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Published in: AIDS and Behavior 12/2018

01-12-2018 | Original Paper

The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples

Authors: Brian A. Feinstein, Emily Bettin, Gregory Swann, Kathryn Macapagal, Sarah W. Whitton, Michael E. Newcomb

Published in: AIDS and Behavior | Issue 12/2018

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Abstract

Young MSM are at increased risk for HIV, especially in the context of serious relationships, but there is a lack of couples-based HIV prevention for this population. The 2GETHER intervention—an HIV prevention and relationship education program for young male couples—demonstrated promising effects in a pilot trial. However, there is evidence that internalized stigma (IS) can influence treatment outcomes among MSM. The current study examined the influence of IS on the efficacy of the 2GETHER intervention among 57 young male couples. The intervention led to decreases in percentage of condomless anal sex partners and increases in subjective norms regarding HIV prevention for those with low/average IS, but not high IS. The intervention also led to increases in motivation to get tested with one’s partner and decreases in alcohol consumption for those with high IS, but not low/average IS. In contrast, IS did not moderate intervention effects on other motivational constructs, dyadic adjustment, or alcohol problems. In sum, IS influences the extent to which young male couples benefit from HIV prevention and relationship education depending on the outcome. Research is needed to understand how IS influences treatment outcomes.
Literature
3.
go back to reference Goodreau SM, Carnegie NB, Vittinghoff E, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.CrossRef Goodreau SM, Carnegie NB, Vittinghoff E, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.CrossRef
4.
go back to reference Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.CrossRef Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.CrossRef
5.
go back to reference Newcomb ME, Macapagal KR, Feinstein BA, Bettin E, Swann G, Whitton SW. Integrating HIV prevention and relationship education for young same-sex male couples: a pilot trial of the 2GETHER intervention. AIDS Behav. 2017;21(8):2464–78.CrossRef Newcomb ME, Macapagal KR, Feinstein BA, Bettin E, Swann G, Whitton SW. Integrating HIV prevention and relationship education for young same-sex male couples: a pilot trial of the 2GETHER intervention. AIDS Behav. 2017;21(8):2464–78.CrossRef
6.
go back to reference Millar BM, Wang K, Pachankis JE. The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. J Consult Clin Psychol. 2016;84(7):565–70.CrossRef Millar BM, Wang K, Pachankis JE. The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. J Consult Clin Psychol. 2016;84(7):565–70.CrossRef
7.
go back to reference Huebner DM, Davis MC, Nemeroff CJ, Aiken LS. The impact of internalized homophobia on HIV preventive interventions. Am J Community Psychol. 2002;30(3):327–48.CrossRef Huebner DM, Davis MC, Nemeroff CJ, Aiken LS. The impact of internalized homophobia on HIV preventive interventions. Am J Community Psychol. 2002;30(3):327–48.CrossRef
8.
go back to reference Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30(5):597–605.CrossRef Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30(5):597–605.CrossRef
9.
go back to reference Newcomb ME, Ryan DT, Garofalo R, Mustanski B. The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Arch Sex Behav. 2014;43(1):61–72.CrossRef Newcomb ME, Ryan DT, Garofalo R, Mustanski B. The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Arch Sex Behav. 2014;43(1):61–72.CrossRef
10.
go back to reference Perez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the P18 study. AIDS Educ Prev. 2015;27(2):112–25.CrossRef Perez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the P18 study. AIDS Educ Prev. 2015;27(2):112–25.CrossRef
11.
go back to reference Greene GJ, Andrews R, Kuper L, Mustanski B. Intimacy, monogamy, and condom problems drive unprotected sex among young men in serious relationships with other men: a mixed methods dyadic study. Arch Sex Behav. 2014;43(1):73–87.CrossRef Greene GJ, Andrews R, Kuper L, Mustanski B. Intimacy, monogamy, and condom problems drive unprotected sex among young men in serious relationships with other men: a mixed methods dyadic study. Arch Sex Behav. 2014;43(1):73–87.CrossRef
12.
go back to reference Mitchell JW, Petroll AE. Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sex Transm Dis. 2012;39(11):871–6.CrossRef Mitchell JW, Petroll AE. Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sex Transm Dis. 2012;39(11):871–6.CrossRef
13.
go back to reference Chakravarty D, Hoff CC, Neilands TB, Darbes LA. Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS Behav. 2012;16(7):1944–8.CrossRef Chakravarty D, Hoff CC, Neilands TB, Darbes LA. Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS Behav. 2012;16(7):1944–8.CrossRef
15.
go back to reference Grov C, Starks TJ, Rendina HJ, Parsons J. Rules about casual sex partners, relationship satisfaction, and HIV risk in partnered gay and bisexual men. J Sex Marital Ther. 2014;40(2):105–22.CrossRef Grov C, Starks TJ, Rendina HJ, Parsons J. Rules about casual sex partners, relationship satisfaction, and HIV risk in partnered gay and bisexual men. J Sex Marital Ther. 2014;40(2):105–22.CrossRef
16.
go back to reference Hoff CC, Beougher SC. Sexual agreements among gay male couples. Arch Sex Behav. 2010;39(3):774–87.CrossRef Hoff CC, Beougher SC. Sexual agreements among gay male couples. Arch Sex Behav. 2010;39(3):774–87.CrossRef
17.
go back to reference Hoff CC, Beougher SC, Chakravarty D, Darbes LA, Neilands TB. Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus. AIDS Care. 2010;22(7):827–35.CrossRef Hoff CC, Beougher SC, Chakravarty D, Darbes LA, Neilands TB. Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus. AIDS Care. 2010;22(7):827–35.CrossRef
18.
go back to reference Mitchell JW. Characteristics and allowed behaviors of gay male couples’ sexual agreements. J Sex Res. 2014;51(3):316–28.CrossRef Mitchell JW. Characteristics and allowed behaviors of gay male couples’ sexual agreements. J Sex Res. 2014;51(3):316–28.CrossRef
19.
go back to reference Parsons JT, Starks TJ. Drug use and sexual arrangements among gay couples: frequency, interdependence, and associations with sexual risk. Arch Sex Behav. 2014;43(1):89–98.CrossRef Parsons JT, Starks TJ. Drug use and sexual arrangements among gay couples: frequency, interdependence, and associations with sexual risk. Arch Sex Behav. 2014;43(1):89–98.CrossRef
20.
go back to reference Mustanski B, Newcomb M, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48(2–3):218–53.CrossRef Mustanski B, Newcomb M, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48(2–3):218–53.CrossRef
21.
go back to reference Jiwatram-Negron T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav. 2014;18(10):1864–87.CrossRef Jiwatram-Negron T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav. 2014;18(10):1864–87.CrossRef
22.
go back to reference Allen S, Meinzen-Derr J, Kautzman M, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40.CrossRef Allen S, Meinzen-Derr J, Kautzman M, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40.CrossRef
23.
go back to reference World Health Organization. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples. Geneva: WHO; 2012. World Health Organization. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples. Geneva: WHO; 2012.
24.
go back to reference Allen S, Tice J, Van de Perre P, et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 1992;304(6842):1605–9.CrossRef Allen S, Tice J, Van de Perre P, et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 1992;304(6842):1605–9.CrossRef
25.
go back to reference Wagenaar BH, Christiansen-Lindquist L, Khosropour C, et al. Willingness of US men who have sex with men (MSM) to participate in couples hiv voluntary counseling and testing (CVCT). PLoS ONE. 2012;7(8):e42953.CrossRef Wagenaar BH, Christiansen-Lindquist L, Khosropour C, et al. Willingness of US men who have sex with men (MSM) to participate in couples hiv voluntary counseling and testing (CVCT). PLoS ONE. 2012;7(8):e42953.CrossRef
26.
go back to reference Stephenson R, Sullivan PS, Salazar LF, Gratzer B, Allen S, Seelbach E. Attitudes towards couples-based HIV testing among MSM in three US cities. AIDS Behav. 2011;15(Suppl 1):S80–7.CrossRef Stephenson R, Sullivan PS, Salazar LF, Gratzer B, Allen S, Seelbach E. Attitudes towards couples-based HIV testing among MSM in three US cities. AIDS Behav. 2011;15(Suppl 1):S80–7.CrossRef
27.
go back to reference Wu E, El-Bassel N, McVinney LD, et al. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men. AIDS Behav. 2011;15(8):1745–54.CrossRef Wu E, El-Bassel N, McVinney LD, et al. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men. AIDS Behav. 2011;15(8):1745–54.CrossRef
28.
go back to reference Wu E, El-Bassel N, Donald McVinney L, Fontaine YM, Hess L. Adaptation of a couple-based HIV intervention for methamphetamine-involved African American men who have sex with men. Open AIDS J. 2010;4:123–31.CrossRef Wu E, El-Bassel N, Donald McVinney L, Fontaine YM, Hess L. Adaptation of a couple-based HIV intervention for methamphetamine-involved African American men who have sex with men. Open AIDS J. 2010;4:123–31.CrossRef
29.
go back to reference Newcomb ME, Mustanski B. Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Arch Sex Behav. 2011;40(1):189–99.CrossRef Newcomb ME, Mustanski B. Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Arch Sex Behav. 2011;40(1):189–99.CrossRef
30.
go back to reference Hatzenbuehler ML, Dovidio JF, Nolen-Hoeksema S, Phills CE. An implicit measure of anti-gay attitudes: prospective associations with emotion regulation strategies and psychological distress. J Exp Soc Psychol. 2009;45(6):1316–20.CrossRef Hatzenbuehler ML, Dovidio JF, Nolen-Hoeksema S, Phills CE. An implicit measure of anti-gay attitudes: prospective associations with emotion regulation strategies and psychological distress. J Exp Soc Psychol. 2009;45(6):1316–20.CrossRef
31.
go back to reference Hofmann W, Gawronski B, Gschwendner T, Le H, Schmitt M. A meta-analysis on the correlation between the implicit association test and explicit self-report measures. Pers Soc Psychol Bull. 2005;31(10):1369–85.CrossRef Hofmann W, Gawronski B, Gschwendner T, Le H, Schmitt M. A meta-analysis on the correlation between the implicit association test and explicit self-report measures. Pers Soc Psychol Bull. 2005;31(10):1369–85.CrossRef
32.
go back to reference Jellison WA, McConnell AR, Gabriel S. Implicit and explicit measures of sexual orientation attitudes: in group preferences and related behaviors and beliefs among gay and straight men. Pers Soc Psychol Bull. 2004;30(5):629–42.CrossRef Jellison WA, McConnell AR, Gabriel S. Implicit and explicit measures of sexual orientation attitudes: in group preferences and related behaviors and beliefs among gay and straight men. Pers Soc Psychol Bull. 2004;30(5):629–42.CrossRef
33.
go back to reference Safren S, Otto MW, Worth JL. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Pract. 1999;6(4):332–41.CrossRef Safren S, Otto MW, Worth JL. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Pract. 1999;6(4):332–41.CrossRef
34.
go back to reference Puckett JA, Newcomb ME, Ryan DT, Swann G, Garofalo R, Mustanski B. Internalized homophobia and perceived stigma: a validation study of stigma measures in a sample of young men who have sex with men. Sex Res Soc Policy. 2017;14(1):1–16.CrossRef Puckett JA, Newcomb ME, Ryan DT, Swann G, Garofalo R, Mustanski B. Internalized homophobia and perceived stigma: a validation study of stigma measures in a sample of young men who have sex with men. Sex Res Soc Policy. 2017;14(1):1–16.CrossRef
35.
go back to reference Nungesser LG. Homosexual acts, actors, and identities. New York: Praeger; 1983. Nungesser LG. Homosexual acts, actors, and identities. New York: Praeger; 1983.
36.
go back to reference Ramirez-Valles J, Kuhns LM, Campbell RT, Diaz RM. Social integration and health: community involvement, stigmatized identities, and sexual risk in Latino sexual minorities. J Health Soc Behav. 2010;51(1):30–47.CrossRef Ramirez-Valles J, Kuhns LM, Campbell RT, Diaz RM. Social integration and health: community involvement, stigmatized identities, and sexual risk in Latino sexual minorities. J Health Soc Behav. 2010;51(1):30–47.CrossRef
37.
go back to reference Shidlo A. Internalized homophobia: conceptual and empirical issues in measurement. In: Greene B, Herek GM, editors. Psychological perspectives on lesbian and gay issues. Thousand Oaks: Sage; 1994. p. 176–205. Shidlo A. Internalized homophobia: conceptual and empirical issues in measurement. In: Greene B, Herek GM, editors. Psychological perspectives on lesbian and gay issues. Thousand Oaks: Sage; 1994. p. 176–205.
38.
go back to reference Mustanski B, Starks T, Newcomb ME. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43(1):21–33.CrossRef Mustanski B, Starks T, Newcomb ME. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43(1):21–33.CrossRef
39.
go back to reference Misovich SJ, Fisher WA, Fisher JD. A measure of AIDS prevention information, motivation, behavioral skills, and behavior. In: Davis C, Yarber R, Bauserman R, et al., editors. Handbook of sexuality-related measures. Thousand Oaks: SAGE; 1998. p. 328–37. Misovich SJ, Fisher WA, Fisher JD. A measure of AIDS prevention information, motivation, behavioral skills, and behavior. In: Davis C, Yarber R, Bauserman R, et al., editors. Handbook of sexuality-related measures. Thousand Oaks: SAGE; 1998. p. 328–37.
40.
go back to reference Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38(1):15–28.CrossRef Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38(1):15–28.CrossRef
41.
go back to reference Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.CrossRef Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.CrossRef
42.
go back to reference Sanchez FJ, Westefeld JS, Liu WM, Vilain E. Masculine gender role conflict and negative feelings about being gay. Prof Psychol Res Pr. 2010;41(2):104–11.CrossRef Sanchez FJ, Westefeld JS, Liu WM, Vilain E. Masculine gender role conflict and negative feelings about being gay. Prof Psychol Res Pr. 2010;41(2):104–11.CrossRef
43.
go back to reference Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385–401.CrossRef Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385–401.CrossRef
44.
go back to reference Rudman LA. Sources of implicit attitudes. Curr Dir Psychol Sci. 2004;13(2):80–3.CrossRef Rudman LA. Sources of implicit attitudes. Curr Dir Psychol Sci. 2004;13(2):80–3.CrossRef
45.
go back to reference Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRef Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRef
46.
go back to reference Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, Parsons JT. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol. 2015;83(5):875–89.CrossRef Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, Parsons JT. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol. 2015;83(5):875–89.CrossRef
47.
go back to reference Whitton SW, Weitbrecht EM, Kuryluk AD, Hutsell DW. A randomized waitlist-controlled trial of culturally sensitive relationship education for male same-sex couples. J Fam Psychol. 2016;30(6):763–8.CrossRef Whitton SW, Weitbrecht EM, Kuryluk AD, Hutsell DW. A randomized waitlist-controlled trial of culturally sensitive relationship education for male same-sex couples. J Fam Psychol. 2016;30(6):763–8.CrossRef
48.
go back to reference Cao H, Zhou N, Fine M, Liang Y, Li J, Mills-Koonce WR. Sexual minority stress and same-sex relationship well-being: a meta-analysis of research prior to the U.S. nationwide legalization of same-sex marriage. J Marriage Fam. 2017;79(5):1258–77.CrossRef Cao H, Zhou N, Fine M, Liang Y, Li J, Mills-Koonce WR. Sexual minority stress and same-sex relationship well-being: a meta-analysis of research prior to the U.S. nationwide legalization of same-sex marriage. J Marriage Fam. 2017;79(5):1258–77.CrossRef
49.
go back to reference Nosek BA, Hawkins CB, Frazier RS. Implicit social cognition: from measures to mechanisms. Trends Cogn Sci. 2011;15(4):152–9.CrossRef Nosek BA, Hawkins CB, Frazier RS. Implicit social cognition: from measures to mechanisms. Trends Cogn Sci. 2011;15(4):152–9.CrossRef
50.
go back to reference Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the implicit association test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17–41.CrossRef Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the implicit association test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17–41.CrossRef
Metadata
Title
The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples
Authors
Brian A. Feinstein
Emily Bettin
Gregory Swann
Kathryn Macapagal
Sarah W. Whitton
Michael E. Newcomb
Publication date
01-12-2018
Publisher
Springer US
Published in
AIDS and Behavior / Issue 12/2018
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-018-2093-6

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