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

Abstract

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