PartnerProvided Social Support Influences Choice

Authors: Lynae A Darbes Deepalika Chakravarty Sean C Beougher Torsten B Neilands Colleen C Hoff

Publish Date: 2011/01/11

Volume: 16, Issue: 1, Pages: 159-167

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Abstract

We investigated the influence of partnerprovided HIVspecific and general social support on the sexual risk behavior of gay male couples with concordant discordant or serostatusunknown outside partners Participants were 566 gay male couples from the San Francisco Bay Area HIVspecific 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 ie serosorting Our findings suggest that prevention efforts should target couples and identify the level of HIVspecific support that partners provide Partnerprovided support for HIVrelated 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 interventionsAccording to recent estimates from five US cites the majority of HIV infections among MSM occur within the context of primary partnerships 1 Prior evidence of this trend has also been found in the Netherlands 2 3 4 These findings underscore the importance of understanding the context of intimate relationships in which this risk may occur Agreements about whether to allow sex with outside partners are common among gay male couples 5 but it is also true that relationship characteristics may impact both those agreements as well as other choices that many couples make in their efforts to reduce their HIV risk For example factors such as intimacy and relationship satisfaction may influence whether partners choose to have unprotected anal intercourse UAI with each other Another dimension often present in primary relationships is the presence of outside partners—a situation commonly addressed by specific agreements among gay male couples as to whether outside partners are permitted or not 6 The presence of an outside partner may not necessarily increase HIV risk particularly with concordant partners but the possibility of UAI with outside partners of discordant or unknown serostatus could confer risk for HIV transmission 7 8 Thus a primary relationship may not bestow the level of protection from HIV previously thought Furthermore most theoretical orientations used in HIV prevention have focused on individuals and do not take into account the role and influence of primary partners on sexual behavior 6 Therefore it is imperative to examine how partners may influence the choices gay men in relationships make about their sexual behaviorsSocial support is one mechanism through which partners influence each others’ health and behavior It is an important influence on individuals’ psychological outcomes in addition to being a significant predictor of morbidity and mortality 9 10 However it has most often been examined in conjunction with psychological outcomes such as depression or anxiety It has been examined with respect to the type of support eg informational emotional 9 the source of support eg friends relatives partners 11 and the dimensions of support eg amount satisfaction 12 It has also been examined in association with a variety of behavioral outcomes eg smoking cessation heart disease medication adherence weight loss 13 14 15 16 For gay men general social support has been examined in the context of psychological outcomes For example support from peers has been found to be an important buffer for gay men against low family support as a result of their sexuality 17 18 and important differences in these types of support peer vs family have been described 19 It has also been noted that lower family support may potentially cause additional strain or distress on gay relationships 20 21 Specific investigations of partner support in gay male relationships have been conducted most often as it relates to overall relationship satisfaction 18 22 However few examinations have been made of the role of partner support specifically regarding sexual risk behavior among gay male couplesIn the realm of HIV examinations of social support have frequently focused on coping with being HIVpositive or having AIDS 23 24 25 or the progression of HIV disease 26 Although the definitions of social support are often heterogeneous fairly consistent findings demonstrated that increased general social support was often a protective or positive factor in coping with being HIVpositive or having AIDS Social support has been examined less often in conjunction with sexual risk behavior As the findings from these studies have been mixed with some reporting that general social support is associated with increased sexual risk behavior 26 27 and others showing decreased risk 28 29 researchers have posited that general social support might be a more reliable predictor of psychological rather than behavioral outcomes 30 31Other examinations of social support’s influence on behavior have focused on domainspecific support or support provided specifically for a singular behavior such as smoking cessation or weight loss These investigations found that domainspecific support was a significant and consistent predictor of positive behavior change 32 33 34 35 However the idea of domainspecific social support as a possible factor for reducing HIV risk behavior has rarely been examinedSexual behavior among gay men has been found to vary depending on partner type primary vs outside 4 36 37 38 39 and serostatus 40 41 For example studies show that rates of UAI increase when primary partners are concordant 42 43 however when primary partners are discordant studies show men making conscious choices about positioning for UAI 44 The presence of outside partners or sexual concurrency brings an additional layer of complexity to the possibility of HIV risk for gay couples as sexual behavior with outside partners can present potential HIV risk to both members of a couple 45 There is also evidence that while relationship characteristics such as intimacy and satisfaction may influence sexual behavior within the couple 43 sexual behavior with outside partners if permitted may not vary substantially from that of single men with their casual partners 46 Specifically Kuyper and colleagues reported that neither the type of sexual behavior with casual partners eg condom use nor the rate of STI diagnoses for men in relationships differed from single menThus previous research has examined aspects of gay relationships such as relationship quality satisfaction and the role of social support while other investigations have been conducted into psychosocial predictors of sexual risk behavior among gay men Fewer investigations have considered these aspects in tandem which could reveal whether psychosocial factors eg social support exert similar influences on sexual risk behavior among gay men in relationships Further there have been few examinations of samples of gay couples which represent all couple serostatus types concordant negative discordant concordant positive Gaps still remain in our knowledge regarding how primary partners influence sexual behavior with outside partners and whether this influence differs by couple serostatus

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