A Conceptual Model of Dyadic Coordination in HIV Care Engagement Among Couples of Black Men Who Have Sex with Men: A Qualitative Dyadic Analysis

Abstract

Among Black men who have sex with men (MSM), HIV incidence is disproportionately high and HIV care engagement is disproportionately low. There may be important opportunities to leverage the primary relationship to improve engagement in HIV care and treatment among Black MSM couples. Using dyadic qualitative analysis of semi-structured, one-on-one interviews, we explored dyadic aspects of HIV care engagement among 14 Black MSM couples in which at least one partner was HIV-positive and identified as a Black cisgender man. Findings showed that men varied in how involved they were in their HIV-positive partner's care and treatment, and in how they reciprocated their partner's involvement. Patterns of dyadic HIV care engagement supported a conceptual model of dyadic coordination that describes Black MSM relationships in terms of two conceptual dimensions of dyadic HIV care engagement, and guides future intervention designs with Black MSM couples.

Couple-Level Dynamics and Multilevel Challenges Among Black Men Who Have Sex with Men: A Framework of Dyadic HIV Care

“…44 Specifically, dyadic processes of couple's resilience, joint problem-solving, and interdependence bolster the couple's capacity to address multilevel challenges to HIV care. 21 The present sample of couples was predominantly of the same race (i.e., black), consistent with previous research. 45 FIG.…”

“…12,20 One common resource with which to address challenges in HIV care among black MSM is the primary relationship. [21][22][23] A nationally representative sample of black MSM living with HIV found that almost half were in a primary relationship, 24 yet, a preponderance of intervention research with black MSM has focused on individual-level barriers and facilitators, rather than those at the couple-level. 25,26 The primary relationship may be a source of both support and challenge in chronic disease management.…”

“…Studies with MSM couples have emerged only recently to highlight how couples work together collaboratively to coordinate behaviors around HIV care and treatment activities. 21,22,27,33 The goal of this study is to address the current evidence gap by exploring dyadic HIV care among black MSM in couples, using individual-level analyses of qualitative interviews to identify care engagement challenges and forms of partner support, and dyadic analysis to explore couple's dynamics around care engagement. While individual-level analysis of qualitative data allows a review of issues and behaviors across participants, dyadic or couple-level analysis of qualitative data allows exploration and comparison of each partner's perspectives on the same issue in the context of the relationship (e.g., medication adherence), providing a richer understanding of relationship dynamics around HIV care.…”

“…Interventions with black MSM in primary relationships could be developed to promote dyadic coordination in the relationship of HIV care by leveraging these dyadic processes. 21 The primary relationship can be a ''double-edged sword.'' Being in a relationship with an uncaring partner violates transactional expectations of mutual caring, leading to perceived asymmetry in caregiving and resentment in the relationship.…”

“…Interventions may do so by using approaches and strategies that are culturally appropriate for engaging and retaining minority couples, including technology-based approaches 55 to HIV care that synchronize dyadic coordination of engagement and adherence between partners. 21 HIV providers and clinics may wish to invite the patient's primary partner to be involved in his HIV care. Doing so acknowledges the primary partner's role in the health of the patient and creates an inclusive environment.…”