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. Author manuscript; available in PMC: 2022 Sep 1.
Published in final edited form as: AIDS Care. 2020 Aug 26;33(9):1209–1217. doi: 10.1080/09540121.2020.1808158

Perceived facilitators of decision-making and usage of biomedical HIV prevention strategies: Findings from an online, qualitative study with same-gender male couples in the United States

Jason W Mitchell 1, Kristi E Gamarel 2,3, Kasey K Kam 1, Jacob T Pennington 1
PMCID: PMC7907248  NIHMSID: NIHMS1620943  PMID: 32844670

Abstract

The early stages of gay and bisexual men’s relationships are a critical period for communicating about HIV prevention strategies. This study sought to: (1) explore facilitators to decision-making to use prevention strategies and (2) describe the prevention strategies being used by same-gender male couples in new relationships. Individual interviews were conducted with 76 partnered men, representing 37 couples and 2 individuals. Couples had been together for one year or less, and varied by US geographical region of residence and HIV serostatus: 8 seroconcordant positive, 17 seroconcordant negative, and 13 serodiscordant couples. Two overarching qualitative themes emerged: (1) communication and (2) information and resources. Notably, few couples had both partners mention the same facilitator. The most commonly used HIV prevention strategies were treatment as prevention for partners in seroconcordant positive and serodiscordant couple relationships, and HIV/STI testing for partners of seroconcordant negative couples. Compared to the other two couple groups, fewer seroconcrdant negative couples were aware of each other’s use of strategies. Study findings suggest these facilitators are important to include in future interventions. Efforts are also needed to improve within-dyad awareness about which strategies partners are using and how they may best support one another toward their sexual health goals.

Keywords: Decision-making facilitators, HIV prevention, male couples, biomedical strategies

Introduction

In the U.S., sexual minority men (SMM) account for approximately two-thirds of new HIV infections (CDC, 2018). Over the past two decades, there has been increased attention to relationship factors and HIV transmission and acquisition risk among SMM (Gamarel & Revenson, 2015; Hoff, Campbell, Chakravarty, & Darbes, 2016). Evidence suggests gay men often did not use condoms with primary partners (Davidovich, de Wit, & Stroebe, 2000) with epidemiological studies illustrating that up to 68% of new HIV infections are attributed to primary relationships (Goodreau et al., 2012; Sullivan, White, Rosenburg, Barnes, & Jones, 2013).

As a result of this evidence, couples-focused HIV prevention intervention research has proliferated with diverse samples SMM (Gamarel, Darbes, Hightow-Weidman, Sullivan, & Stephenson, 2019; Martinez et al., 2014; Newcomb et al., 2017; Starks et al., 2019; Stephenson, Freeland, et al., 2017; Wu et al., 2011). Several interventions have been designed to help more established couples and young men develop a sexual agreement (i.e., decisions couples make about allowing sex with outside partners) and/or improve communication skills to engage in HIV prevention strategies (Gamarel et al., 2019; Newcomb et al., 2017; Starks et al., 2019; Stephenson et al., 2017). Although this research has been critical in advancing HIV prevention efforts for same-gender male couples and SMM in primary partnerships, there has been limited attention to SMM in the early stages of their relationships (e.g., within the first year).

According to many theories, the start of a relationship is characterized by excitement as individuals get to know one another (Brehm, Miller, Perlman, & Campbell, 1992; Furman & Wehner, 1994; Gottlieb, 1985). The beginning of a relationship can also be a critical time for HIV transmission and acquisition risk (Mitchell, Wu, & Gamarel, 2019; Starks, Tuck, Millar, & Parsons, 2016). Although condomless anal sex (CAS) is not inherently risky, accurate knowledge of both partner’s HIV status and communication about HIV prevention strategies (e.g., pre-exposure prophylaxis (PrEP), antiretroviral treatment (ART), treatment as prevention (TasP), condoms, HIV/STI testing) are critical to negotiating sexual safety and making decisions about prevention method(s) (Kippax et al., 1997; Starks et al., 2016).

Evidence suggests men may engage in CAS with their primary partner prior to disclosing their HIV serostatus (Davidovich, de Wit, & Stroebe, 2004; Elford, Bolding, Maguire, & Sherr, 1999; Mitchell, 2014a; Starks et al., 2016) and that these events often occurs within the first month of a relationship (Mitchell et al., 2019). During this time, individuals may not want to discuss HIV, as it could undermine pleasure and intimacy (Golub, Starks, Payton, & Parsons, 2012; Malebranche, Fields, Bryant, & Harper, 2009; Suarez & Miller, 2001). Thus, there is a need to understand the enabling factors to engaging in decision-making around HIV prevention strategies among SMM and their partners’ in the early phase of their relationship.

The study sought to: 1) explore facilitators of decision-making to use HIV prevention strategies during the first year of a couple’s relationship; and 2) describe which HIV prevention strategies couples are currently using. We examined whether partners within each couple concur about perceived facilitators and HIV prevention strategies.

Methods

A cross-sectional, qualitative study was conducted with 39 same-gender male couples in the U.S. All procedures were conducted online with approval from the University of Hawaii Institutional Review Board.

Recruitment

Recruitment occurred over a 6-month period via targeted Facebook and Instagram advertisements, and email distribution of electronic flyers to AIDS- and community-based organizations. Ads targeted adult (i.e., ≥ 18 years of age), English-speaking men in the U.S. who were in a new relationship, and interested in LGBTQ-related topics. Both forms of recruitment directed interested individuals to a study landing webpage that briefly described the study and provided access to the consent and eligibility screener, which was hosted on Qualtrics.

Eligibility

Eligibility was assessed at the individual- and couple-level. At the individual-level, eligibility was based on: (1) having access to an internet-connected computer or mobile device with video capabilities; (2) being 18 years of age or older; (3) self-identifying as a male; and (4) being in a new relationship (i.e., 1 year or less) with an adult man (18 and older). An established protocol was used to verify each couple’s relationship and the validity of their data to meet couple-level eligibility criteria (Mitchell, Lee, & Stephenson, 2016).

Procedures

Once an individual (herein referred to as Partner 1) provided consent and passed individual-level eligibility (from the screener), he was then prompted to enter his own and his partner’s (i.e., Partner 2) contact information (e.g., email addresses, phone numbers) to enable scheduling of individual interviews by the research team, dyadic data collection, linkage of partners as a couple, verification of their relationship, and data validity checks. A study invitation email was sent to Partner 2 once his email addressed was entered by Partner 1, via our partner referral system; the sent email contained an invitation message along with a link to the study landing page. Partner 2 then followed the same screening procedures as his partner (Partner 1).

Once both partners completed the eligibility screener and provided consent, the research team evaluated their data for couple-level eligibility. Couples who passed couple-level eligibility of relationship verification and data validation were invited to participate in a one-time, individual interview. Those who did not consent, meet individual- and couple-level eligibility, provide complete contact information, and/or enrollment criteria were excluded from the study and provided with HIV prevention resources (e.g., AIDSVu.org).

Qualitative Interviews

Once a couple was deemed eligible, both partners were individually contacted (email, phone call, text) to schedule their 45-minute online interview via Zoom. The interview was semi-structured and consisted of different sections, including which HIV prevention strategies were being used and what men perceived to be helpful about deciding which strategies to use in their relationship. At the conclusion of the interview, participants were compensated with a $50 Amazon.com gift card. Each interview was digitally recorded, transcribed verbatim, checked for accuracy, and de-identified for analysis.

Data Analyses

Descriptive statistics (e.g., mean, counts, proportions) were used to characterize the enrolled sample as individuals and couples. We used template analysis as a framework for coding all interview transcripts (Brooks, McCluskey, Turley, & King, 2015). Codes were discussed and developed by two coders using specific questions from the interview guide domains (e.g., Tell me about your goals for protecting yourself from HIV and other STIs; What kinds of discussions about HIV and STIs have you had with your partner?; What would make it easier to talk with your partner about your risk for HIV and other STIs?). The authors then refined the relationships between the indexed data and the interpreting theme and contextualized their meaning within and across participants and couples. Two overarching themes were coded for facilitators of decision-making to use HIV prevention strategies in: Communication and Information / Resources. Each overarching theme then had sub-themes that emerged from our analyses, discussions, and synthesis of the transcripts. We then coded the different HIV prevention strategies that each participant self-reported currently using and whether the participant’s partner concurred about the prevention strategy. For each code, we examined differences by couple HIV status. Summary counts, per dyad serostatus, were calculated to describe concordance for each overarching facilitator of decision-making theme and current use of biomedical prevention strategy(ies).

Results

Study Sample

Table 1 describes the sample of 76 participants, representing 37 couples and 2 partnered individuals. Participants’ ranged in age from 18 to 55 (M=30.3) with a 6.3 years average age difference between partners. Most participants resided in the South and West, identified as Non-Hispanic White, identified as a cisgender man, and had been together for more than 6 months. Participants varied by couple serostatus (8 seroconcordant positive, 17 seroconcordant negative, and 13 serodiscordant couples).

Table 1.

Demographic characteristics of the sample at the individual- and couple-level

Individual Couple-level
Sample size n=76 N=38
Partners concur a or have same characteristic b Partners do not concura or differ on characteristic b
Demographic Characteristic n (%) N (%) N (%)
U.S. region 38 (100) 0 (0)
 Northeast 11 (14)
 South 34 (45)
 Midwest 8 (11)
 West 24 (32)
Racial ethnic background 30 (79) 8 (21)
 Non-Hispanic White 45 (59)
 Non-Hispanic Black 12 (16)
 Non-Hispanic Asian 1 (1)
 Non-Hispanic multiracial 3 (4)
 Hispanic White 13 (17)
 Hispanic Black 1 (1)
 Hispanic multiracial 1 (1)
Sex assigned on original birth certificate -- --
 Male 73 (96)
 Female 3 (4)
Current gender identity c 37 (97) 1 (3)
 Male 73 (96)
 Trans man 2 (3)
 Gender queer / Gender non-conforming 1 (1)
Education attainment 9 (24) 29 (76)
 Some high school 2 (3)
 High school diploma or G.E.D. 7 (9)
 Associate’s degree or some college 34 (45)
 Bachelor’s degree 18 (24)
 Some graduate school 4 (5)
 Graduate or professional degree 11 14)
Relationship length 35 (92) 3 (8)
 Less than 1 month 1 (1)
 Between 1 and 3 months 9 (12)
 More than 3 months, but less than 6 months 13 (17)
 More than 6 months, but less than 12 months 53 (70)
Cohabitation 37 (97) 1 (3)
 Living together 35 (46)
 Not living together 41 (54)
Couple HIV status 38 (100) 0 (0)
 Seroconcordant negative (17 dyads) 34 (45)
 Seroconcordant positive (8 dyads) 16 (21)
 Discordant (13 dyads) 26 (34)
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Notes:

a

Both partners’ responses to the same question were compared to assess whether they concurred or not about their relationship HIV status, cohabitation, relationship length, relationship descriptor, and U.S. region.

b

Both partners’ responses to the same question were compared to assess whether they reported the same answer, indicating they shared the same characteristic of racial ethnic background, education attainment.

c

Three participants identified as transgender men; one reported as male for current gender identity

Facilitators of Decision-making to Discuss the Use Biomedical HIV Prevention Strategies

Communication, and information and resources were identified as key facilitators to using HIV prevention strategies. As shown in Table 2, 38% of men in seroconcordant positive relationships, 47% in seroconcordant negative relationships, and 77% in serodiscordant relationships described the importance of communication in their decision-making to use HIV prevention strategies. Few couples had both partners mention communication with their partner as important in their decision-making process to use HIV prevention strategies: 13% of seroconcordant positive couples, 29% of seroconcordant negative couples, and 8% of serodiscordant couples.

Table 2.

Couples’ perceived facilitators of decision-making about using HIV prevention strategies, by couple HIV status

Seroconcordant positive Seroconcordant negative Serodiscordant
Sample size N=8 couples a N=17 couples N=13 couples a
By one partner By both partners By one partner By both partners By one partner By both partners
Perceived facilitator N (%) N (%) N (%) N (%) N (%) N (%)
Communication 3 (38) 1 (13) 8 (47) 5 (29) 10 (77) 1 (8)
Information / Resources 4 (50) 1 (13) 5 (29) 5 (29) 12 (92) 2 (15)
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Note.

a

One partner in this group of couples did not participate in the interview (e.g., 25 partnered men in the serodiscordant couple group and 15 partnered men in the seroconcordant negative couple group).

Communication took on different forms; Table 3 has illustrative quotes. Several couples described how they discussed different prevention strategies and came to a mutual decision together. Other couples described the importance of establishing boundaries and having open communication about what they were willing to sacrifice in their relationship. One man in a serodiscordant relationship discussed how there are times many assumptions were made at the beginning of a relationship. He described the importance of having difficult conversations and deciding on the right prevention strategy.

Table 3.

Exemplary quotes of couples’ perceived facilitators of decision-making toward the use of HIV prevention strategies

Communication Information / Resources
Seroconcordant positive Concurrent
Partner A: After we have talked about it, after talking about I guess sitting down and trying to decide what strategies I like, what strategies he like, prevention strategy, just come together as one and making a decision.
Partner B: “Going over all the research, all the prevention strategies we could to come up with a plan of this is what we’re going to do. This is how we’re going to prevent it and stay safe.”		 Partner A: “Research the different options.”
Partner B: “A resource or tool that was online to learn more details about different types of prevention strategies and how they work to see which one is best in my situation; someone to talk to.”
Seroconcordant positive Divergent
Partner A: “Going to our separate doctors.”
Partner B: “Being on the same page and talking.”		 Partner A: “I want a pros and cons list.”
Partner B: “Having someone else there. A third party but you also have to know the facts.”
Seroconcordant negative Concurrent
Partner A: I think just kind of continued dialogue about where we are and the sex that we’re having. If that changes, I don’t anticipate it, but if ... we started having outside couples either kind of separately or together or something, then that would kind of be another conversation that we would just have.
Partner B: I guess just talking through it would be the easiest way to do it. You know, if he had a problem with something, or I had a problem with something, we would talk about it and change the way we protect ourselves.
 Partner A: I feel like talking to my doctor individually and then him talking to his doctor about ... But both, essentially, discussing beforehand and after what we discussed with our physicians and stuff like that.”
Partner B: I feel like doubling back to education. Just having some kind of platform out there that’s more ... obviously things like Grinder are huge with the gay area, the gay community, not the gay area. And I feel like maybe having some kind of platform like that to reach out to these people and just give them little tidbits on how to keep themselves protected and how to keep themselves safe would be huge. Because especially in smaller areas, there’s no resource really unless you reach out.”
Seroconcordant negative Divergent
Partner A: “We both give each other quite a bit of leeway with our personal health decisions, but it is something that we would inform each other about going into it.”
Partner B: “A conversation that establishes limits and boundaries I think would be the most helpful there, you know, I’m going to indulge this for you, but here are my terms,’ sort of thing. And just making sure that everyone’s comfortable with what’s going to happen. And should any partner want to withdraw from the activity at any point, they feel comfortable doing so, and they don’t feel embarrassed or I guess nervous to not want to back out for themselves.”		 Partner A: For me, what would help me decide is the research and the facts and the data. I’m just like an analytical person. For him, it would probably be the emotion behind it. He definitely wants to either feel comfortable or have like a pleasurable feeling during sex. Condoms may not be the best option for him unless there’s like a certain condom that you can still feel the sensation, which I did find, which in my opinion is SKYN. But I think like, yeah, for me, it’s more the data. For him, it’s more the feelings.
Partner B: I think that we have ... since not using condoms, I don’t know. I think that we just feel really close to each other and I think that whatever strategy would allow us to maintain that closeness is what we would take. So we don’t use condoms, and I think that if I was to pick any strategy out of any of them it would probably be just to take PrEP because therefore it would not ... that sense of intimacy that maybe putting a condom on can kind of interrupt. And I’m not an advocate for not using condoms, but I think that sometimes there’s moments where you are in an intimate setting that maybe you don’t have access to a condom or would maybe interrupt what you guys were doing.”
Serodiscordant Concurrent
Partner A: “Talking to each other; asking each other questions; checking in with each other and reminding each other to take their meds like they already do.”
Partner B: “Having a conversation with hi doctor and with also with my doctor with partner present.”		 Partner A: “It’s important that I that understand not only what the medication’s intended to do, but the effects of it on my system and how to go about thinking about that choice because that’s something that will only affect him.”
Partner B: “Getting opinions other than just our opinions, but professional opinions as well.”
Serodiscordant Divergent
Partner A: Nothing else aside from communication.”
Partner B: Sitting down with a doctor and getting concrete answers		 Partner B: “Open communication and making sure that each person understands the others concerns and then making sure they address them.”
Partner B: “Have information that we don’t already have like side effects and getting HIV while on PrEP.”
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Half of men in seroconcordant positive relationships, 29% of men in seroconcordant negative relationships, and 92% in serodiscordant relationships described the importance of information and resources in using HIV prevention strategies (Table 2). Few couples had both partners mention information and resources as being important in their decision-making process about using HIV prevention strategies.

Regardless of couple HIV status, participants described the importance of accessible and reliable information on HIV prevention strategies (see Table 3 for illustrative quotes). Participants had different experiences with and preferences for receiving information and resources. The majority of participants living with HIV described how they received information from healthcare centers whereas, HIV-negative men often learned about strategies from peers or online platforms. Participants often described the need for accurate and accessible online information and resources. One seroconcordant positive couple discussed how they wanted to receive LGBTQ+ specific-sexual education on social media. Other participants described the importance of receiving LGBTQ+ affirming information online from peers as “opposed to textbooks that are really homophobic.” Finding information when a seroconversion occurs was also noted as a challenge by partners of men living with HIV, and resources for those without insurance. Other men discussed a desire for an online tool that would help them choose the best HIV prevention strategy based on their current relationship and sexual behaviors.

Participants – across all three couple serostatus groups – shared how communication and information and resources played a facilitating role in their perceptions about making decisions toward the use of HIV prevention strategies in their relationship. One difference was noted between cisgender and transgender men: One transgender man in a seroconcordant negative relationship described it would be helpful to include resources on HIV and pregnancy prevention.

Awareness and Current Use of HIV Prevention Strategies

As shown in Table 4, all men living with HIV were using TasP as their prevention strategy. Three couples had explicitly discussed TasP (2 serodiscordant, 1 seroconcordant positive). Among men in seroconcordant positive relationships, all were using TasP, 27% were using condoms, and one was using STI testing. There were high levels of within-couple concordance about awareness of these strategies. Among men in seroconcordant negative relationships, 9% were using PrEP, 32% were using condoms, 44% were testing for HIV/STIs, and 41% were not using any strategy. Within-couple concordance about awareness of using such strategies ranged between 40% (testing) and 56% (condoms). Among serodiscordant couples, all partners living with HIV were using TasP, 62% of HIV-negative partners were using PrEP, 28% were using condoms, 24% were using HIV/STI testing, and 12% were not using any strategy. Within-couple concordant about awareness of these strategies ranged between 33% (no strategy) and 100% (PrEP). Across all three groups of couples, participants used a variety of HIV prevention strategies, with the highest within-couple concordance being among the seroconcordant positive and serodiscordant couples.

Table 4.

Partner-level use and awareness of which HIV prevention strategies were being used, by couple HIV serostatus

Seroconcordant positive Seroconcordant negative Serodiscordant
Sample size N=8 couples a N=17 couples N=13 couples a
Couples’ use of HIV prevention strategies Couples’ use of HIV prevention strategies Couples’ use of HIV prevention strategies
Only one partner uses Both partners use Both partners knew about each other’s use Only one partner uses Both partners use Both partners knew about each other’s use Only one partner uses Both partners use Both partners knew about each other’s use
Strategy N N % N N % N N %
TasP 1 7 6/7 -- -- -- 12 -- 10/12
PrEP -- -- -- 1 1 1/2 8 -- 8/8
Condoms 2 1 3/3 7 2 5/9 3 2 3/5
HIV/STI testing 1 0 1/1 5 5 4/10 6 0 5/6
None 0 0 0 6 4 5/10 3 0 1/3
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Notes.

Some participants reported using more than one prevention strategy.

a

One partner living with HIV in this group of couples did not participate in the interview (e.g., 25 partnered men in the serodiscordant couple group and 15 partnered men in the seroconcordant positive couple group).

Discussion

This study found that among same-gender male couples who are in a new relationship, communication and information/resources are important facilitators of decision-making about using HIV prevention strategies. Couples’ use of HIV prevention strategies, and partner-level concurrence, was also investigated and revealed important differences by couple serostatus. Relative to making decisions about which HIV prevention strategies to use, partners shared how communication focused on three areas: 1) having discussions to come to a mutual decision; 2) the importance of establishing boundaries and negotiation; and 3) preventing assumptions by having potentially difficult conversations. Collectively, these areas pertain to mutual constructive communication strategies where both partners play an equal role in the decision making process to help resolve any conflicts within their relationship (Bodenmann, 2005; Manne, Badr, Zaider, Nelson, & Kissane, 2010; Porter, Keefe, Hurwitz, & Faber, 2005) by negotiating and establishing boundaries about their sexual health and HIV prevention needs.

Few couples concurred about communication as a facilitator to their own decisions to use HIV prevention strategies; however, almost half of all partners believed communication was an important facilitator to decision-making. As a theoretical construct and relationship dynamic, several other studies conducted with male couples have identified communication as an important factor associated with HIV-related outcomes. Greater mutual constructive communication – ability to communicate constructively when a problem or concern arises (Christensen & Shenk, 1991) – has been associated with lower HIV risk among male couples (Darbes, Chakravarty, Neilands, Beougher, & Hoff, 2014; Gomez et al., 2012; Hoff et al., 2009). Communication also impacts other relationship dynamics (e.g., commitment, trust) (Mitchell, 2014b; Mitchell & Gamarel, 2018). Couples-based HIV prevention interventions should integrate content and exercises that teach and encourage couples to practice mutual constructive communication strategies. Several published interventions (Gamarel et al., 2019; Martinez et al., 2014; Mitchell et al., 2020; Newcomb et al., 2017; Starks et al., 2019; Stephenson et al., 2017; Wu et al., 2011), as well as interventions underway, include communication strategies as content via exercises, educational material, and/or informative videos to help improve HIV-related prevention outcomes among same-gender male couples.

Information and resources was another important facilitator of decision-making in using HIV prevention strategies. Participants expressed the importance of having accessible and reliable information about strategies, yet also noted their difficulty in finding publically available accurate information, content on when someone seroconverts in the relationship, and content that is inclusive of the sexual health of transgender men. Several publically available HIV prevention and care resources exist online (e.g., https://www.cdc.gov/hiv/ (Centers for Disease Control and Prevention [CDC], 2019); www.AIDSVu.org (AIDSVu, 2019); www.pleaseprepme.org (Pleaseprepme.org, 2019), yet none explicitly address the potential ways seroconversion may impact a couples’ relationship and HIV prevention strategies. Although participants were not asked about their awareness of online resources, none mentioned them. Existing couples-based HIV prevention interventions may offer opportunities to help couples navigate and manage when a seroconversion occurs in their relationship (Bazzi et al., 2016; Gamarel et al., 2019; Newcomb et al., 2017; Starks et al., 2019; Stephenson et al., 2017).

Men also discussed a desire for an online tool that would help them choose the best HIV prevention strategy(ies) based on their relationship and sexual behaviors. This is noteworthy with increased attention on providing tailored interventions to meet individual’s and couples’ needs. The CDC will soon be providing an HIV risk reduction tool to obtain tailored information about one’s risk of acquiring or transmitting HIV and provide prevention options that can lower one’s risk (CDC, 2019). Our findings suggest that similar online risk reduction tools that incorporate communication strategies are warranted for same-gender male couples.

Men used a variety of HIV prevention strategies and knowledge of partner’s prevention strategy use varied by couple HIV serostatus. TasP was commonly used among men in seroconcordant positive and serodiscordant couples; both couple groups had high within-dyad concordance on TasP awareness. Few couples reported having explicit conversations about TasP. PrEP was another strategy used, mostly among men in serodiscordant couples who also had high within-dyad concordance on PrEP awareness. Serostatus disclosure and communication may have already been established due to the nature of the study eligibility criteria, such that partners needed to know each other’s HIV status, which may not be generalizable to all couples. Men may have more conversations now about TasP in their relationships than at the time of their interview given the proliferation of Undetectable = Untransmittable (U=U) campaigns. It is plausible some partners may have forgotten to share this information at the time of the interview, while others in seroconcordant negative relationships may not talk about their use of strategies with one another on a regular basis because of low risk perception.

For same-gender male couples, partners may need to renegotiate and reestablish sexual goals and communication is an ongoing process for HIV prevention. One way to encourage couples to talk about their strategies on a regular basis and enhance social support is to incorporate this type of conversation with other regularly occurring events to help form a habit, and set reminders (as needed). This in turn may help improve knowledge of HIV prevention strategy use and sexual health goals.

Limitations

Findings from these same-gender male couples, inclusive of 2 transgender men and 1 gender non-conforming man, may not reflect the awareness and use of prevention strategies of other same-gender male couples in the U.S. The enrolled sample was exclusively recruited through social media, which may further limit generalizability. Other indicators of socioeconomic status (SES) were not collected, which impedes our ability to examine the role SES may have had toward couples’ decisions and use of HIV prevention strategies. The study design also limits our understanding whether the facilitators described by the participants led to decisions to use different HIV prevention strategies. In light of these limitations, the sample was diverse with respect to age, couple HIV serostatus, relationship length, and cohabitation.

Conclusion

Communication and information and resources appear to be important facilitators toward couples making decisions to use HIV prevention strategies during the first year of their relationship. Findings also revealed efforts are needed to improve within-dyad awareness about which strategies partners are using and how they may best support one another toward their sexual health goals. Greater awareness of existing HIV prevention resources and availability of interventions have the potential to improve the uptake of strategies, with the addition of accessible tailor-based tools to help couples with their decision-making processes.

Acknowledgments

Funding details: This work was supported by the National Institute of Mental Health under Grant R21MH116684.

Footnotes

Author Disclosure Statements: For each author, no competing financial interests exist.

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