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

Abstract

The primary romantic relationship may offer critical opportunities for improving HIV care among key populations affected by high rates of HIV infection and low rates of care engagement, such as black men who have sex with men. A conceptual framework is needed to identify dyadic processes involved in addressing challenges in retention in care and adherence to antiretroviral therapy. This study conducted dyadic and individual-level qualitative analyses of individual interviews with men living with HIV from 14 black gay couples (n = 28). Interviews explored each partner's perspectives on challenges to and supportive strategies for retention in care and medication adherence. Findings highlighted challenges at various levels of care engagement and patterns of dyadic interactions that impeded or facilitated HIV care. Couple-level processes (i.e., couple's resilience, interdependence) underlined a joint problem-solving approach toward addressing challenges in care engagement. Findings support a conceptual framework of dyadic HIV care that highlights the impacts of dyadic and individual factors on coordination of care and treatment to influence retention and adherence. The generalizability of study findings is limited by the small sample size. Implications for intervention design include leveraging drivers of partner support, including couples' resilience, in enhancing joint problem-solving in HIV care among black gay couples.

Psychosocial Challenges and Protective Factors Among MSM Living with HIV: An Integrative Review of the Literature Using an Intersectional Framework

“…Derived from a qualitative study, having greater partner or social support can help reduce the impact of stigma in Black MSM (where N = 12 couples), thereby easing access to HIV services (Tan et al, 2018). This was especially true when their partner was of HIV-positive status as well.…”

Recent HIV Risk Behavior and Partnership Type Predict HIV Pre-Exposure Prophylaxis Adherence in Men Who Have Sex with Men

“…Likewise, MSM reporting higher-risk sexual partnership types (i.e., serodiscordant or multiple partners) were more adherent to PrEP than those in lower-risk partnerships. Although not addressed in this analysis, partnership dynamics beyond conferred HIV risk, including sex stigma, 19 sexual health goals, 20 and intimacy motivations, 21 have been shown 22 and other factors. Further research exploring the interplay between relationship dynamics and sociodemographics on PrEP engagement and adherence is warranted.…”

Study protocol: a pilot randomised waitlist-controlled trial of a dyadic mobile health intervention for black sexual-minority male couples with HIV in the USA

“…Assessments at baseline, 6 months, 8 months and 14 months will be administered online and will measure HIV care engagement using a comprehensive behavioural composite of engagement in HIV care 52 ; engagement and retention in care using the Index of Engagement in HIV Care (eg, “How well do you follow through on your HIV care when things in your life get tough?”) 54 ; and self-reported ART adherence (eg, “In the last 30 days, on how many days did you miss at least one dose of any of your medication?”) 55 and viral suppression (eg, “Was your last viral load detectable or undetectable?”). Guided by our conceptual framework ( figure 1 ), 22 we will measure dyadic capacity using the Dyadic Coping Inventory, 56 Couple Health Support, Partner Support for HIV Treatment 57 and relationship factors using the Power Imbalance in Couples Scale, 58 and the Couple Sexual Satisfaction Scale (Conroy AA, Development and Validation of the Couple Sexual Satisfaction Scale for HIV and Sexual Health Research, Under Review). We will also assess individual-level factors as indicated by our conceptual framework, including the HIV Stigma Scale.…”

“… 42 Black sexual-minority couples show great interest in using a couples-based app to facilitate joint problem-solving to coordinate care and treatment activities, and provided ideas for the app features they want. 22 36 In contexts where same-sex relationships are highly stigmatised, black sexual-minority couples may appreciate an app that focuses on their primary romantic relationships.…”