Individual and Interpersonal Factors Associated with HIV Prevention Conversations and Condomless Anal Intercourse among Non-Concordant MSM Main Partners Open Access

Palacios Torres, Nydia Esther (2017)

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Background : About 65% of new U.S. HIV infections are found in the men who have sex with men (MSM) population. Recent studies suggest that 32-68% of HIV transmission within this population occurs between main partners in a relationship. HIV transmission between non-concordant couples is particularly concerning.

Objective: Drawing from the Social Ecological Model, this study aims to: 1) describe the individual and interpersonal characteristics of MSM in non-concordant relationships, and 2) examine how factors are associated with HIV prevention conversations and condomless anal intercourse (CAI).

Methods: This study is a secondary data analysis of the 2015 American Men's Internet Survey, a quantitative, cross-sectional online study. Eight hundred and fifty six US MSM in a non-concordant relationship with a main partner were included in the study subsample. Outcome measures were HIV prevention conversations within the past 6 months and CAI within the past 12 months.

Results: Most respondents were early 30's, White, had some college education, did not use non-injection drugs, experienced low levels of stigma, had at least one ACE exposure, had a sexual agreement with their main partner, and did not use technology-based social networking sites.

HIV prevention conversation scores were low while CAI was high. No association was found between these outcome variables. Age, education, number of sexual partners in the past 12 months, and sexual agreement were significantly associated with HIV prevention conversation. Marital status, drug use, and sexual agreement were associated with CAI in the first multivariate regression while education, sexual agreement, and breaking the sexual agreement were associated with CAI in the second model. Specifically, participants in open sexual agreements without conditions or those who broke their agreement were 4 and 12 times as likely to engage in CAI, respectively.

Conclusions: Findings suggest potentially increased HIV transmission risk within and outside of the dyad. HIV prevention conversations that only include topics such as condom usage, testing, or PrEP/TasP may not mitigate HIV transmission risk. Relationship dynamics, and accompanying conversations, may play a more influential role in CAI decision-making. Adding communication elements including relationship satisfaction, sexual agreements, and commitment may strengthen HIV prevention conversation campaigns.

Table of Contents

Chapter 1: Introduction 1

Social Ecological Model 2

Research Question 4

Chapter 2: Literature Review 5

Individual Factors 5

Sociodemographics 5

Substance Use 6

Stigma 7

Experiences of Adverse Childhood Events 8

Interpersonal Factors 9

Sexual Agreements among MSM 9

Engagement in Technology-based MSM Social Networks 10

Summary 11

Chapter 3: Methods 13

Study Design 13

Participants and Sampling 13

Measures 15

Outcome Measures 15

Correlates of Interest 16

Individual Factors 16

Interpersonal Factors 21

Data Analysis 23

Chapter 4: Results 26

Descriptive Statistics of Participants Individual and Interpersonal Factors 26

HIV Prevention Conversation Score Outcome 28

Bivariate Analyses 28

Multivariate Analyses 29

CAI Outcome 30

Bivariate Analyses 30

Multivariate Analyses 31

Summary 33

Chapter 5: Discussion 43

Individual and Interpersonal Characteristics of Non-concordant Dyads 43

Factors Associated with HIV Prevention Conversations 44

Factors Associated with CAI 45

Bivariate Level Outcomes in Relation to the Literature 48

Limitations 50

Implications of Findings and Future Areas of Research and Programs 51

References 53

Appendices 58

Appendix A: AMIS Subsample Selection Flowchart 58

Appendix B: AMIS HIV Prevention Conversation Items 59

Appendix C: CDC Stigma Items 63

Appendix D: JHS Stigma Items 66

Appendix E: ACE Subcategory Exposure Decision Matrix 71

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