266949 Beyond UAI: The Need for Couple-Level Interventions to Reduce Substance Abuse Among Gay Men in Intimate Relationships

Monday, October 29, 2012 : 12:30 PM - 12:45 PM

Kirk Grisham, MPH(c) , Mailman School of Public Health, Columbia University, New York, NY
Patrick Wilson, PhD , Mailman School of Public Health, Columbia University, New York, NY
Anu Gomez, PhD, MSc , Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
Deepalika Chakravarty, MA , Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, NY
Torsten B. Neilands, PhD , Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
Chadwick Campbell, MPH , Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
Shari Dworkin, PhD, MS , Social and Behavioral Sciences and Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA
Colleen Comny Hoff, PhD , Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
Background: Substance use is a strong predictor of unprotected anal intercourse (UAI) among gay men. Substance abuse poses threats to psychological and physical well-being, housing, and employment, and increases vulnerability to HIV among HIV-negative men and reduces engagement in care among HIV-positive men. This study of gay couples explores substance abuse and its impacts on their primary romantic/sexual relationships.

Methods: Semi-structured, individual qualitative interviews were conducted with both members of 48 same-sex male couples in the San Francisco and New York metropolitan areas (n=96). We utilized purposive sampling to recruit and included Black (n=16), White (n=17) and interracial Black/White (n=15) couples. In each group, about half of couples were HIV-concordant-negative and half were serodiscordant. Grounded theory was used to guide coding and analysis.

Results: UAI was reported more often in couples where at least one partner abused substances, posing multiple health risks. Couples where one or both partners were abusing substances demonstrated poorer emotional and physical health and more often experienced poverty, homelessness, and sometimes incarceration. These findings were particularly pronounced among couples in which both partners had -or historically- abused substances.

Conclusions: Primary partners can enable substance abuse in relationships, however, enablement can be replaced by partner support to reduce and prevent substance abuse. Therefore, interventions for substance-abusing members of gay couples should target both partners to most effectively reduce HIV risk and enhance relationship stability, as well as consider structural factors that may inhibit the success of individual-level and even dyadic prevention approaches.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe barriers to individual–level substance abuse prevention/treatment for gay men in intimate relationships. Explain why HIV risk among gay male couples is associated with substance abuse beyond Unprotected Anal Intercourse(UAI). Identify associations of substance abuse and structural dynamics within gay-male couples.

Keywords: Gay Men, Substance Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Project Director of a multisite NIMH funded research project focusing on HIV risk and same-sex male couples (which provided data for this study). I am also a candidate for a Masters of Public Health at Columbia University. Among my scientific interests have been the exploration and analysis of current and developing HIV prevention interventions and research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.