Yes we can: A dyadic investigation of cognitive interdependence, relationship communication, and optimal behavioral health outcomes among HIV serodiscordant same-sex male couples

Research suggests that couples who adopt a we orientation in relation to illness demonstrate greater resiliency and an increased capacity to cope with stressors. HIV serodiscordant couples (one partner is HIV-positive, the other is HIV-negative) have been identified as a critical mode of HIV transmission. The present study integrates dyadic coping models and interdependence theory to examine whether cognitive interdependence (i.e., the extent to which couples include aspects of their partner into their self-concept) and communication strategies are associated with sexual behavior, antiretroviral therapy (ART) adherence, depressive symptoms, sexual satisfaction, and relationship satisfaction. The study also tested whether the associations between cognitive interdependence and behavioral health outcomes were mediated by each partners\u27 reports of communication strategies. Further, this study qualitatively examined relationship dynamics in relation to behavioral health outcomes among a subsample of couples with different levels of cognitive interdependence. Data involved secondary analyses from the Duo Project (R01-NR010187; PI: Mallory Johnson). Quantitative analyses were guided by a multilevel structural equation modeling approach appropriate for dyadic data, and thematic analyses were used for qualitative data. For both partners, cognitive interdependence was associated with greater relationship satisfaction and lower depressive symptoms. For both partners, cognitive interdependence was associated with their partners\u27 greater relationship and sexual satisfaction. Over-time mediation hypotheses were supported for relationship satisfaction, indicating that those who reported higher levels of cognitive interdependence also reported higher levels of positive communication, and in turn, higher levels of relationship satisfaction. Mediation was not found for sexual behavior, ART adherence, depressive symptoms, or sexual satisfaction. Qualitative analyses suggested that couples\u27 who held congruent levels of cognitive interdependence appraised HIV and other health events as a shared stressor and engaged in effective communal coping strategies around ART adherence and sexual behaviors. The results of this study suggest that cognitive interdependence represents an important step in understanding couples\u27 health threat appraisals, transformation of motivation process, and support strategies to promote better health behaviors. Findings have important practical implications that can be incorporated into biomedical prevention strategies, such as Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP), for same-sex couples affected by HIV

Ambiguity, Ambivalence, and Apprehensions of Taking HIV-1 Pre-Exposure Prophylaxis among Male Couples in San Francisco: A Mixed Methods Study

Objective: We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIVpositive) male couples’ PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple. Design: Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants’ awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it. Methods: We used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes. Results: Among 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIVnegative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse. Conclusions: Findings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact