Young Men's Relationships: Opportunities for HIV Prevention

Introduction: HIV rates among young men who have sex with men (YMSM) have increased over the last several years as other subgroups’ HIV prevalence has decreased.   Research indicates that the majority of HIV transmissions occur within primary partner relationships, not casual encounters as was once believed.  Research estimating the prevalence of intimate partner violence (IPV) in MSM relationships indicates rates similar to heterosexual women, ranging from 12% to 51%, depending on type of abuse, sampling techniques, and measurement of IPV.  IPV among MSM and YMSM has been linked to substance use, HIV risk behaviors and mental health issues. In spite of the fact that IPV has been described as the third most significant health problem experienced by MSM, just after HIV/AIDS and substance abuse, research is limited. However, no evidence-based prevention interventions exist to address IPV in same-sex relationships. 

Methods: To develop a conceptual and theoretical framework for a culturally and developmentally relevant IPV intervention with YMSM, a mixed-methods pilot study was designed.  An ACASI survey was administered to 100 YMSM ages 18-25 who reported being involved in a primary partner relationship in the past year.  A total of 12 focus groups were convened with these same YMSM and one-on-one qualitative interviews were completed with a total of 26 YMSM who reported experiencing one or more forms of IPV based on responses to the ACASI survey.

Results: Survey data report high levels of involvement in IPV (e.g., 25% report injuries from fights with partners and 24% reported their partners had injuries as a result of a fight; 9% had partners who used threats for sexual intimidation). Qualitative data indicate that some aspects of IPV may be unique to MSM/YMSM relationships such as: 1) the conceptualizations of power dynamics (e.g., age, income, self-esteem, sexual positioning); 2) views of IPV in same-sex relationships (e.g., acceptability, normalization); 3) perceptions of YMSM relationships (e.g., lack of long-term commitment, instability); 4) mutual perpetration (e.g., respondents being both victim and perpetrator) and 5) internalized homophobia (e.g., negative perception of other MSM, dating YMSM who are not “out”).  These issues need to be integrated into any IPV prevention intervention with this vulnerable population. 

Conclusions:  Given the lack of prevention for IPV in YMSM relationships, this pilot study was designed to identify prevention targets for a newly developed/adapted curriculum.  HIV prevention may be best addressed through couple-level interventions given the high rate of HIV transmission between intimate partners.  Thus, HIV prevention interventions that integrate HIV education and developing healthy relationship dynamics may be a new avenue for addressing the HIV epidemic in this vulnerable population.