. Substantial evidence indicates that up to two-thirds of new HIV infections occur in the context of a main partnership. Couples HIV testing and counseling (CHTC) has been shown to be a promising and effective strategy for increasing HIV prevention uptake among male couples; however, YMSM who are new to relationships may not have yet developed the efficacy, negotiation, and communication skills to navigate HIV testing in their relationship and communicate around developing a prevention plan. OBJECTIVE This study aims to develop and test a relationship skills–focused HIV prevention intervention for YMSM and their partners. The intervention consists of two telehealth-delivered sessions: the first focuses on relationship skills and the second consists of CHTC and prevention planning. Both sessions are attended by both members of the dyad. METHODS This protocol describes the development of the proposed intervention (We Prevent) and pilot test to examine its feasibility and preliminary efficacy. The intervention will include two motivational interviewing–based sessions: session one is a relationship skills–building session, focused on techniques to explore and build communication skills in a relationship, to help YMSM develop and enhance necessary skills for their current and future relationships; the second session is a CHTC session with YMSM and their partners, to help them develop an HIV prevention plan. Through qualitative data collection and a one-arm pilot with YMSM, we will develop and refine a developmentally appropriate relationship skills session as an addition to the current CHTC intervention. We will then conduct a pilot randomized controlled trial (RCT), comparing the acceptability, feasibility, and preliminary efficacy of the adapted two-session telehealth intervention for YMSM versus a control group receiving one session only—a CHTC session delivered via telehealth. RESULTS The We Prevent intervention is designed to increase uptake of HIV prevention, shown through self-reported reductions in condomless sex and increases in knowledge and uptake of pre-exposure prophylaxis. In addition, the intervention is designed to increase HIV and sexually transmitted infection (STI) testing. STI incidence is examined as a secondary outcome. A cost-input analysis will examine the costs associated with intervention delivery to inform future scale-up of the intervention. CONCLUSIONS Drawing on theory and existing CHTC protocols delivered with video-based counseling, this proposed intervention affords the opportunity to empower YMSM with the skills necessary to communicate with their partners and protect themselves from HIV in their current and future relationships. CLINICALTRIAL Clinicaltrials.gov NCT03551938; https://clinicaltrials.gov/ct2/show/NCT03551938 (Archived by WebCite at http://www.webcitation.org/73omJCz1a) INTERNATIONAL REGISTERED REPOR RR1-10.2196/10370 more...

Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men's perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy. However, thematic analysis revealed several obstacles that hindered participation. Poor couple relationship dynamics seemed negatively to influence male engagement. Some men were apprehensive that clinic staff might force them to test for HIV and disclose the results; if HIV-positive, men feared being labelled as 'victimisers' in situations of serodiscordancy, and described fears of abandonment by their wives. Some men avoided accompanying their wives, citing local culture as rationale for avoiding the 'effeminate' act of antenatal care attendance. Amidst these obstacles, some men chose to use their partners' HIV status as proxy for their own. Findings suggest that improving male engagement in essential maternal and child health-related activities will require addressing both structural and interpersonal barriers. more...

Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings. more...