Online Feasibility Study about HIV-Negative Male Couples' Use of Substances with Weekly Ecological Momentary Diary Assessments

Introduction: Despite between one- and two- thirds of MSM acquire HIV from their main relationship partners, and the role that substance use plays in HIV seroconversion, little is known about male couples' substance use.

Methods: We conducted an Internet-based feasibility study to assess whether panel dyadic data could be collected online from substance-using, concordant HIV-negative male couples in the US. A longitudinal study design paired with a modified ecological momentary assessment of weekly electronic diaries was used to examine male couples use of substances with and without sex over a period of six weeks and the context in which they had used substances. Targeted facebook advertisements were used to recruit partnered gay men and their main relationship partners; a partner referral system was also used to invite eligible participants’ main partners to the study. In 24 hours, a total of 531 men took the screener and 97 men were eligible to enroll into the study based on these criteria: 18 years of age and older; lived in the US; been in their current relationship at least 3 months; never used condoms for anal sex with their main partner; self-reported currently being in an HIV-negative relationship; used substances with sex within the prior three months.

Results: Although 23 male couples with both partners and 51 male couples with only one partner were eligible and provided consent, enrollment and participation in the study consisted of 13 male couples (n=26) with both partners and 15 male couples with only one partner (n=15). The 41 partnered gay men completed 6 electronic weekly diaries that contained quantitative and qualitative responses about their use of substances. Over the 6-week period, men’s frequencies, alcohol consumption (lite and heavy), and use of marijuana, cocaine, methamphetamines, club drugs, erectile dysfunction medication (EDM), and/or prescription pain medications varied greatly. Using condoms for anal sex with the main partner rarely occurred whereas engagement in unprotected anal sex varied from none to occurring almost daily for the men and couples. Men’s use of marijuana and consumption of alcohol were frequent events compared to methamphetamines, EDM, and prescription pain medications. Among the 13 male couples with both partners participating, men’s frequency of using marijuana and lite alcohol were highly similar to their main partners whereas more variability between partners was noted for heavy alcohol consumption. Inter-relationship comparisons could not be made for the other substances because most who used them were among the male couples with only one partner who participated in the study.

Conclusions: Findings from this pilot study indicate dyadic data collection about male couples substance use is feasible with caution. Additional resources may help bolster enrollment and follow-up. Our findings also highlight the need for further inquiry to elucidate how partners’ influence one another’s use of substances with and without sex and under what context(s). These results and suggestions for future research are applicable for development of future HIV and substance use prevention interventions for at-risk male couples, of which, few currently exist.