Abstract
Previous studies of HIV testing among gay men describe the motivations, facilitators and barriers, behaviors, and demographic characteristics of individuals who test. What little research focuses on HIV testing among gay men in relationships shows that they do not test regularly or, in some cases, at all—their motivations to test have not been investigated. With so little data on HIV testing for this population, and the continued privileging of individually focused approaches, gay men in relationships fall into a blind spot of research and prevention efforts. This study examined motivations to test for HIV using qualitative data from both partners in 20 gay male couples. Analysis revealed that the partners’ motivations were either event-related (e.g., participants testing at the beginning of their relationship or HIV-negative participants in an HIV-discordant relationship testing after risky episode with their discordant primary partner) or partner-related (e.g., participants testing in response to a request or suggestion to test from their primary partner or participants testing out of concern for their primary partner’s health and well-being). These data provide insight into relationship-oriented motivations to test for HIV for gay men in relationships and, in doing so, evidence their commitment to their primary partner and relationship. These motivations can be leveraged to increase HIV testing among gay men in relationships, a population that tests less often than single gay men, yet, until recently, has been underserved by prevention efforts.
Similar content being viewed by others
References
Beougher, S. C., Chakravarty, D., Garcia, C. C., Darbes, L. A., Neilands, T. B., & Hoff, C. C. (2012). Risks worth taking: Safety agreements among discordant gay couples. AIDS Care, 24(9), 1071–1077.
Beougher, S. C., Gómez Mandic, C., Darbes, L. A., Chakravarty, D., Neilands, T. B., Garcia, C. C., et al. (2013). Past present: Discordant gay male couples, HIV infection history, and relationship dynamics. Journal of Gay and Lesbian Social Services, 25(4), 379–398.
Bouhnik, A. D., Preau, M., Schiltz, M. A., Lert, F., Obadia, Y., & Spire, B. (2007). Unprotected sex in regular partnerships among homosexual men living with HIV: A comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study). AIDS, 21(Suppl 1), S43–S48.
Brooks, R. A., Landovitz, R. J., Kaplan, R. L., Lieber, E., Lee, S., & Barkley, T. W. (2012). Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: A mixed methods study. AIDS Patient Care & STDs, 26(2), 87–94.
Campbell, C. K., Gómez, A., Dworkin, S. L., Wilson, P. A., Grisham, K., McReynolds, J., et al. (2014). Health, trust, or “just understood”: Explicit and implicit condom decision-making processes among Black, White, and interracial same-sex male couples. Archives of Sexual Behavior, 43(4), 697–706.
Carballo-Diéguez, A., Frasca, T., Balan, I., Ibitoye, M., & Dolezal, C. (2012a). Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with me. AIDS Behavior, 16(7), 1753–1760.
Carballo-Diéguez, A., Frasca, T., Dolezal, C., & Balan, I. (2012b). Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? Journal of Sex Research, 49(4), 379–387.
CDC (2012). Estimated HIV incidence in the United States, 2007–2010. HIV surveillance supplemental report, 2012.
Chakravarty, D., Hoff, C. C., Neilands, T. B., & Darbes, L. A. (2012). Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS and Behavior, 16(7), 1944–1948.
Charlebois, E. D., Das, M., Porco, T. C., & Havlir, D. V. (2011). The effect of expanded antiretroviral treatment strategies on the HIV epidemic among men who have sex with men in San Francisco. Clinical Infectious Diseases, 52(8), 1046–1049.
Crawford, I., Hammack, P. L., McKirnan, D. J., Ostrow, D., Zamboni, B. D., Robinson, B., et al. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships. AIDS Care, 15(4), 513–524.
Darbes, L. A., Chakravarty, D., Neilands, T. B., Beougher, S. C., & Hoff, C. C. (2014). Sexual risk for HIV among gay male couples: A longitudinal study of the impact of relationship dynamics. Archives of Sexual Behavior, 43(1), 47–60.
Davidovich, U., de Wit, J., Albrecht, N., Geskus, R., Stroebe, W., & Coutinho, R. (2001). Increase in the share of steady partners as a source of HIV infection: A 17-year study of seroconversion among gay men. AIDS, 15(10), 1303–1308.
Davidovich, U., de Wit, J. B., & Stroebe, W. (2004). Behavioral and cognitive barriers to safer sex between men in steady relationships: Implications for prevention strategies. AIDS Education and Prevention, 16(4), 304–314.
Denning, P. H., & Campsmith, M. L. (2005). Unprotected anal intercourse among HIV-positive men who have a steady male sex partner with negative or unknown HIV serostatus. American Journal of Public Health, 95(1), 152–158.
Denzin, N. K., & Lincoln, Y. S. (2003). The landscape of qualitative research (2nd ed.). Thousand Oaks, CA: Sage Publications.
Eaton, L. A., West, T. V., Kenny, D. A., & Kalichman, S. C. (2009). HIV transmission risk among HIV seroconcordant and serodiscordant couples: Dyadic processes of partner selection. AIDS and Behavior, 13(2), 185–195.
Elford, J., Bolding, G., Maguire, M., & Sherr, L. (1999). Sexual risk behaviour among gay men in a relationship. AIDS, 13(11), 1407–1411.
Fenton, K. A. (2007). Changing epidemiology of HIV/AIDS in the United States: Implications for enhancing and promoting HIV testing strategies. Clinical Infectious Diseases, 45(4), 213–220.
Fernández, M. I., Perrino, T., Bowen, G. S., Royal, S., & Varga, L. (2003). Repeat HIV testing among Hispanic men who have sex with men—a sign of risk, prevention, or reassurance? AIDS Education and Prevention, 15, 105–116.
Flowers, P., Duncan, B., & Knussen, C. (2003). Re-appraising HIV testing: An exploration of the psychosocial costs and benefits associated with learning one’s HIV status in a purposive sample of Scottish gay men. British Journal of Health Psychology, 8, 179–194.
Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., Sanchez, J., Grinsztejn, B., et al. (2012). What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS One, 7(11), e50522.
Guzman, R., Buchbinder, S., Mansergh, G., Vittinghoff, E., Marks, G., Wheeler, S., et al. (2006). Communication of HIV viral load to guide sexual risk decisions with serodiscordant partners among San Francisco men who have sex with men. AIDS Care, 18(8), 983–989.
Hays, R. B., Kegeles, S. M., & Coates, T. J. (1997). Unprotected sex and HIV risk taking among young gay men within boyfriend relationships. AIDS Education and Prevention, 9(4), 314–329.
Helms, D. J., Weinstock, H. S., Mahle, K. C., Bernstein, K. T., Furness, B. W., Kent, C. K., et al. (2009). HIV testing frequency among men who have sex with men attending sexually transmitted disease clinics: Implications for HIV prevention and surveillance. Journal of Acquired Immune Deficiency Syndrome, 50(3), 320–326.
Hoff, C. C., & Beougher, S. C. (2010). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39(3), 774–787.
Hoff, C. C., Beougher, S. C., Chakravarty, D., Darbes, L. A., & Neilands, T. B. (2010). Relationship characteristics and motivations behind agreements among gay male couples: Differences by agreement type and couple serostatus. AIDS Care, 22(7), 827–835.
Hoff, C. C., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Darbes, L. A. (2012). Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS Patient Care & STDs, 26(12), 738–745.
Hoff, C. C., Pals, S. L., Purcell, D. W., Parsons, J. T., Halkitis, P. N., Remien, R. H., et al. (2006). Examining the role of partner status in an HIV prevention trial targeting HIV-positive gay and bisexual men: The Seropositive Urban Men’s Intervention Trial (SUMIT). AIDS and Behavior, 10(6), 637–648.
Hoff, C. C., Stall, R., Paul, J. P., Acree, M., Daigle, D., Phillips, K., et al. (1997). Differences in sexual behavior among HIV discordant and concordant gay men in primary relationships. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 14(1), 72–78.
Jin, F., Crawford, J., Prestage, G. P., Zablotska, I., Imrie, J., Kippax, S. C., et al. (2009). Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS, 23(2), 243–252.
Kalichman, S. C., Schaper, P. E., Belcher, L., Abush-Kirsh, T., Cherry, C., Williams, E. A., et al. (1997). It’s like a regular part of gay life: Repeat HIV antibody testing among gay and bisexual men. AIDS Education and Prevention, 9, 41–51.
Kelley, H. H., & Thibaut, J. W. (1978). Interpersonal relations: A theory of interdependence. New York: Wiley.
Kippax, S., Slavin, S., Ellard, J., Hendry, O., Richters, J., Grulich, A., et al. (2003). Seroconversion in context. AIDS Care, 15(6), 839–852.
Knussen, C., Flowers, P., & Church, S. (2004). The intentions of gay men in taking an HIV test. Culture, Health & Sexuality, 6(1), 45–59.
Kubicek, K., McNeeley, M., & Collins, S. (2015). “Same-sex relationship in a straight world”: Individual and societal influences on power and control in young men’s relationships. Journal of Interpersonal Violence, 30, 83–109.
Lattimore, S., Thornton, A., Delpech, V., & Elford, J. (2010). Changing patterns of sexual risk behavior among London gay men: 1998–2008. Sexually Transmitted Diseases, 38(3), 221–229.
Lewis, M. A., McBride, C. M., Pollack, K. I., Puleo, E., Butterfield, R. M., & Emmons, K. M. (2006). Understanding health behavior change among couples: An interdependence and communal coping approach. Social Science and Medicine, 62, 1369–1380.
Lorenc, T., Marrero-Guillamón, I., Aggelton, P., Cooper, C., Llewellyn, A., Lehmann, A., et al. (2011a). Promoting the uptake of HIV testing among men who have sex with men: Systematic review of effectiveness and cost-effectiveness. Sexually Transmitted Diseases, 87, 272–278.
Lorenc, T., Marrero-Guillamón, I., Llewellyn, A., Aggelton, P., Cooper, C., Lehmann, A., et al. (2011b). HIV testing among men who have sex with men (MSM): Systematic review of qualitative evidence. Health Education Research, 26(5), 834–846.
MacKellar, D. A., Hou, S., Whalen, C. C., Samuelsen, K., Sanchez, T. H., Smith, A., et al. (2011). Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sexually Transmitted Diseases, 38(5), 419–428.
MacKellar, D. A., Valleroy, L. A., Secura, G. M., Batholow, B. N., McFarland, W., Shehan, D., et al. (2002). Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: A call to monitor and improve the practice of prevention. Journal of Acquired Immune Deficiency Syndrome, 29, 76–85.
Mitchell, J. W. (2014a). Gay male couples’ attitudes toward using couples-based voluntary HIV counseling and testing. Archives of Sexual Behavior, 43(1), 161–171.
Mitchell, J. W. (2014b). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51(3), 316–328.
Mitchell, J. W., & Horvath, K. J. (2013). Factors associated with regular HIV testing among a sample of US MSM with HIV-negative main partners. Journal of Acquired Immune Deficiency Syndrome, 16(4), 417–423.
Mitchell, J. W., & Petroll, A. E. (2012a). HIV testing rates and factors associated with recent HIV testing among male couples. Sexually Transmitted Diseases, 39(5), 379–381.
Mitchell, J. W., & Petroll, A. E. (2012b). Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases, 39(11), 871–876.
Moreau-Gruet, F., Jeannin, A., Dubois-Arber, F., & Spencer, B. (2001). Management of the risk of HIV infection in male homosexual couples. AIDS, 15(8), 1025–1035.
Myers, T., Orr, K. W., Locker, D., & Jackson, E. A. (1993). Factors affecting gay and bisexual men’s decisions and intentions to seek HIV testing. American Journal of Public Health, 83(5), 701–704.
Nanín, J., Osubu, T., Walker, J., Powell, B., Powell, D., CASAC-T, et al. (2009). “HIV is still real”: Perceptions of HIV testing and HIV prevention among Black men who have sex with men in New York City. American Journal of Men’s Health, 3(2), 150–164.
Neilands, T. B., Chakravarty, D., Darbes, L. A., Beougher, S. C., & Hoff, C. C. (2010). Development and validation of the sexual agreement investment scale. Journal of Sex Research, 47(1), 24–37.
Nieto-Andrade, B. (2010). The effect of HIV-discordance on the sexual lives of gay and bisexual men in Mexico City. Journal of Homosexuality, 57(1), 54–70.
Ostrow, D. E., Fox, K. J., Chmiel, J. S., Silvestre, A., Visscher, B. R., Vanable, P. A., et al. (2002). Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS, 16(5), 775–780.
Palmer, R., & Bor, R. (2001). The challenges to intimacy and sexual relationships for gay men in HIV serodiscordant relationships: A pilot study. Journal of Marital and Family Therapy, 27(4), 419–431.
Parent, M. C., Torrey, C., & Michaels, M. S. (2012). “HIV testing is so gay”: The role of masculine gender role conformity in HIV testing among men who have sex with men. Journal of Counseling Psychology, 59(3), 465–470.
Phillips, G., Magnus, M., Kuo, I., Shelley, K. D., Rawls, A., West-Ojo, T., et al. (2013). Correlates of frequency of HIV testing among men who have sex with men in Washington, DC. AIDS Care, 25(12), 1481–1484.
Phillips, K. A., Paul, J. P., Kegeles, S., Stall, R., Hoff, C. C., & Coates, T. J. (1995). Predictors of repeat HIV testing among gay and bisexual men. AIDS, 9, 769–775.
Prestage, G., Jin, F., Zablotska, I., Grulich, A., Imrie, J., Kaldor, J., et al. (2008). Trends in agreements between regular partners among gay men in Sydney, Melbourne and Brisbane, Australia. AIDS and Behavior, 12(3), 513–520.
Prestage, G., Mao, L., Kippax, S., Jin, F., Hurley, M., Grulich, A., et al. (2009). Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS and Behavior, 13(4), 645–651.
Purcell, D. W., Mizuno, Y., Smith, D. K., Grabbe, K., Courtenay-Quirk, C., Tomlinson, H., et al. (2014). Incorporating couples-based approaches into HIV prevention for gay and bisexual men: Opportunities and challenges. Archives of Sexual Behavior, 43(1), 35–46.
Remien, R. H., Carballo-Dieguez, A., & Wagner, G. (1995). Intimacy and sexual risk behaviour in serodiscordant male couples. AIDS Care, 7(4), 429–438.
Rendina, H. J., Breslow, A. S., Grov, C., Ventuneac, A., Starks, T. J., & Parsons, J. T. (2014). Interest in couples-based voluntary HIV counseling and testing in a natioan US sample of gay and bisexual men: The role of demographic and HIV risk factors. Archives of Sexual Behavior, 43(1), 149–159.
Rusbult, C. E., & Van Lange, P. A. M. (2003). Interdependence, interaction, and relationships. Annual Review of Psychology, 54, 351–375.
Shernoff, M. (2006). Negotiated nonmonogamy and male couples. Family Process, 45(4), 407–418.
Sorenson, S. W., Sansom, S. L., Brooks, J. T., Marks, G., Begier, E. M., Buchacz, K., et al. (2012). A mathematical model of comprehensive test-and-treat services and HIV incidence among men who have sex with men in the United States. PLoS One, 7(2), e29098.
Stephenson, R., Sullivan, P. S., Salazar, L. F., Gratzer, B., Allen, S., & Seelbach, E. (2011). Attitudes towards couple-based HIV testing among MSM in three US cities. AIDS and Behavior, 15(1), 80–87.
Stolte, I. G., de Wit, J. B., van Eeden, A., Coutinho, R. A., & Dukers, N. H. (2004). Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men. AIDS, 18(14), 1943–1949.
Straub, D. M., Arrington-Sanders, R., Harris, R., Williard, N., Kapogiannis, B., Emmanuel, P., et al. (2011). Correlates of HIV testing history among urban youth recruited through venue-based testing in 15 US cities. Sexually Transmitted Diseases, 38(8), 691–696.
Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23(9), 1153–1162.
Sullivan, P. S., Wall, K. M., O’Hara, B., Jones, J., Barnes, J., DiClemente, R., et al. (2014). The prevalence of undiagnosed HIV serodiscordance among male couples presenting for HIV testing. Archives of Sexual Behavior, 43(1), 173–180.
The White House Office of National AIDS Policy. (2010). National HIV/AIDS Strategy for the United States.
Van de Ven, P., Mao, L., Fogarty, A., Rawstorne, P., Crawford, J., Prestage, G., et al. (2005). Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney. AIDS, 19(2), 179–184.
Van der Bij, A. K., Kolader, M. E., de Vries, H. J., Prins, M., Coutinho, R. A., & Dukers, N. H. (2007). Condom use rather than serosorting explains differences in HIV incidence among men who have sex with men. Journal of Acquired Immune Deficiency Syndrome, 45(5), 574–580.
Wagenaar, B. H., Christiansen-Lindquist, L., Khosropour, C., Salazar, L. F., Benbow, N., Prachand, N., et al. (2012). Willingness of US men who have sex with men (MSM) to participate in couples HIV voluntary counseling and testing (CVCT). PLoS One, 7(8), e42953.
Woods, D., & Fassnacht, C. (2007). Transana v2.23-MU (Version 2.2x). Madison: The Board of Regents of the University of Wisconsin System.
Acknowledgments
The authors extend their thanks to the participants and to the following individuals who assisted with data collection and analysis: Praney A. Anand, Jessica Bowen Bazyl, Julianne Carroll, J. Robin Darling, Terry D. Dyer, Jaih B. McReynolds, and Clarissa Quismorio. This research was supported by grants MH 75598 and MH 65141 from the National Institute of Mental Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Beougher, S.C., Bircher, A.E., Chakravarty, D. et al. Motivations to Test for HIV Among Partners in Concordant HIV-Negative and HIV-Discordant Gay Male Couples. Arch Sex Behav 44, 499–508 (2015). https://doi.org/10.1007/s10508-014-0403-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-014-0403-2