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There are several examples of dyadic interventions that aim to address HIV risk among same-sex male couples. Couples HIV testing and counseling (CHTC), originally developed for heterosexual couples in sub-Saharan Africa, has been adapted for same-sex male couples, as a Centers for Disease Control and Prevention Public Health Strategy. There have been recent attempts to address this disproportionate focus on individualistic approaches to HIV prevention by focusing on the dyads and their relationship.
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Historically, HIV prevention efforts have focused on reducing the number of casual sex partners, indirectly messaging a false sense of protection associated with primary partners. Within the context of same-sex male couples’ relationships, various research findings have illustrated high rates of sexual risk behavior for HIV (with primary and casual partners), low rates of disclosure of potentially risky episodes with casual partners to primary partners, and reduced frequency of HIV testing. As a result of this individualistic approach, HIV prevention efforts have largely ignored the risk of HIV transmission that occurs within primary partnerships. Programmatic efforts have traditionally focused on men who have sex with men (MSM), in particular, gay-identifying men as individuals rather than dyads, with a focus on casual sex as a risk for HIV acquisition. Given these estimates, a significant paradigm shift in HIV prevention is needed. There is now substantial evidence for the role of male dyads in the US HIV epidemic, with primary partners identified as the source of approximately one-third to two-thirds of new HIV infections. Men with college education and those who labeled their relationships as husband or other (vs boyfriend) were more likely to have a partner who did not complete the survey. Men from the Midwest were less likely to have a partner who did not complete the survey. The likelihood of being in a matched couple varied significantly by race and ethnicity, region, and relationship type. Furthermore, 492/3826 (12.86%) individuals were fraudulent. Of the remaining 2740 ineligible participants, 1293/3826 (33.80%) were unlinked because their partner did not screen for eligibility, 48/2740 (1.75%) had incomplete partner data because at least one partner did not finish the survey, 22/2740 (0.80%) were ineligible because of 1 partner not meeting the eligibility criteria. Of the 4589 clicks, 3826 individuals were assessed for eligibility, of which 1076 individuals (538/1913, 28.12% couples) met eligibility criteria and were included in the study.
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