Relationship Characteristics Differ Based on Use of Substances with Sex among an Urban Internet Sample of HIV-Discordant and HIV-Positive Male Couples

Abstract

Previous research with men who have sex with men (MSM) has found that substance use with sex is strongly associated with HIV acquisition and poor adherence to HIV treatments. Although some studies have assessed male couples' use of substances with unprotected anal sex, little is known on whether differences in their relationship dynamics are associated with their usage. Current HIV prevention initiatives underscore the importance of studying male couples' relationship dynamics. Using dyadic data from 28 HIV-positive and 58 HIV-discordant male couples, this analysis sought to: (1) describe, by substance type, whether neither, one, or both partners in the couple used a particular substance with sex within their relationship or outside of the relationship, respectively, and (2) assess, by substance type, whether relationship characteristic differences existed between these three groups of couples with respect to substance use with sex within and outside the relationship. Data from 86 dyads came from a cross-sectional, Internet study. Multivariate multinomial regression models were employed to achieve the aims. Except for alcohol, most did not use substances with sex. Within the relationship, those who used with sex varied by substance type; outside the relationship, most couples had only one partner who used with sex regardless of substance type. Several relationship characteristic differences were noted between the groups of couples. Within the relationship, marijuana and erectile dysfunction medication (EDM) use with sex was associated with having less tangible resources; for outside the relationship, these were associated with perceiving to have greater quality of alternatives. In general, amyl nitrates and party drug use with sex were associated with viewing the main partner as being less dependable for trustworthiness. Marijuana and party drug use with sex within the relationship and EDM use with sex outside the relationship were negatively associated with being able to communicate constructively. Mixed results were noted for relationship satisfaction. Additional research is urgently needed for prevention and promotion of healthy relationships for male couples who use substances with sex.

Relationship Dynamics in the Context of Binge Drinking and Polydrug Use Among Same-Sex Male Couples in Atlanta, Boston, and Chicago

“…Additionally, being the older partner and reporting higher levels of internalized homophobia was associated with significantly lower reported binge drinking, while history of arrest, HIV-positive status and feelings of being more loved in a relationship was associated with binge drinking. These findings are in line with findings from other studies that have demonstrated significant effect of relationship-level factors on drug use and binge drinking in MSM couples (Martinez et al, 2016;Mitchell et al, 2015;Mitchell et al, 2016).…”

Stress and substance use among sexual and gender minority individuals across the lifespan

“…Substance use disparities also persist in the sexual and romantic endeavors in many SGM individuals. While some members of SGM communities use drugs and alcohol to enhance the pleasure of sexual encounters (Grov et al, 2013; Mitchell, 2015; Sugano et al, 2006), others, such as Black and Latino sexual minority men, have been reported doing so as a means of facilitating sexual comfort and exploration of one's sexual identity (Harawa et al, 2008; Mutchler et al, 2014). Use of substances during sexual encounters contributes to disparities in interpersonal violence (Bimbi et al, 2008; Kelly et al, 2011) and health concerns prevalent in SGM communities, including unsafe sex and the transmission of sexually transmitted infections (Greenwood and Gruskin, 2007; Lee et al, 2016).…”

Linguistic correlates of the Communication Patterns Questionnaire: The correspondence of language and quantitative measures of perceived communication patterns among emerging adult gay male couples.

“…Although the current study sought to examine the linguistic underpinnings of perceived communication among gay couples as distal indicators of HIV behavioral health among couples, future studies should examine direct associations of language use and actual HIV preventive risk and behavior. These behavioral outcomes may include a variety of behaviors associated with perceived communication patterns, such as sexual risk behavior (Darbes et al, 2014), substance use during sex (Mitchell, 2015), as well as willingness to participate in CHTC (Mitchell, 2014b). Further, although the present analyses provide insight into the linguistic underpinnings of perceived communication associated with traditional HIV behavioral health outcomes among couples, it must be noted that the majority of these data were collected prior to the roll-out of pre-exposure prophylaxis (PrEP) in the summer of 2012 as an HIV prevention strategy (U.S. Food & Drug Administration, 2012).…”

“…Among partnered gay men, perceptions of these two communication patterns are associated with HIV risk behavior and preventive attitudes. For instance, among HIV-seroconcordant couples, high levels of perceived constructive communication reduce the odds of condomless anal sex with outside sex partners (Darbes et al, 2014) and are negatively associated with substance use during sex within the relationship (Mitchell, 2015). Relatedly, Mitchell (2014b) observed that among partnered gay men, although perceived constructive communication was positively associated, perceived avoidant communication was negatively associated with willingness to engage in couples HIV testing and counseling (CHTC; also referred to as couples voluntary counseling and testing), an evidence-based behavioral couples’ HIV intervention (Burton, Darbes, & Operario, 2010; El-Bassel et al, 2011) recently adapted for gay male couples in the United States (Sullivan et al, 2014).…”

“…The present study extends work from Rentscher and colleagues (2013) to examine the association between linguistic markers in individual speech and perceptions of communication patterns among gay couples specifically. Because perceived communication patterns have been associated with both HIV risk behavior and preventive attitudes at the level of the dyad among individual partnered gay male couples (Darbes et al, 2014; Mitchell, 2014b; Mitchell, 2015), these exploratory analyses aim to identify concrete, linguistic indicators of perceived communication patterns among partnered gay men. As such, in the investigation of the linguistic underpinnings of these communications patterns related to HIV behavioral health among gay male couples, this study initiates a line of research intended to identify distal indicators of these processes, which may inform the development of dyadic behavioral HIV prevention interventions, with particular focus on couples that include emerging adult gay men.…”