Some have argued that the lack of direct counseling with home-based testing may prevent MSM from (1) fully understanding the results, (2) adopting safer preventive strategies, and/or (3) successfully linking to care if newly HIV positive. In addition to CHTC, another HIV testing option is home-based HIV testing, which was approved by the US Food and Drug Administration in 2012. Additionally, promoting positive relationship dynamics has the potential to reduce couples’ risk for HIV, as increased trust, communication, commitment, and social support are shown to be associated with lower odds of breaking a sexual agreement, which can ultimately reduce unique HIV risks (eg, CAI) for the couple. Research regarding male couples’ sexual agreements has shown that men are less likely to practice concurrent condomless anal intercourse (CAI) if they value and commit to their agreement and if they perceive their main partner to be dependable and investing in the relationship. In CHTC, male couples discuss their sexual agreements, role-play with the counselor about how they would communicate about breaking their sexual agreement to their partner, and develop an HIV prevention plan based on their sexual agreement and couple HIV serostatus.
Sexual agreements are common among male couples. Sexual agreements refer to mutually understood rules between two partners that describe the kinds of sexual behavior that are allowed within and outside of their relationship. Ī critical aspect of CHTC involves discussing a couple’s sexual agreement. CHTC is now considered by the CDC to be an effective public health strategy and is currently being implemented in over 40 US states. Preliminary data also suggests that male couples receiving CHTC do not report increased levels of intimate partner violence (IPV) or relationship dissolution. Through the adaptation of CHTC and the high acceptability among MSM, preliminary data from MSM in three US cities-Atlanta, Chicago, and Seattle-demonstrate the readiness of US MSM to receive and use CHTC. During the CHTC session, the counselor learns about the couple’s relationship and provides tailored counseling and HIV prevention recommendations based on the characteristics of the couple’s relationship and their joint HIV status. The difference between CHTC and individual HIV testing and counseling is that both partners of the male couple receive counseling and testing together at the same time. Labeled as a “high leverage HIV prevention intervention” by the US Centers for Disease Control and Prevention (CDC), CHTC is considered an effective approach to HIV prevention among male couples. ĬHTC has been used as an HIV prevention intervention for heterosexual couples in Africa for over 20 years. The Office of the US Global AIDS Coordinator, through dissemination of prevention guidelines for MSM in the President’s Emergency Plan for AIDS Relief-supported countries, now recommends couples HIV testing and counseling (CHTC) for male couples. In addition, relationships may convey a misplaced sense of protection, to some degree created by the historical prevention focus on reducing numbers of sexual partners among MSM. Recent 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 among male couples. Efforts have traditionally focused on MSM, in particular gay-identifying men, (1) as individuals versus dyads and (2) as having been the focus of messages about HIV risks, primarily in the context of casual sex. Given these estimates, a significant paradigm shift in HIV prevention is needed. Recent research has drawn attention to 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.
HIV prevalence remains high among men who have sex with men (MSM) in the United States.
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