Deepalika Chakravarty

Relationship characteristics and motivations behind agreements among gay male couples: Differences by agreement type and couple serostatus

Abstract Gay men in relationships are often overlooked in HIV prevention efforts, yet many engage in sexual behaviors that increase their HIV risk and some seroconvert as a result. While different aspects of gay male relationships have been studied, such as sexual agreements, relationship characteristics, and couple serostatus, little research combines these elements to examine HIV risk for this population. The present study recruited 566 gay male couples from the San Francisco Bay Area to study their sexual agreements, motivations behind making agreements, and other relationship characteristics, such as agreement investment, relationship satisfaction, intimacy, and communication. Participants rated their level of concurrence with a set of reasons for making their agreements. They were also measured on relationship characteristics using standard instruments. Analyses were conducted by agreement type (monogamous, open, and discrepant) and couple serostatus (concordant negative, concordant positive, and discordant). A majority reported explicitly discussing their agreements and nearly equal numbers reported being in monogamous and open relationships. A small number (8%) reported discrepant agreements. Across all agreement type and serostatus groups, HIV prevention as a motivator for agreements fell behind every motivator oriented toward relationship-based factors. Only concordant negative couples endorsed HIV and STD prevention among their top motivators for making an agreement. Mean scores on several relationship characteristics varied significantly. Couples with monogamous agreements had higher scores on most relationship characteristics, although there was no difference in relationship satisfaction between couples with monogamous and open agreements. Scores for concordant positive couples were distinctly lower compared to concordant negative and discordant couples. Agreements, the motivations behind them, and the relationship characteristics associated with them are an important part of gay male relationships. When examined by agreement type and couple serostatus, important differences emerge that must be taken into account to improve the effectiveness of future HIV prevention efforts with gay couples.

Relationship Characteristics Associated with Sexual Risk Behavior Among MSM in Committed Relationships

Understanding situations that increase HIV risk among men who have sex with men (MSM) requires consideration of the context in which risky behaviors occur. Relationships are one such context. This study examines the presence and predictors of unprotected anal intercourse (UAI) in the past 3 months among 566 MSM couples. A majority of couples allowed sex with outside partners. Overall, 65% of the sample engaged in UAI with primary partner, including nearly half of discordant couples. Positive relationship factors, such as attachment and intimacy, were associated with an increased likelihood of UAI with primary partner. Meanwhile, 22% of the sample engaged in at least one episode of UAI with an outside partner, half of whom were discordant or unknown HIV status outside partners. Higher levels of HIV-specific social support, equality, and sexual agreement investment were significantly associated with a decreased likelihood of engaging in UAI with a discordant or unknown HIV status outside partner. HIV-positive men in discordant relationships had two and one half times the odds of having UAI with a discordant or unknown HIV status outside partner as their HIV-negative partners. Many MSM in relationships, including some in serodiscordant ones, engage in UAI with primary partners. Potential explanations include relationship closeness, relationship length, and agreement type. In addition, relationship context appears to have a differential impact upon UAI with primary and outside partners, implying that prevention messages may need to be tailored for different types of couples. Prevention efforts involving MSM couples must take into account relationship characteristics as couples balance safer sex and HIV risk with intimacy and pleasure.

Relationship dynamics as predictors of broken agreements about outside sexual partners: Implications for HIV prevention among gay couples

Agreements about sex with outside partners are common among gay couples, and breaks in these agreements can be indicative of HIV risk. Using longitudinal survey data from both partners in 263 HIV-negative and -discordant gay couples, we investigate whether relationship dynamics are associated with broken agreements. Twenty-three percent of respondents reported broken agreements. Partners with higher levels of trust, communication, commitment, and social support were significantly less likely to report breaking their agreement. Promoting positive relationship dynamics as part of HIV prevention interventions for gay couples provides the opportunity to minimize the occurrence of broken agreements and, ultimately, reduce HIV risk.

Serostatus differences and agreements about sex with outside partners among gay male couples.

This article describes agreements gay male couples make about sex outside the relationship and how the process of making those agreements, and their perceived quality, varies depending on couple serostatus. Data include 191 couples recruited in the San Francisco Bay Area from June to December 2004. Monogamous agreements were reported by 56% of participants in concordant-negative, 47% in concordant-positive, and 36% in discordant relationships. The remaining participants reported agreements allowing sex with outside partners in some form. Agreement quality was lowest among men in discordant relationships. Overall, few (30%) reported breaking their agreements; only half of whom reported disclosing those breaks to their partners. Although differences in agreement type, quality, and satisfaction were found among the three couple serostatus groups, rates of breaks and their disclosure did not vary significantly by group. Future HIV prevention efforts aimed at couples must integrate both couple serostatus and relationship-based issues.

Development and Validation of the Sexual Agreement Investment Scale

Sexual agreements are ubiquitous among gay men. Lower levels of investment in these agreements may be associated with breaking them or engaging in risky sexual behavior. A scale was developed to measure agreement investment levels among gay men. Qualitative data from 78 gay men in committed relationships were analyzed to inform item development, followed by quantitative analyses of two larger samples (n = 380, n = 1,001) to assess construct, convergent, and discriminant validity. The Sexual Agreement Investment Scale (SAIS) is a psychometrically sound measure of the level of investment in sexual agreements among gay men in relationships. Men with higher agreement investment were less likely to break agreements and less likely to engage in unprotected anal intercourse with outside partners. The SAIS can be used to measure investment in sexual agreements and its impact on sexual behavior in a wide variety of settings, including research on relationships, sexuality, couples therapy and HIV prevention.

Women with lung cancer: quality of life after thoracotomy: a 6-month prospective study.

Background: Data about health-related quality of life (QOL) after surgical treatment for lung cancer are limited. Such information can be valuable in developing appropriate nursing interventions for follow-up care for survivors. Objectives: The purposes of this study were to describe physical and emotional QOL of disease-free female non-small cell lung cancer (NSCLC) survivors and to determine characteristics associated with greater risk for disruptions. Methods: One-hundred-nineteen women surgically treated for NSCLC completed the Short-Form 36 (as a measure of physical and mental QOL) along with health status assessments (including comorbidity, depression, Center for Epidemiologic Studies-Depression Scale, smoking status, and body mass index), dyspnea (Dyspnea Index), meaning of illness, and demographic and clinical information at baseline and 3 and 6 months. Results: On average, the women were 68 years of age, diagnosed 2 years previously, had adenocarcinoma, and were treated surgically with lobectomy. The majority (66%) had comorbid disease, 29% had depressed mood (Center for Epidemiologic Studies-Depression Scale score ≥16), 8% were current smokers, 62% were overweight, 22% had dyspnea (scores ≥2), and 24% had a negative meaning of illness. Physical and emotional QOL scores were comparable to Short-Form 36 norms for older adults and exhibited little change over time. Controlling for time since diagnosis, dyspnea, and depressed mood were strongly related to disruptions in physical and emotional QOL, respectively, across the 6-month study period, with comorbid disease contributing to both models. Conclusion: Depressed mood, comorbidities, and dyspnea were factors related to poorer physical and emotional QOL. Survivors with these characteristics might benefit from greater supportive care. Implications for Practice: Screening for dyspnea, depressed mood, and comorbid illness can identify female survivors at-risk for poorer QOL after surgery.

Partner-Provided Social Support Influences Choice of Risk Reduction Strategies in Gay Male Couples

We investigated the influence of partner-provided HIV-specific and general social support on the sexual risk behavior of gay male couples with concordant, discordant, or serostatus-unknown outside partners. Participants were 566 gay male couples from the San Francisco Bay Area. HIV-specific social support was a consistent predictor for reduced unprotected anal intercourse (UAI) with both concordant outside partners (all couple types) and outside partners of discordant or unknown serostatus (concordant negative and discordant couples). General social support was associated with increased UAI with concordant outside partners for concordant negative and concordant positive couples (i.e., serosorting). Our findings suggest that prevention efforts should target couples and identify the level of HIV-specific support that partners provide. Partner-provided support for HIV-related behaviors could be an additional construct to consider in gay male relationships, akin to relationship satisfaction and commitment, as well as an important component of future HIV prevention interventions.

Risks worth taking: Safety agreements among discordant gay couples

Abstract As HIV research and prevention efforts increasingly target gay men in relationships, situational factors such as couple serostatus and agreements about sex become central to examinations of risk. Discordant gay couples are of particular interest because the risk of HIV infection is seemingly near-at-hand. Yet, little is known about their sexual behaviors, agreements about sex, and safer sex efforts. The present study utilized longitudinal semi-structured, qualitative interviews to explore these issues among 12 discordant couples. Findings show that nearly every couple had agreements about reducing the likelihood of HIV transmission from one partner to the other. Negotiating these agreements involved establishing a level of acceptable risk, determining condom use, and employing other risk-reduction techniques, such as seropositioning and withdrawal. For half of the couples, these agreements did not involve using condoms; only two couples reported consistent condom use. Despite forgoing condoms, however, none reported seroconversion over the course of data collection. Additional issues are raised where long-term HIV prevention is concerned. Future prevention efforts with discordant couples should work with, rather than fight against, the couples decision to use condoms and endeavor to complement and accentuate their other safer sex efforts.

Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges.

BackgroundConcerns about the confidentiality of personal health information have been identified as a potential obstacle to implementation of Health Information Exchanges (HIEs). Considering the stigma and confidentiality issues historically associated with human immunodeficiency virus (HIV) disease, we examine how trust—in technology, processes, and people—influenced the acceptability of data sharing among stakeholders prior to implementation of six HIEs intended to improve HIV care in parts of the United States. Our analyses identify the kinds of concerns expressed by stakeholders about electronic data sharing and focus on the factors that ultimately facilitated acceptability of the new exchanges.MethodsWe conducted 549 surveys with patients and 66 semi-structured interviews with providers and other stakeholders prior to implementation of the HIEs to assess concerns about confidentiality in the electronic sharing of patient data. The patient quantitative data were analyzed using SAS 9.2 to yield sample descriptive statistics. The analysis of the qualitative interviews with providers and other stakeholders followed an open-coding process, and convergent and divergent perspectives emerging from those data were examined within and across the HIEs.ResultsWe found widespread acceptability for electronic sharing of HIV-related patient data through HIEs. This acceptability appeared to be driven by growing comfort with information technologies, confidence in the security protocols utilized to protect data, trust in the providers and institutions who use the technologies, belief in the benefits to the patients, and awareness that electronic exchange represents an enhancement of data sharing already taking place by other means. HIE acceptability depended both on preexisting trust among patients, providers, and institutions and on building consensus and trust in the HIEs as part of preparation for implementation. The process of HIE development also resulted in forging shared vision among institutions.ConclusionsPatients and providers are willing to accept the electronic sharing of HIV patient data to improve care for a disease historically seen as highly stigmatized. Acceptability depends on the effort expended to understand and address potential concerns related to data sharing and confidentiality, and on the trust established among stakeholders in terms of the nature of the systems and how they will be used.

Health information exchange interventions can enhance quality and continuity of HIV care

PURPOSE The purpose of this article is to describe how comprehensive HIV care is delivered within Ryan White Program (RWP)-funded clinics and to characterize proposed health information exchange (HIE) interventions, which employ technology to exchange information among providers, designed to improve the quality and coordination of clinical and support services. METHODS We use HIV patient care quality and coordination indicators from electronic data systems to describe care delivery in six RWP demonstration sites and describe HIE interventions designed to enhance that care. RESULTS Among patients currently in care, 91% were retained in care in the previous six months (range across sites: 63-99%), 79% were appropriately prescribed antiretroviral therapy (54-91%) and 52% had achieved undetectable HIV viral load (16-85%). To facilitate coordination of care across clinical and support services, sites designed HIE interventions to access a variety of data systems (e.g. surveillance, electronic health records, laboratory and billing) and focused on improving linkage and retention, quality and efficiency of care and increased access to patient information. DISCUSSION Care quality in RWP settings can be improved with HIE tools facilitating linkage, retention and coordination of care. When fully leveraged, HIE interventions have the potential to improve coordination of care and thereby enhance patient health outcomes.