Cory Woodyatt

In-Person Versus Online Focus Group Discussions A Comparative Analysis of Data Quality

Online focus group discussions (FGDs) are becoming popular as a qualitative research method. Methodological examinations regarding the data quality of online versus more traditional in-person FGDs are limited. We compared two online FGDs with two in-person FGDs conducted with gay and bisexual men using a sensitive topic (the experience of intimate partner violence) to examine differences in data quality between the two methods. The online FGDs resulted in larger word count but were shorter in time than the in-person FGDs. There was high overlap in the themes generated across groups; however, the online discussions yielded one additional theme regarding a sensitive topic. In-person FGDs involved less sharing of in-depth stories, whereas sensitive topics were discussed more candidly in the online FGDs. The results illustrate that although the format of the data generated from each type of FGD may differ, the content of the data generated is remarkably similar.

Perceived Challenges and Rewards of Forming a Sexual Agreement Among HIV-Negative Male Couples

Sexual agreements, explicit mutual understandings made between two partners about which sexual and related behaviors they agree to engage in within and/or outside of their relationship, are common among male couples. However, little is known about the perceived rewards and challenges partnered men face in the process of forming a sexual agreement. Such knowledge may be useful for the development of future HIV preventive and sexual health programs that encourage male couples to establish a sexual agreement in their relationship. By using qualitative dyadic data from a sample of 29 self-reported concordant HIV-negative male couples who had a sexual agreement, the present qualitative study sought to assess partnered men’s perceived rewards and challenges of forming a sexual agreement in their relationship and examine whether both men in the couple concurred about their perceived rewards and challenges of forming a sexual agreement. Themes for perceived rewards were (1) being honest, (2) improving communication, (3) increasing understanding about expectations and permitted behaviors, (4) enhancing intimacy and relational bond, and (5) building trust. Themes for perceived challenges were: (1) stigma about having an open agreement; (2) awkwardness about the topic and talking about it; (3) jealousy; and (4) no perceived challenges. Few couples had both partners concur about their perceived rewards or challenges toward establishing a sexual agreement. The variety of perceived rewards and challenges highlight the need for tailoring given that a variety of factors may influence partnered men’s establishment of a sexual agreement in their relationship.

Couple-level Minority Stress: An Examination of Same-sex Couples' Unique Experiences

Social stress resulting from stigma, prejudice, and discrimination—“minority stress”—negatively impacts sexual minority individuals’ health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

HIV-negative male couples' attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement

ABSTRACT One efficacious strategy to help prevent HIV is oral pre-exposure prophylaxis (PrEP), a daily regimen of antiretroviral treatment taken by HIV-negative individuals. Two of the recommendations of Centers for Disease Control and Prevention (CDC) guidelines for PrEP pertain to being in a relationship (i.e., male couples). Despite the recognition of how primary partners in male couples’ relationships shape HIV risk and CDC’s PrEP guidelines, there is a paucity of data that examine HIV-negative male couples’ attitudes toward PrEP use and using PrEP with a sexual agreement. A sexual agreement is an explicit agreement made between two individuals about what sex and other related behaviors may occur within and outside of their relationship. In this qualitative study, we examine HIV-negative male couples’ attitudes toward PrEP use and whether they thought PrEP could be integrated into a sexual agreement. Data for this study are drawn from couple-level interviews conducted in 2014 with 29 HIV-negative male couples who had a sexual agreement and were from Atlanta or Detroit. Both passive (e.g., flyers) and active (e.g., targeted Facebook advertisements) recruitment methods were used; the sample was stratified by agreement type. Thematic analysis was applied to identify the following themes regarding HIV-negative male couples’ attitudes toward PrEP use: (1) PrEP and condom use; (2) concerns about PrEP (e.g., effectiveness, side effects, and promoting sexually risky behavior); and (3) accessibility of PrEP. Some thought PrEP could be a part of couples’ agreement because it could help reduce sexual anxiety and sexual risk, and would help keep the couple safe. Others described PrEP use with an agreement as something for “others”. Some were also concerned that incorporating PrEP could usurp the need for a sexual agreement in a couples’ relationship. These themes highlight the need to improve informational messaging and promotion efforts about PrEP among HIV-negative male couples who may benefit from using it.

Illuminating the Context and Circumstances of Male Couples Establishing a Sexual Agreement in Their Relationship

A sexual agreement is an explicit mutual understanding made between two partners about which sexual and relational behaviors they agree to engage in within and/or outside of their relationship. Factors that prompt male couples to form a sexual agreement and under what circumstances remain underinvestigated, yet are important considerations for development of couples-based sexual health and HIV prevention interventions. By using thematic analysis with qualitative dyadic data from a convenience sample of 29 HIV-negative male couples, the present study sought to describe the timing and investigate the context and circumstances that led male couples to establish a sexual agreement in their relationship at both the individual and couple levels, and by agreement type. Themes identified for when a sexual agreement was formed included within the first 6 months, and after 6 months in the relationship. Themes related to context and circumstances of couples’ sexual agreement formation were as follows: (a) desire for sexual exploration, (b) arisen circumstances or events with other men, (c) influences from past relationship(s) and/or other couples (i.e., peers), (d) to protect against HIV, and (e) purposeful conversations versus understood. Findings suggest HIV prevention efforts should include skill-building exercises to help improve communication and promote sex positivity within male couples’ relationships.

Emotional intimate partner violence experienced by men in same-sex relationships

Abstract Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men.

Similar Others in Same-Sex Couples’ Social Networks

Same-sex couples experience unique minority stressors. It is known that strong social networks facilitate access to psychosocial resources that help people reduce and manage stress. However, little is known about the social networks of same-sex couples, in particular their connections to other same-sex couples, which is important to understand given that the presence of similar others in social networks can ameliorate social stress for stigmatized populations. In this brief report, we present data from a diverse sample of 120 same-sex couples in Atlanta and San Francisco. The median number of other same-sex couples known was 12; couples where one partner was non-Hispanic White and the other a person of color knew relatively few other same-sex couples; and there was a high degree of homophily within the social networks of same-sex couples. These data establish a useful starting point for future investigations of couples’ social networks, especially couples whose relationships are stigmatized or marginalized in some way. Better understandings of the size, composition, and functions of same-sex couples’ social networks are critically needed.

Perception of community tolerance and prevalence of depression among transgender persons

ABSTRACT The goal of the study was to examine the association between depression and perceived community tolerance after controlling for various demographic and personal characteristics, treatment receipt, and past experiences with abuse or discrimination. An online survey assessed depressive symptoms among transgender and gender nonconforming individuals. Depression was assessed using the 7-item Beck Depression Inventory for Primary Care (BDI-PC) and the 10-item Center for Epidemiologic Studies Depression (CESD-10) scale. The prevalence ratios (95% confidence intervals) comparing depression in persons who did and did not perceive their area as tolerant were 0.33 (0.20–0.54) for BD-PC and 0.66 (0.49–0.89) for CESD-10. Other factors associated with depression were experience with abuse or discrimination, lower education, and unfulfilled desire to receive hormonal therapy. Depression was common in this sample of transgender and gender nonconforming individuals and was strongly and consistently associated with participants’ perceptions of community tolerance, even after adjusting for possible confounding. The association between desire to receive hormonal therapy and depression is a finding that warrants further exploration. Future research should also assess depression and changes in perception of community tolerance in transgender individuals before and after initiation of gender confirmation treatment.

Decisions About Testing for HIV While in a Relationship: Perspectives From an Urban, Convenience Sample of HIV-Negative Male Couples Who Have a Sexual Agreement

Many HIV-negative male couples establish a sexual agreement to help manage their HIV risk; however, less is known about their decisions about testing in this context. The present study examined whether male couples discussed HIV testing and explored their decisions about testing in the context of their sexual agreement at the individual- and couple-levels. Qualitative dyadic interview data were collected from 29 HIV-negative male couples with a sexual agreement who resided in Atlanta or Detroit; the sample was stratified by agreement type. Content analysis revealed male couples’ decisions about HIV testing as routine, self-assurance, reliance and assumption on partner, beginning of relationship testers, and/or trust; decisions varied between partners and by agreement type. Findings suggest prevention efforts should help male couples integrate HIV testing into their sexual agreement that matches their agreement type and associated HIV-related risk behavior, and help shift their one-sided decisions about testing to a couple’s mutually shared decision.