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Relationship-based Motives for Making Sexual Agreements Associated with HIV Risk Among Gay Male Couples. Colleen C. Hoff 1 , PhD, Deepalika Chakravarty 1,2 , MS, Sean C. Beougher 1 , MA, Torsten B. Neilands 2 , PhD, Lynae A. Darbes 2 , PhD

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  1. Relationship-based Motives for Making Sexual Agreements Associated with HIV Risk Among Gay Male Couples Colleen C. Hoff1, PhD, Deepalika Chakravarty1,2, MS, Sean C. Beougher1, MA, Torsten B. Neilands2, PhD, Lynae A. Darbes2, PhD 1 Center for Research and Education on Gender and Sexuality, San Francisco State University 2 Center for AIDS Prevention Studies, University of California - San Francisco

  2. Background • In the US, MSM represent 62% of all HIV infections and 30-68% of those infections occur in gay male couples. • Sexual agreements are ubiquitous among male couples and vary from monogamous to various types of non-monogamous ones. • Broken agreements are associated with HIV risk. • Research suggests that male couples who are more invested in their agreements, and satisfied with their relationships are less risky sexually.

  3. Significance of Motivations for Sexual Agreements Understand motivations behind agreements Incorporate in future HIV prevention interventions Develop skills to negotiate and create a mutually satisfactory agreement Develop skills to maintain the agreement Greater satisfaction with, and investment in agreement Lower sexual risk for HIV

  4. Objective of Study • Identify key motivators for making agreements. • Explore whether motivations for making agreements are associated with HIV risk, agreement maintenance, and relationship and sexual satisfaction.

  5. Methods • Recruitment: Longitudinal survey in San Francisco, California, US between February 2012 and August 2013 using active and passive strategies (N = 441 male couples). • Eligibility: In the relationship for at least 3 months, knowledge of own and partner’s HIV status, discordant or HIV- couple, 18 years or older, at leastone partner reported anal sex in past 3 months, not transgender.

  6. Factor Analyses Exploratory factor analysis with Mplus(N=1001 from GCS) • Cluster-based robust standard errors and test statistics to account for clustering of men within couples (MplusCOMPLEX model type) • Two factors extracted based on simple structure and interpretability of factor loadings • Relationship Quality Enhancement Motive (RQEM) with 7 items • Sex-life Enhancement Motive (SLEM) with 2 items Confirmatory factor analysis with Mplus(independent sample of N=699 from GCS-C) • Same treatment of standard errors as above • Global model fit via attainment of two of the three global fit criteria for structural equation models (as recommended by Hu & Bentler, 1999): • CFI = 0.966 (≥ .95) • RMSEA = 0.056 (≤ .06) • SRMR = 0.042 (≤ .08) • Internal consistency reliability estimated via Cronbach’s alpha • RQEM = 0.82 • SLEM = 0.78

  7. Outcomes • Sexual Risk: Had unprotected anal intercourse with an outside partner of discordant or unknown serostatus in the past 3 months? (0=No; 1=Yes) • Broken Agreement: Ever broken current agreement? (0=No; 1=Yes) • Relationship Satisfaction(RusbultInvestment Model Scale,1980) • Sexual Satisfaction (Ritvo et al., 1997)

  8. Data Analyses • RQEM and SLEM as predictors • Generalized estimating equations with an exchangeable correlation structure, with individuals clustered within couples (PROC GENMOD in SAS) • Interactions of predictors with agreement type (monogamous vs. non-monogamous) tested • All models controlled for relationship length

  9. Sample Characteristics (N=441)

  10. Results: Sexual Risk Both RQEM and SLEM showed significant interactions with agreement type. Note: All models controlled for relationship length

  11. Results: Broken Agreements RQEM showed significant interaction with agreement type. Note: All models controlled for relationship length

  12. Results: Satisfaction For the satisfaction outcomes, neither RQEM nor SLEM showed significant interactions with agreement type. Note: All models controlled for relationship length

  13. Conclusions • Men who report higher relationship-enhancement motivation were less likely to engage in sexual risk with outside partners regardless of agreement type. • Monogamous men who report higher relationship-enhancement motivation were also less likely to break their agreements, were more satisfied with their relationship, and were more sexually satisfied.

  14. Conclusions • Non-monogamous men who report higher sex-life enhancement motivation were more likely to engage in sexual risk with outside partners. • However, scores on sex-life enhancement motivation were not significantly associated with the other outcome variables.

  15. Implications • Relationship enhancement is important to many male couples. Given the association between positive relationship characteristics and reduced risk behavior for HIV, prevention efforts should highlight relationship enhancement strategies. • A satisfying sex-life is also important to many couples. Future prevention efforts should guide couples in achieving this in ways that are safe for both partners.

  16. Thank you Colleen Hoff choff@sfsu.edu Funded by NIMH RO1 #MH065141 and NIMH R01 #MH075598

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