Some gay male couples, including ones in Atlanta and two other cities, support getting HIV tests with their partner as a way to bolster the relationship, but current testing protocols may not support it, according to a new study from Emory University researchers.
The study, “Attitudes Towards Couples-Based HIV Testing Among MSM in Three U.S. Cities,” was published in the journal AIDS and Behavior. Dr. Rob Stephenson of the Rollins School of Public Health at Emory worked with three colleagues from the school and others in Chicago and Seattle to complete the study. It calls on opening HIV testing to gay couples as a way to fill “a significant gap” in couples-based services for men who have sex with men (MSM) and to help them integrate routine HIV testing into their lives.
“Services remain individually focused,” the researchers say. “[Couples-based voluntary HIV counseling and testing] provides an opportunity for MSM to talk about sex, and to make plans for safer sexual behavior as a couple in the presence of a counselor.”
“The initial results presented here are encouraging. Couples-based voluntary HIV counseling and testing] is an acceptable format for HIV counseling and testing among MSM in this study, and if it is adapted and promoted well, could fill a significant gap in couples-based services for U.S. MSM,” they add.
The researchers launched the study after noting that heterosexual couples in Africa in which one member is HIV-positive and the other is not who receive HIV counseling and testing together helped bring about behavioral changes that reduced HIV transmission. So they examined attitudes toward couples-based testing with four focus groups of gay men in relationships in Atlanta, Chicago and Seattle.
“Although initially hesitant, participants reported an overwhelming acceptance of [couples-based voluntary HIV counseling and testing],” the researchers say.
Couples-based testing is seen as a sign of commitment in a relationship, though the researchers add that it may be more appropriate for long-term relationships. The study also found that couples-based testing is seen as providing a forum for talking about risk-taking within the relationship.
But few HIV testing and prevention strategies target gay couples, the researchers say.
“Given that main sex partners may contribute significantly to the acquisition of HIV among MSM and that MSM couples as a demographic in the U.S. are increasing, preventive efforts that target MSM dyads may be an effective strategy in reducing HIV incidence,” the researchers say.
The focus groups were questioned about their attitudes towards HIV and couples-based testing, motivation for HIV testing, willingness to participate in couples-based testing, barriers to couples-based testing and the impact it might have on relationships and their behavior. The four groups included 39 people that ranged in age from 19 to 53. Some 54 percent of the participants were black; 46 percent were white. Slightly more than half of the participants – 51 percent – said they had sex partners other than their main partner in the relationship.
“We had been in a relationship together for six months, and I was thinking that it was going to be just like any other doctors appointment and I could go in with him, and I got there, and it hit me, and I thought ‘Ok, gay rights, cool’; I asked the nurse if I could go in with him and she told me no it was confidential, and my boyfriend was actually really shaking and nervous and it was hard for me to be out there. I got angry,” one the participant told the researchers.
Participants in the focus groups told the researchers that couples-based testing provided a way for them to share their HIV status with one another with the help of a trainer counselor. Others said it would serve as a sign of commitment in their relationship or help them move away from condom use.
But other participants expressed concern that couples-based HIV testing would force them to reveal their sexual behaviors to their partners or that they might face violence or the end of their relationship if they were HIV-positive.
“The fear of loss of a partner was the main reason many felt that [couples-based voluntary HIV counseling and testing] would not occur early in a relationship; participants reported that the identification of sero-discordant results [one person is HIV-positive; the other is not] early on in a relationship would lead to the dissolution of the relationship,” the researchers say.
Though the results of their study were positive, the researchers note that more information is needed from a larger sample to see if couples-based testing is widely acceptable to gay men and couples. Service providers also must be trained to address the varying need of couples as well as ways to meet federal health regulations concerning privacy.
“The key limitation to this research is that focus group participants were self-selected, and thus may be more interested in or motivated to participate in [couples-based voluntary HIV counseling and testing] or other HIV prevention interventions than the general population of MSM in these cities. The results are thus not necessarily generalizable to all MSM in these cities,” the researchers say.
Would you take an HIV test with your partner? Tell us why (or why not) in the comments below.