The sexual transmission of HIV is often believed to be associated with promiscuity, but gay and bisexual men are far more likely to contract the disease while in a relationship than from a casual sex partner.
“If you look at new HIV infections among men who have sex with men, about two-thirds of new HIV infections come from main sex partners,” said Patrick Sullivan, an associate professor at Emory University’s Rollins School of Public Health.
Sullivan and Emory researchers have adapted a strategy that has been used since the late 1980s for heterosexual couples in Africa, where HIV transmission often takes place within marriage, to help gay male couples in the United States learn their HIV status alongside their partners. After a year of research conducted at AID Atlanta, “Testing Together” was officially launched in September, and “gives people a forum and a supportive place in which to have conversations that may be more difficult to raise individually,” Sullivan said.
“We made some important changes in the intervention [that has been used to test couples in Africa] to make it appropriate for male couples in the US,” Sullivan said. “For example, one of things that is addressed in the intervention is the issue of agreements.
“We know that most male couples in the United States have some kind of explicit agreement about whether or not they can have sex with partners outside their relationship.” he said. “We feel like ‘Testing Together’ is an important opportunity for guys to have a safe place to talk about that agreement and clarify it.”
According to data collected for the initiative, about 90 percent of gay male couples have had discussions about whether it is acceptable to have sexual partners outside of the relationship, with more than half of the couples identifying as strictly monogamous. Of those monogamous couples, one quarter of partners acknowledged having sex outside of the relationship within the past year, and only one quarter of those men informed their primary partner about the lapse in monogamy.
“So the reality is that although most male couples in our research report that they have agreements toward monogamy, people are human and sometimes people step out of those agreements,” Sullivan said. “One of the things we do in this intervention is we give couples the chance to talk openly about what they want to do if that slip-up happens, and this isn’t a conversation that’s always comfortable to raise with your partner.”
The “Testing Together” intervention — which is financed by the MAC AIDS Fund and currently available at AID Atlanta, the Ric Crawford Clinic (formerly AID Gwinnett) and a gay health clinic in Chicago — emphasizes a “future forward” approach that helps it avoid being a high-anxiety “confessional” for partners, said Lamont Scales, prevention programs manager at AID Atlanta.
“We don’t have to go into the details of the last time you had unprotected sex, or if you have multiple partners,” Scales said. “None of that is discussed, it’s all about where you are today and where you are moving toward the future.”
Counselors prepare the partners for the results of their HIV tests and the potential impact on their relationships, and help the couples develop prevention strategies going forward.
While the intervention can be adjusted to fit couples who have been together for decades or those on their first date, Scales said reaching newly formed couples is vital to decreasing HIV infections.
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