HPV positivity status in males is related to the acquisition of HPV infection in females in heterosexual couples.

PURPOSE: Few studies have focused on the impact of human papillomavirus (HPV) positivity in male partners on female HPV infection and cervical lesions. The purpose of this study was to evaluate the impact of the HPV infection status of husbands on wives' cervical HPV infection and lesions. METHODS: We surveyed 251 monogamous couples who attended the outpatient department of Fujian Maternity and Child Health Hospital from 2013 to 2021. HPV type analysis was performed on exfoliated cells of the females' cervix and males' urethra by the PCR-reverse dot blot method. We analyzed the prevalence and consistency of HPV types in 251 couples. Subsequently, the risk of HPV infection in females with HPV-positive male partners was analyzed. SPSS version 26 (IBM, Chicago, USA) was used for statistical analysis. RESULTS: In 251 couples, the most commonly detected high-risk HPV (HR-HPV) genotypes were 52, 51, 16, and 58 for males and 16, 52, 18, and 58 for females. Wives with HPV-positive husbands had higher infection rates for most HR-HPV genotypes. HR-HPV positivity in husbands was a risk factor for the development of cervical lesions in wives (OR = 2.250, P = 0.014). Both single-type (OR = 2.085, P = 0.040) and multiple-type (OR = 2.751, P = 0.036) infection in husbands will contributed to an increased risk of non-HR-HPV infection and cervical lesions in wives. CONCLUSION: Husbands' HPV positivity increases the burden of non-HR-HPV infection and increases the risk of cervical lesions developing in wives. It is hoped to provide a reference value for cervical cancer prevention in females and HPV vaccination in males.

Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence.

INTRODUCTION: HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. METHODS: Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. RESULTS: Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (ß = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (ß = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. CONCLUSIONS: Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.

Relationship satisfaction in Black heterosexual couples: The role of self-compassion and openness.

The study examined how Black heterosexual couples cope with the impact of racial discrimination on their relationship. The Vulnerability Stress Adaptation (VSA) model was utilized to examine the role of self-compassion in mitigating negative interaction in the relationship and how racial discrimination might disrupt this protective process. Further, the influence of open communication on the relationship between negative interaction and overall relationship satisfaction was explored. Participants included 210 Black married heterosexual couples. A common-fate moderated mediation model was used to analyze the data. The results indicated that first, higher levels of self-compassion in both spouses were associated with lower negative interaction within the couple's relationship. Second, among wives, the relationship between self-compassion and negative interaction changed in response to higher levels of racial discrimination. Third, couples' negative interaction suppressed the positive effects of self-compassion on overall relationship satisfaction. Fourth, for wives, the level of open communication played a role in the relationship between negative interaction and relationship satisfaction. Fifth, specifically for wives, the extent to which self-compassion was related to relationship satisfaction through negative interaction depended on the level of discrimination perceived by wives and the degree of open communication in their relationships. The findings have implications for clinical work and further research.

Victimization and Perception of Abuse in Adolescent and Young Homosexual and Heterosexual Couples in Spain.

Currently, violence in adolescent and young couples has a significant social impact on young people's physical and psychological health. However, the study of violence in homosexual couples must also be addressed. This research analyzes the levels of violent victimization and the perception of abuse in both homosexual and heterosexual couples. Participants' ages ranged between 14 and 29 years (M = 20.14, SD = 3.464). We used The Dating Violence Questionnaire-Revised (CUIVNO-R), which was applied in two consecutive studies. The results indicate high levels of victimization, especially in the sample of homosexual participants. The scores generally show a low perception of couple violence but high victimization rates. The results of this study reveal the importance of the issue of violence in couples from minority groups and suggest that couple violence should not be understood as unidirectional, i.e., exclusively from men to women. These findings show the need for education in healthy relationships and consideration of different types of couples in these relationships.

"It's all my fault": a qualitative study of how heterosexual couples experience living with vulvodynia.

INTRODUCTION: Vulvodynia, a chronic genital pain disorder with a high lifetime prevalence among women, has a significant negative impact on both women and their partners. Although there is a growing body of literature on the experiences of women with vulvodynia, there has been little research on the condition's implications for partners and romantic relationships. The aim of this study is to explore how heterosexual couples experience living with vulvodynia. MATERIAL AND METHODS: Eight Norwegian women diagnosed with vulvodynia by gynecologists were recruited with their partners (couples aged 19-32 years). Data was collected via individual semi-structured interviews and analyzed using inductive thematic analysis. RESULTS: Three main themes were identified in the analysis: Mysterious disorder, Social exclusion and Sexual expectations. The results show that the couples struggle with understanding the pain, as well as navigating their social and sexual lives. We discuss these findings in light of a new theoretical model: the fear-avoidance-endurance model of vulvodynia. CONCLUSIONS: Heterosexual couples living with vulvodynia experience communication difficulties with partners, health professionals, and their social network. This sustains avoidance and endurance behavior, increasing pain and dysfunction over time and giving rise to feelings of powerlessness and loneliness. Social expectations regarding male and female sexuality also promote guilt and shame for both parties in couples affected by vulvodynia. Our results suggest that heterosexual couples living with vulvodynia, as well as health professionals treating them, should be helped to communicate more effectively in order to break vicious circles of maladaptive avoidance and endurance behavior.

Strategies to increase couples HIV testing and counselling in sub-Saharan Africa: a systematic review.

INTRODUCTION: Couple HIV testing and counselling (CHTC) is associated with measurable benefits for HIV prevention and treatment. However, the uptake remains limited in much of sub-Saharan Africa, despite an expanded range of strategies designed to promote access. METHODS: Following PRIMSA guidelines, we conducted a systematic review to characterize CHTC uptake strategies. Five databases were searched. Full-text articles were included if they were: conducted in sub-Saharan Africa during the study period (1980-2019), targeted heterosexual couples, reported at least one strategy to promote CHTC and provided a quantifiable measure of CHTC uptake. After the initial and full-text screening, key features of the studies were abstracted and synthesized. RESULTS: Of the 6188 unique records found in our search, 365 underwent full-text review with 29 distinct studies included and synthesized. Most studies recruited couples through antenatal care (n = 11) or community venues (n = 8) and used provider-based HIV testing (n = 25). The primary demand creation strategies included home-based CHTC (n = 7); integration of CHTC into clinical settings (n = 4); distribution of HIV self-testing kits (n = 4); verbal or written invitations (n = 4); community recruiters (n = 3); partner tracing (n = 2); relationship counselling (n = 2); financial incentives (n = 1); group education with CHTC coupons (n = 1); and HIV testing at other community venues (n = 1). CHTC uptake ranged from negligible to nearly universal. DISCUSSION: We thematically categorized a diverse range of strategies with varying levels of intensity and resources used across sub-Saharan Africa to promote CHTC. Offering CHTC within couples' homes was the most common approach, followed by the integration of CHTC into clinical settings. Due to heterogeneity in study characteristics, we were unable to compare the effectiveness across studies, but several trends were observed, including the high prevalence of CHTC promotion strategies in antenatal settings and the promising effects of home-based CHTC, distribution of HIV self-tests and integration of CHTC into routine health services. Since 2019, an updated literature search found that combining partner notification and secondary distribution of HIV self-test kits may be an additionally effective CHTC strategy. CONCLUSIONS: There are many effective, feasible and scalable approaches to promote CHTC that should be considered by national programmes according to local needs, cultural context and available resources.

Genital HPV Prevalence, Follow-Up and Persistence in Males and HPV Concordance Between Heterosexual Couples in Wenzhou, China.

Purpose: This study aimed to investigate male HPV infection, re-examination rate, clearance rate and relevant influencing factors as well as HPV infection between heterosexual partners in Wenzhou, China. Methods: The study enrolled 2359 men who accepted ≥1 HPV detection in the First Affiliated Hospital of Wenzhou Medical University between June 2014 and June 2020. An outpatient follow-up was carried out for collecting HPV re-test results among males who were tested HPV positive. In addition, we collected female sexual partners' HPV infection state through outpatient information system or telephone call. For males who had not re-tested HPV more than half a year after the first HPV positive result, a telephone follow-up would be provided. Results: Male HPV prevalence was 39.39% (928/2359) at baseline, of which the median age was 38.00 years. The percentage of co-infection and HR HPV infection was 35.24% (327/928) and 61.08% (874/1431). Genotype-specific concordance of HPV infection among heterosexual partners was 61.19% (123/201). The most common types were HPV6, HPV52, HPV16, HPV53, HPV11, HPV43 and HPV58. Percentage of males finishing HPV re-examination was low (40.09%). Infection with HR HPV, discomfort or HPV-related diseases and sexual partners with HPV infection were possible motivator for male HPV re-test. The medium time to male HPV clearance was 300.000 (95% CI=274.845-325.155) days. Infection with HR HPV, sexual partners with HPV infection and growth of age might prolong HPV persistence time included. Conclusion: Males are susceptible population for genital HPV infection as well as females. Whereas, males are generally less aware of HPV and its influence on their couples. The study showed that male HPV testing as well as the role of males in the diagnosis and treatment of HPV-associated cervical diseases for females should be popularized and co-treatment of couples was necessary.

Couple-level determinants of syphilis infection among heterosexual married couples of reproductive age in Guangdong Province, China: A population-based cross-sectional study.

Background: Syphilis remains a major public health problem worldwide, and its prevention requires knowledge of factors that go beyond the individual-level. However, most syphilis-related studies have focused on individual-level and regional-level factors, neglecting couple-level factors. Thus, this study aimed to explore couple-level determinants of syphilis infection among heterosexual married couples. Methods: This population-based cross-sectional study used data from heterosexual married couples who participated in the National Free Preconception Health Examination Project in Guangdong Province, China during 2014-2019. The syphilis infection was tested by the rapid plasma reagin test. Couple-level data were obtained by combining information provided by the man and woman living in the same household. Multivariate logistic models were employed to explore the couple-level determinants of syphilis infection by gender after adjusting for potential confounders. Results: A total of 1,755,156 couples were recruited in this analysis. The seroprevalence was 0.25% (95%CI: 0.24-0.25%) and 0.26% (95%CI: 0.25-0.27%) among men and women, respectively. The median age was 28.0 (interquartile range, IQR: 25.0-31.0) years, and the median duration of marriage was 0.2 (IQR: 0.0-2.5) years. After adjusting for individual and regional-level variables, duration of marriage was a protective factor for syphilis infection in men (adjusted odds ratios, AOR: 0.97; 95% CI: 0.96-0.98) and women (AOR: 0.95, 95% CI: 0.94-0.96). The age gap and the difference in education level between the husband and wife were associated with syphilis infection, but these associations were somewhat different between men and women. Condom use was negatively associated with syphilis infection in men (AOR: 0.77; 95% CI: 0.70-0.84) and women (AOR: 0.77, 95% CI: 0.71-0.84). Our results also showed that couple mobility and the number of children were not statistically significant determinants of syphilis infection among heterosexual married couples. Conclusion: This study contributes to a more comprehensive understanding of syphilis outcomes in individuals in the context of marriage in China. Several couple-level factors are indeed associated with syphilis infection, but these associations differ between men and women. Couple-based strategies that engage both women and men and efforts to promote condom use among heterosexual married couples need to be developed and further evaluated for syphilis prevention.

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, "Strengthening Our Vows": Study protocol and baseline data.

BACKGROUND: Heterosexual couples contribute to most new HIV infections in areas of generalized HIV epidemics in sub-Saharan Africa. After Couples' Voluntary HIV Counseling and Testing (CVCT), heterosexual concordant HIV negative couples (CNC) in cohabiting unions contribute to approximately 47% of residual new infections in couples. These infections are attributed to concurrent sexual partners, a key driver of the HIV epidemic in Zambia. METHODS/DESIGN: Ten Zambian government clinics in two of the largest cities were randomized in matched pairs to a Strengthening Our Vows (SOV) intervention or a Good Health Package (GHP) comparison arm. SOV addressed preventing HIV infection from concurrent partners and protecting spouses after exposures outside the relationship. GHP focused on handwashing; water chlorination; household deworming; and screening for hypertension, diabetes and schistosomiasis. CNC were referred from CVCT services in government clinics. Follow-up includes post-intervention questionnaires and outcome assessments through 60 months. Longitudinal outcomes of interest include self-report and laboratory markers of condomless sex with outside partners and reported sexual agreements. We present baseline characteristics and factors associated with study arm and reported risk using descriptive statistics. RESULTS: The mean age of men was 32 and 26 for women. On average, couples cohabited for 6 years and had 2 children. Baseline analyses demonstrated some failures of randomization by study arm which will be considered in future primary analyses of longitudinal data. An HIV/STI risk factor composite was not different in the two study arms. Almost one-quarter of couples had an HIV risk factor at baseline. DISCUSSION: In preparation for future biomedical and behavioral interventions in sub-Saharan Africa, it is critical to understand and decrease HIV risk within CNC.

Efficient Brain Connectivity Reconfiguration Predicts Higher Marital Quality and Lower Depression.

Social-information processing is important for successful romantic relationships and protecting against depression, and depends on functional connectivity (FC) within and between large-scale networks. Functional architecture evident at rest is adaptively reconfigured during task and there were two possible associations between brain reconfiguration and behavioral performance during neurocognitive tasks (efficiency effect and distraction-based effect). This study examined relationships between brain reconfiguration during social-information processing and relationship-specific and more general social outcomes in marriage. Resting-state FC was compared with FC during social-information processing (watching relationship-specific and general emotional stimuli) of 29 heterosexual couples, and the FC similarity (reconfiguration efficiency) was examined in relation to marital quality and depression 13 months later. The results indicated wives' reconfiguration efficiency (globally and in visual association network) during relationship-specific stimuli processing was related to their own marital quality. Higher reconfiguration efficiency (globally and in medial frontal, frontal-parietal, default mode, motor/sensory and salience networks) in wives during general emotional stimuli processing was related to their lower depression. These findings suggest efficiency effects on social outcomes during social cognition, especially among married women. The efficiency effects on relationship-specific and more general outcome are respectively higher during relationship-specific stimuli or general emotional stimuli processing.

A Qualitative Investigation of Facilitators to Black and Latino Adolescent and Young Adults' Participation in a Couple-Based HIV Prevention Study.

PURPOSE: Recruitment and retention of adolescents and young adults (AYAs) in couple-based HIV prevention research can be difficult. This study's primary objective is to identify factors that influenced Black and Latino AYAs to participate in couple-based HIV/STI prevention research. DESIGN: In-depth, semi-structured qualitative interviews. SETTING: Face-to-face interviews with couples recruited from the South Bronx, New York. PARTICIPANTS: Twenty-three heterosexual couples (46 individuals) aged 16-28 (M = 20.1, SD = 3.01). METHODS: Participants completed 60 to 90-minute individual and dyadic interviews. All interviews were audio-recorded and transcribed. Thematic analysis was conducted to identify key themes. RESULTS: Two levels of influence emerged from participants' interviews regarding their reasons for study participation: 1) individual factors (interest in the study topic, study incentives, opportunity to help their community, and opportunity to learn something new), 2) interpersonal factors (positive interactions with the research team, partner's desire to participate and relationship strengthening). There were key differences by gender and recruitment order. CONCLUSION: Black and Latino AYAs report multiple reasons for participating in couple-based research. Highlighting the benefits of study participation to themselves, their relationships, and their communities may be an important strategy for engaging AYAs in couple-based research.

Dyadic Invariance of the Positive Sexuality Scale in Chilean Heterosexual Couples.

Gender differences in sexuality-related dimensions have long been investigated in close relationship research. An important assumption when comparing values across gender in dyadic research is that both partners conceptualize the construct under investigation in the same way. Thus, issues of measurement invariance should be considered when working with dyadic data. The aim of the present study was to test the dyadic invariance of the Positive Sexuality Scale (PSS) to assess an individual's sense of happiness and fulfillment with his/her sexual expression. The PSS was completed by 166 Chilean heterosexual couples, and measurement invariance was tested using confirmatory factor analysis within a dyadic framework. Configural, metric, scalar, and partial strict measurement invariance were supported for the PSS original one-factor model. No between-partner difference was found in the PSS latent factor mean. The functioning of the PSS and the meaning attributed to positive sexuality were the same for both partners. Hence, variations in the PSS levels between both partners in heterosexual couples can be interpreted as true mean differences rather than measurement artifacts.

Links among Ambivalent sexism, Gender Role Ideology and domestic and care work in Argentinian households

Abstract The present empirical study inquires on the relations among sexism, gender role ideology and domestic and care work in heterosexual women who share a home with their couples and at least one child, in CABA and GBA (Argentina) in 2019. Two previously existent (Moya, Expósito & Padilla, 2006; Glick & Fiske, 1996) and validated in Argentina scales were used, and a new scale for measuring domestic and care activities was created. A correlational and transversal study with a quantitative approach was carried out, and the data was recollected through an auto-administrated evaluation instrument sent by Facebook and Whatsapp social media. The sample includes 437 cases. Regarding the constructed scale, reliability, exploratory and confirmatory analysis were performed. Additionally, a moderate positive correlation among the dependent and independent variables was identified. It is possible to suggest that the hypothesis presented in this study is partially corroborated, that is, that the domestic and care work type of division is explained by the level of adhesion to the Gender Role Ideology.

Resumen El presente estudio empírico indaga respecto a las relaciones entre el sexismo, la adhesión a la ideología del rol de género y la división del trabajo doméstico y de cuidados en mujeres heterosexuales que viven en pareja y tienen al menos une hije compartiendo el mismo hogar, en CABA y GBA (Argentina) en 2019. Se utilizaron dos escalas existentes (Moya, Expósito y Padilla, 2006; Glick y Fiske, 1996) previamente validadas en Argentina, y se construyó una escala nueva para medir las tareas domésticas y de cuidado. Se realizó un estudio correlacional de corte transversal con un abordaje cuantitativo y los datos fueron recolectados a través de un instrumento de evaluación de índole autoadministrable mediante las redes sociales Facebook y Whatsapp. La muestra estuvo compuesta por 437 casos. Se realizaron los correspondientes análisis de fiabilidad, exploratorio y confirmatorio para la escala construida. Asimismo, se identificó una correlación positiva moderada entre la variable dependiente y las variables independientes. Es posible sugerir que se corrobora parcialmente la hipótesis planteada en este trabajo, es decir, que el tipo de división del trabajo doméstico y de cuidados se explica por el nivel de adhesión a la ideología del rol de género.

Sero-risk neutral and sero-risk averse: perceptions of risk and condom use among Black African heterosexual migrant couples in serodiscordant relationships in the UK.

This paper explores how perceptions of risk of infecting HIV-negative partners influence condom use among Black African heterosexual couples in stable relationships with one partner living with HIV (serodiscordant relationships). Twenty-five in-depth couple and individual interviews were analysed through phenomenological reflection and writing. A major finding was that in attempts to preserve their relationships, couples debated condom use strategies based on their perceptions of risk of infecting HIV-negative partners. We recommend that HIV prevention information among Black African heterosexual couples with a partner living with HIV should be understood from the perceptions of risk from both partners.

Directionality of Genital Human Papillomavirus Infection Transmission Within Heterosexual Couples: A Systematic Review and Meta-analysis.

BACKGROUND: Limited evidence indicates greater female-to-male (F-M) transmission of genital infection with human papillomavirus (HPV) relative to male-to-female (M-F). We verified the hypothesis of a differential transmission rate in couple-based studies by conducting a systematic review and meta-analysis. METHODS: We searched MEDLINE, EMBASE, Scopus, and Cochrane Library databases for studies published until December 2019. We calculated pooled estimates of F-M and M-F transmission rates and their rate differences per 100 person-months, with 95% confidence intervals (CI), using a random-effects model. We counted occurrences of directionality preponderance for each HPV type. RESULTS: We identified 7 eligible studies published between 2008 and 2019, providing data for 752 couples. Pooled estimates for F-M and M-F transmission rates were 3.01 (95% CI, 1.19-7.64; I2 = 97%) and 1.60 (95% CI, 0.86-2.98; I2 = 89%), respectively. The overall rate difference was 0.61 (95% CI, -0.27 to 1.49; I2 = 75%). Three studies provided rates by sex and HPV genotype; 2 favored a preponderance of F-M and 1 favored M-F transmission. CONCLUSIONS: There was slight evidence for a differential transmission rate favoring higher F-M than M-F transmission with substantial statistical heterogeneity across studies.

HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis.

INTRODUCTION: High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub-Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. METHODS: We followed adults (≥15 years old) using a population-based, longitudinal and open surveillance system in KwaZulu-Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual-based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV-positive or HIV-negative partners by participants' own time-varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. RESULTS: A total of 18,341 HIV-negative and 11,361 HIV-positive individuals contributed 154,469 person-years (PY) of follow-up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV-positive seroconcordant (i.e. both individuals in the partnership were HIV-positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV-positive, 1.12/1000PY with HIV-negative and 2.65/1000PY with unknown serostatus partners. HIV-positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV-positive partner than did HIV-negative individuals after adjusting for age, opposite-sex HIV prevalence (by 5-years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV-negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV-negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). CONCLUSIONS: A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.

Individual and Relationship Predictors of Couple-Level Sexual Concurrency in Heterosexual South African Couples.

One of the major goals of couple-based HIV prevention programs in sub-Saharan Africa is to reduce outside sex partners, known as sexual concurrency. This cross-sectional study examined sexual concurrency at the couple-level and differentiated couples based on whether neither, one, or both partners engaged in sexual concurrency over the past 6 months. Individual predictors (alcohol use and lifetime history of physical or sexual trauma) and relationship predictors (mistrust, relationship inequity, relationship satisfaction, and sexual satisfaction) were used as predictors of couple-level sexual concurrency. A quantitative investigation using path analysis was carried out with data collected from 286 South African heterosexual couples. Results showed that alcohol use for both sexes, relationship dissatisfaction for women, and mistrust among women were predictive of different types of sexual concurrency. Findings suggest that consideration of the experiences and behavior of both partners may be useful in understanding different reasons for engagement in sexual concurrency.

A Dyadic Investigation of Relationship Dynamics and Depressive Symptoms in HIV-Affected Couples in Malawi.

Depression is the leading cause of disability worldwide with health implications for people living with HIV. Primary partnerships like marriage could be protective against depression but may worsen depression depending on the relationship quality. We examined depression and its association with relationship dynamics in a cross-sectional sample of 211 HIV-affected married couples in Malawi. We fit multivariable multilevel linear regression models for depressive symptoms. Men and women reported similar levels of depressive symptoms; 28% had a score indicative of probable depression. Almost half of couples had at least one partner with probable depression. In the adjusted models, equality (B = - 0.22; p < 0.01) and unity (B = - 0.94; p < 0.05) were associated with fewer depressive symptoms while individuals with more experiences of physical (B = 0.81; p < 0.01), sexual (B = 0.87; p < 0.01), and emotional violence (B = 1.52; p < 0.001) had higher levels of depressive symptoms. Couples-based interventions aiming to improve relationships may address depression, especially in settings with inadequate mental health services.

Parents' relationship with their surrogate in cross-border and domestic surrogacy arrangements: comparisons by sexual orientation and location.

OBJECTIVE: To study heterosexual and gay couples' relationship with their surrogate and their disclosure decisions when the surrogacy arrangement was completed domestically compared with internationally. DESIGN: Cross-sectional study. SETTING: Not applicable. PATIENT(S): Participants were 40 gay couples and 76 heterosexual couples who had domestic surrogacy in the United Kingdom (UK) (n = 38) or international surrogacy in the United States (n = 58) or Asia (20). Most (75%) of the children were aged <4 years. INTERVENTION(S): Online surveys containing open-ended and multiple-choice questions. MAIN OUTCOME MEASURE(S): Experiences of finding a surrogate, relationship with the surrogate, and disclosure to the child were examined among UK parents who had undergone surrogacy in the UK, United States, or India/Thailand. RESULT(S): Parents who had surrogacy in the UK and United States felt very involved in the pregnancy compared with those who had surrogacy in Asia. Couples whose surrogacy was completed in Asia were less likely to want contact with their surrogate after the birth and were also less likely to have any current contact with the surrogate. Parents who had surrogacy in the UK and United States described positive relationships with their surrogate. Gay couples intended to tell their child about surrogacy more than heterosexual couples. CONCLUSION(S): The specific country where couples conducted their surrogacy arrangement (i.e. United States, UK, or Thailand/India) was associated with how involved they were in the pregnancy and their contact with the surrogate over time. Limitations of the study include use of survey methodology and that the representativeness of the sample is not known.

The Dynamics of Partner Violence and Alcohol Use in Couples: Research Methods.

OBJECTIVE: This research team uses complexity science to gain a deeper understanding of daily dynamics of intimate partner violence (IPV). This report describes research methods for gathering daily information about patterns of partner violence and alcohol use from couples in near-real time, and addresses recruitment and retention, adherence to study protocol, data validity, and participant safety. METHODS: Researchers enrolled 20 heterosexual couples with violent relationships from a primary healthcare center. Every day for 8 weeks, participants telephoned an interactive voice response (IVR) system and responded to 33 survey questions assessing violence, alcohol use, and household environment. They also completed baseline and end-of-study surveys. RESULTS: Of 20 enrolled couples, 15 completed the study, providing 90% adherence to daily reporting. Participants reported verbal aggression on an average of 11-13 days over 8 weeks, and physical abuse on an average of 2-4 days. Alcohol use was modest and infrequent. Women and men differed in their reports of women's physical aggression. No reports of physical violence were correlated with social desirability. CONCLUSIONS: We demonstrated the feasibility of enrolling and engaging both women and men in daily longitudinal research about partner violence and described advantages of IVR in daily longitudinal research.