Relationship-based Motives for Making Sexual Agreements Ass - PowerPoint Presentation

Slide1

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, PhD1 Center for Research and Education on Gender and Sexuality,San Francisco State University2 Center for AIDS Prevention Studies, University of California - San FranciscoSlide2

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.Slide3

Significance of Motivations for

Sexual AgreementsUnderstand motivations behind agreementsIncorporate in future HIV prevention interventionsDevelop 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 HIVSlide4

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. Slide5

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 least one partner reported anal sex in past 3 months, not transgender.Slide6

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 (Mplus COMPLEX model type) Two factors extracted based on simple structure and interpretability of factor loadings Relationship Quality Enhancement Motive (RQEM) with 7 itemsSex-life Enhancement Motive (SLEM) with 2 itemsConfirmatory 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 = 0.82SLEM = 0.78Slide7

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 (Rusbult Investment Model Scale,1980)Sexual Satisfaction (Ritvo et al., 1997)Slide8

Data Analyses

RQEM and SLEM as predictorsGeneralized 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) testedAll models controlled for relationship length Slide9

Sample Characteristics (N=441)

 Couple-leveln%Relationship length(yrs) (mean, SD)

7.8

7.9

Couple

HIV-status

Seroconcordant

negative

336

76.2

Serodiscordant

105

23.8

Couple Race

Inter-racial

213

48.3

White, not of Hispanic Origin

183

41.5

Hispanic (Latino)

19

4.3

Black, not of Hispanic Origin

184.1 Asian/Pacific Islander81.8   Live Together34177.3

 Individual-leveln%Age(yrs) ( mean, SD)41.312.4 Education   High School / GED or less889.98 Some college/ Associate Degree27130.73 Bachelor’s Degree or more52359.21   Employment   Employed (full-time/ self-employed)54361.6 Employed part-time - less than 40 hours per week11312.8 Unemployed22625.6Slide10

Results: Sexual Risk

Both RQEM and SLEM showed significant interactions with agreement type. Note: All models controlled for relationship lengthOdds Ratio95% Confidence Intervalp-value

Monogamous:

RQEM

0.04

0.01,

0.26

0.001

SLEM

NS

Non-monogamous:

RQEM

0.63

0.42, 0.95

0.029SLEM1.671.21, 2.310.002Slide11

Results: Broken Agreements

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

Odds Ratio95% Confidence Interval

p-value

Monogamous:

RQEM

0.53

0.32. 0.89

0.016

SLEM

NS

Non-monogamous:

RQEM

NS

SLEM

NSSlide12

Results: Satisfaction

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

Estimate(B)95% Confidence Intervalp-value

Relationship Satisfaction:

RQEM

0.55

0.37,

0.73

<.001

SLEM

NS

Sexual Satisfaction:

RQEM

1.380.79, 1.96<.001

SLEMNSSlide13

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.Slide14

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.Slide15

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. Slide16

Thank you

Colleen Hoffchoff@sfsu.eduFunded by NIMH RO1 #MH065141 and NIMH R01 #MH075598