Testing the Partnership-Health Association among African American Men Who Have Sex with Men
Partnered individuals frequently report better psychological health and health behaviors than singletons. Few studies have examined this partnership-health association among African American men who have sex with men (AAMSM), even though such partnerships may differ meaningfully from other partnerships. We used t-tests on self-reported data among AAMSM (N=229) participating in an HIV-prevention intervention, to compare AAMSM with a primary male partner (n=147) to AAMSM with no primary male partner (n=82), on measures of psychosocial health and health behaviors. Partnered AAMSM reported less social isolation, fewer female sexual partners, and more drug use. Potential explanations of these mixed findings are discussed.
MSM, African American, AAMSM, Partnership, Health
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Decades of research indicate that partnered heterosexuals are psychologically, behaviorally, and physically healthier than are single heterosexuals (Horwitz et al., 1996; Robles & Keicolt-Glaser 2003; Ross & Mirowsky, 1990; Wilson & Oswald, 2002). In terms of psychological health, compared to single individuals, partnered individuals are less likely to be depressed (Rich-Edwards et al., 2006), distressed (Mills, Paul, Stall, et al., 2004), and to meet criteria for several mental health disorders (Helbig, Lampert, Klose, & Jacobi, 2006). Additionally, partnered individuals are less likely to engage in some health behaviors that relate to mortality, e.g. alcohol use (Leonard & Rothbard, 1999), smoking (Graham, Francis, Inskip, & Harman, 2006), and heavy substance use (Helbig et al., 2006). Partnership also relates to better chances of survival in the case of illness and disease (Atzema, Austin, Huynh, et al., 2011). These health differences have important implications for the lifespan. For example, in a longitudinal study tracking participants for many decades, of all participants alive at age 48, married men and women were 90% likely to live to age 65, compared to only 60% likelihood for single men and 80% for single women (Waite & Gallagher, 2000). Here we refer to the phenomenon of romantic partnership relating to positive health as the partnership-health association. There are a number of explanations for this phenomenon, including that partnership is protective of health (Rendall, Weden, Favreault, & Waldron, 2011), specifically via increased social support (Haas, 2002), intimacy (Rindfuss & Vanden Heuvel, 1990), and health-promotion (Anand, Du Bois, Sher, & Grotkowski, 2017).
Despite the enduring and robust nature of empirical support for the partnership-health association, we do not know if it applies to everyone, and if so, how strongly. This can be attributed partially to many studies of partnership and health, and other studies from which partnership and health findings are reported, comprising predominantly White, heterosexual participants— a group that can differ significantly from other, non-majority groups (Wood et al., 2007). For example, the Terman Life-Cycle Study of Children with High Ability is a longitudinal study tracking 1,200 individuals from childhood to adulthood. The study provides compelling and frequently-cited findings on the intergenerational effects of marriage on health (Terman, Sears, Cronbach, & Sears, 1995). Yet, the sample is relatively homogenous, specifically comprised of middle-class Whites. Such findings beg the question: To whom, specifically, does the partnership-health association apply? [End Page 34]
For at least two groups—African Americans, and men who have sex with men (MSM)— there is relatively scant evidence that the partnership-health association applies. There are two reasons for this: First, research regarding partnership and health is less common among these groups than other groups; and second, extant research has produced mixed findings when testing the partnership-health association in these groups. Regarding this second explanation: On average, African Americans prefer and expect to marry; and, report strong pro-marriage attitudes (Harknett & McLanahan, 2004). Nonetheless, African Americans may not experience the partnership-health association commensurate to others, for several reasons. Proportionally, African Americans may be partnered less, and when partnered, more likely to divorce, than other-race groups (Cherlin, 1998; U.S. Census Bureau, 2007). Therefore, the positive health associated with partnership may be experienced less often, and less enduringly, than for, e.g. Whites and Latinos. Moreover, when partnered, cultural factors may diminish some associated health gains among African Americans. These factors include relatively high rates of incarceration and joblessness, and lower wages, among African American males compared to White males (e.g. Western & Petit, 2005). African Americans also may report lower romantic relationship quality compared to Whites, due potentially to economic hardship that strains the relationship, or to disproportionate partner availability and the perception of better alternatives outside the current relationship (Trent & South, 2003). In turn, lower romantic relationship quality may explain the attenuated the partnership-health association in this population.
Similarly, it is questionable whether the partnership-health association applies to MSM. On one hand, both heterosexuals, and gay and bisexual men, report high levels of partner love and relationship satisfaction (Kurdek, 1998; Peplau & Fingerhut, 2007). And, partnered MSM have reported less distress and depression than single MSM (Mills et al., 2004). Simultaneously, serious relationships among MSM now serve as a primary venue for HIV-transmission (Sullivan, Salazar, Buchbinder, & Sanchez, 2009). Perhaps related, MSM engage in non-monogamous relationship arrangements more frequently than heterosexuals (LaSala, 2004). These arrangements may influence the partnership-health association in unique ways. For example, in a study comparing the health of single gay and bisexual men, to those in various relationship arrangements (monogamous, open, and monogamish—somewhat sexually open), researchers found some [End Page 35] advantages; some disadvantages; and, no group-level differences, across health outcomes (Parsons, Starks, Du Bois, et al., 2013). Overall, findings point to further research being warranted among MSM to explore the partnership-health association.
African American men who have sex with men (AAMSM) represent the intersection of the above two groups. Given that evidence for the partnership-health association is mixed for African Americans and MSM, it is important to assess partnership-health associations among this intersectional group. These men are both non-White, and engage in same-sex sexual behavior. Therefore, AAMSM seem particularly vulnerable to attenuated health benefits in the context of partnership. This potentially-attenuated, partnership-health effect is important to understand further, given that AAMSM face psychological and physical health disparities compared to other African Americans (Newman & Berman, 2008); other MSM (Alvy, McKirnan, Du Bois, et al, 2011; McKirnan, Du Bois, Alvy, et al., 2013); and general population members (Centers for Disease Control, 2005). These health disparities feasibly could be reduced by the positive health experience associated with partnership. Notably, research on partnered AAMSM and related populations exists (e.g. on same gender loving Black men; Applewhite & Littlefield, 2015); however, that research focuses not on individual health, but on other important variables such as resiliency in romantic relationships.
This study aims to test the partnership-health association within a sample of AAMSM participating in an HIV-prevention intervention. We have one primary research question: How does the health of AAMSM who report a primary male partner, compare to the health of AAMSM who report no primary male partner? This is the first known study to ask this research question. We hope our findings establish an empirical foundation that may be used to ask more specific and complex health-related questions in this group, in future studies. Here we define health in multiple ways, so we can gain a broad understanding of the partnership-health association in this group: psychological health (psychological distress, self-homophobia); health behaviors (hard drug use, exercise); sexual health (sex partners, HIV transmission risk); and, social support (social isolation).
Our analyses will be exploratory, for two reasons: First, this is consistent with our goal to gain a broad understanding of partnership and health [End Page 36] among AAMSM. Second, research on this topic is limited, and findings are mixed; therefore, we had no a priori hypotheses about partnership and health in this sample. Extrapolations from extant research are varied, and include that partnered AAMSM will report better health the single AAMSM (e.g. Mills et al., 2004); that there will be mixed health findings across groups (e.g. Parsons et al., 2013); or, that partnered AAMSM will report poorer health than single AAMSM (e.g. Sullivan et al, 2009).
Data for this study were obtained from the baseline assessment of a longitudinal behavioral intervention study aiming to reduce sexual risk behavior, increase sense of community-involvement and collective responsibility for reducing HIV infections, and increase access to resources such as testing and counseling services in AAMSM. Data were collected from various sites in the Chicago area. The study was funded through a cooperative agreement with the CDC, Division of HIV/AIDS Prevention, Prevention Research Branch.
The study population consisted of HIV-negative and HIV-positive AAMSM who: (a) were 18+ years old (b) self-identified as African American; (c) understood and read English; (d) lived within the Chicago area; and (e) reported at least two (male or female) sex partners in the past three months, and condomless anal sex with at least one male sex partner in the past three months. Men were ineligible to participate in the study if they: (a) had been diagnosed with HIV within the past three months (to allow for psychological and behavioral adjustment following an initial HIV diagnosis); (b) had a specific plan to move from the Chicago area within the next nine months; (c) reported active injection drug use other than hormones or steroids; (d) participated in the intervention video or the pilot phase of this study; or, (e) were under the age of 18. In this case, investigators reasoned those under 18 were likely to be at different cognitive and developmental stages than adults, and thus a different intervention message would be appropriate for them. Using the above criteria resulted in a final analytic sample of 229 individuals. [End Page 37]
Recruitment for the study lasted approximately 18 months. Researchers used both active and passive recruitment methods to recruit study participants. “Active” recruitment included outreach recruitment at street and venue locations where AAMSM socialize or congregate, such as bars, clubs, gay businesses, and agencies; and, website advertisements. The research team “passively” recruited men through information cards, and through referrals from local agencies and organizations, community advisory board members, and other study participants. Potential participants were screened by telephone. If they were eligible, willing to participate, and voluntarily provided written informed consent, they were enrolled.
Both verbal and written informed consent procedures were used to enroll men into the full trial. During screening, participants were asked to provide verbal consent, based on a brief description of the screening materials and confidentiality provisions. Additionally, written consent was obtained prior to the baseline interview with all participants. Before a participant signed the informed consent form, staff thoroughly reviewed the form, asked if the participant understood the consent form content, and answered any questions. The informed consent form provided details of the study procedures, risks, benefits, site contact information, the nature of confidentiality and voluntary participation, and the reimbursement schedule. The consent process also covered information on the trial procedures (i.e., randomization to a condition and follow-up schedule). Participants were given a copy of the informed consent form for their records. This copy was blank, to protect confidentiality in case the form was lost, misplaced, or stolen.
At the baseline visit, participant eligibility was confirmed; and, informed consent, locator information, and the baseline assessment was obtained. Risk reduction counseling and HIV testing were also administered. Those who did not screen eligible at the baseline visit were informed of that, reimbursed $5, and thanked for their time.
The baseline assessment consisted of an approximately one-hour, Audio-Computer-Assisted-Self-Interview(ACASI)of self-reported demographics; recent sexual and drug use behavior; and, related attitudes, beliefs, and knowledge. Staff were present to assist the participant in starting the ACASI, and to address any technical problems or to answer questions during the interview. To ensure privacy, the staff person did not directly observe the full process of completing the ACASI. [End Page 38]
Following completion of the ACASI, the participant met one-on-one with a counselor in a private room to receive risk reduction counseling. Participants were reimbursed $25 for the initial baseline visit. Statistical analyses here are based on the baseline assessment data.
Primary male partner. Participants were grouped into either “primary male partner” or “no primary partner” based on their answers to items asking about their sexual behavior in the last three months. Participants provided information regarding the most recent male partners they had sex with in the last three months at baseline assessment. For each partner, participants indicated if that partner was a main partner: “By main partner, we mean a man you felt committed to above anybody else, like a boyfriend or lover.” If participants indicated any of those partners were a main partner, they were included in the “primary male partner” group. If participants indicated none of their male partners in the last three months were main partners, they were included in the “no primary partner” group.
Male partners. Number of male partners was calculated by asking participants, “In the past three months, how many men have you had anal sex with (as a top or bottom, insertive, or receptive)?” Participants were then asked to indicate “none” or “one or more.” If the participant selected, “one or more” they were asked to indicate the number of partners.
Female partners. Number of female partners was calculated by asking participants, “In the past three months, how many women have you had vaginal or anal sex with?” Participants were then asked to indicate “none” or “one or more.” If the participant selected, “one or more” they were asked to indicate the number of partners.
Condomless sex. Condomless sex was a count variable, indicating the total number of times the participant had condomless insertive anal, receptive anal, or vaginal sex in the past three months. This number was summed from items throughout the survey, e.g. “In the last 3 months, how many times have you had anal sex with [partner] when you were the top?” and “How many of these times did you not use a condom from start to finish?”
Transmission risk. Transmission risk was calculated by summing the number of HIV-unknown or HIV-discordant status partners with whom each participant reported having condomless insertive anal, receptive anal, or vaginal sex with, in the past three months. [End Page 39]
Substance Use. Substance use was calculated by asking participants to indicate their frequency of use (i.e., Never; Less than once a month; Once a month; 2 or 3 days a month, Once a week, 2 or 3 days a week; 4–6 days a week; Every Day) of various substances (e.g., ecstasy, powdered cocaine, crack cocaine, methamphetamines, poppers/Amyl Nitrate, etc.), over the past three months. If participants indicated they had used a substance at least once a month or more over the past three months, it was counted as a substance used. Number of substances used was then summed to obtain the number of “hard drugs” used over the last three months.
Exercise. Exercise was calculated by summing the number of days weekly a participant indicated they engaged in either strength training or cardiovascular exercise. Neither activity was defined specifically on these items.
Self-Homophobia. Self-Homophobia was measured using the Personal Homonegativity subscale of the Internalized Homonegativity Inventory (IHNI), which measures internalized homonegativity in gay men (Mayfield, 2001). The subscale consists of four items assessing negative attitudes towards the self for same-sex related thoughts and behaviors, with Likert scale ratings from 1 “strongly disagree” to 5 “strongly agree.” Examples from the subscale are “Sometimes I dislike myself for being sexually attracted to men,” and “I sometimes feel guilty about having sex with men.” The scale demonstrated high reliability in this sample (α = .90).
Social isolation. Social isolation was measured using the UCLA Loneliness Scale, a 17-item scale designed to measure participants’ subjective feelings of loneliness as well as feelings of social isolation. Participants rated each item from 1 (“I never feel this way”) to 4 (“I always feel this way;” Peplau & Cutrona, 1980). Examples of items from this measure are “In the last three months, how often did you feel you lacked companionship?” and “In the last three months, did you feel there were people who really understood you?” Items were averaged to create a scale score. The scale demonstrated high reliability in this sample (α = .90).
Psychological Distress. Psychological distress was measured by the Kessler Psychological Distress Scale (K10), a 10-question screening scale of psychological distress meant for use in general-purpose health surveys. Example items are “In the past month, how often did you feel tired for no good reason?” and “In the past month, how often did you feel so nervous that nothing could calm you down?” Items were averaged to create a scale score. The scale demonstrated high reliability in this sample (α = .91). [End Page 40]
Data Analytic Strategy
We first report sample characteristics using descriptive statistics. Then we report results of independent samples t-tests that compared mean scores of AAMSM reporting a primary male partner, to AAMSM reporting no primary male partner, on various health indices. The Levene’s test for equality of variances was used to test for homogeneity. If this assumption was violated, the t-test reported was adjusted for Type I error rate by reporting the value in which equal variances were not assumed. The degrees of freedom (df) reported in these cases is lower, which reflects a conservative adjustment made when interpreting data in which the assumption of sample variance homogeneity is violated (Satterthwaite, 1946).
Participants were (N =229) AAMSM ages 18–58 (M = 35.08, SD = 11.83). A majority of participants reported an income of less than $10,000 per year (58.5%); were not working (48.5%); and, identified as Christian (65.5%). Regarding partnership, a majority of participants indicated they had a primary male partner (N = 147); eighty-two participants indicated they had no primary male partner. Demographics are presented in Table 1.
Few health measures differed across groups. AAMSM with a primary male partner reported less social isolation (p = .03); marginally fewer female sexual partners (p = .06); and, marginally more hard drug use (p = .06). Group-level comparisons are presented in Table 2.
We conducted a post hoc analysis based on the above findings. Given that hard drug use was marginally more frequent among partnered AAMSM, we used linear regressions to assess whether this variable predicted the sexual risk variables of condomless sex and HIV transmission risk among partnered AAMSM. We found that among partnered AAMSM, hard drug use did not predict HIV transmission risk (b = .25 (SE = .15), β = .13, t(147) = 1.61, p = .11), nor condomless sex (b = .14 (SE = .61), β = .02, t(147) = .24, p = .81).
Despite the partnership-health association being well established in the literature, this study represents the first known examination of the partnership-health link in a sample of AAMSM. We aimed to establish [End Page 41]
whether the same health advantages of partnership observed in large-scale studies of mostly heterosexual, White samples (e.g., Terman et al., 1995; Wood et al., 2007) generalize to AAMSM— a population facing significant health disparities in psychological and physical health (e.g., Centers for Disease Control, 2005). Results revealed mixed support for the partnership-health link in this sample: Having a primary male partner was associated with one clear health-related advantage, in the form of less social isolation. [End Page 42] However, importantly, our groups did not differ on most health outcomes. In fact, partnered AAMSM showed potentially higher risk on one index—marginally higher drug use— than AAMSM reporting no primary male partner. Lastly, men with a primary partner reported marginally fewer female sexual partners.
Consistent with the literature, AAMSM with a primary male partner reported less social isolation than those with no primary male partner. This makes sense, as primary partners themselves represent an important source of support for both heterosexual and sexual minority couples (Darbes, Chakravarty, Beougher, Neilands, & Hoff, 2012; Roisman, Clausell, Holland, Fortuna, & Elieff, 2008). This finding has important health implications: Social isolation is a clear risk factor for illness, disease, and mortality (Holt-Lunstad, Smith, Baker, Harris, & Stephenson, 2015). Therefore, our findings suggest that AAMSM with a primary male partner might report lower rates of some illnesses and diseases, and perhaps live longer, than AAMSM without a primary male partner. Further, an underlying mechanism, i.e., mediator, explaining this group-level difference may be decreased social isolation, or increased social support, related to having that primary partner. Extending this proposed model, the above mediation could be moderated by relationship-level variables such as relationship length, satisfaction, or [End Page 43] stress. Such an analysis would be consistent with recent, increased research efforts to assess relationship stress and its association with the health of individuals in the relationship (e.g., Du Bois, Sher, Grotkowski, et al., 2016).
Even though AAMSM with a primary male partner reported less social isolation, no other clear health benefit was observed in this sample. Whereas null findings can be interpreted as uninteresting, we believe these specific null findings are compelling. Although our study was exploratory in nature, it would have been reasonable to expect more valenced results here, based on ample research indicating the robust, positive association between romantic relationships and health (Robles & Keicolt-Glaser 2003). However, no clear pattern of health advantages emerged for partnered AAMSM in this study.
Our null findings may be explained by social-contextual variables. Specifically, culture-specific, relationship-level variables could moderate partnership-health associations in AAMSM. For example, MSM couples commonly report being in non-monogamous relationship arrangements (LaSala, 2004), with those in monogamous relationships reporting the lowest levels of substance use as compared to those in non-monogamous relationships (Parsons et al., 2013). As our data revealed similar rates of male sexual partners among AAMSM with and without a primary male partner, it is possible that relationship arrangement may have impacted results. Similarly, those in legally-recognized or committed relationships show better health outcomes than those in dating relationships (Riggle, Rostosky, & Horne, 2010); however, legally recognized marriage is a privilege conferred to sexual minorities only recently (Obergefell, 2015). Finally, as some of the individuals in this study were HIV-positive, this could be an added source of stress impacting relationships (Fair & Albright, 2012). While this inquiry is outside the scope of this study, explicitly assessing the above, and other, relationship-specific variables is critical for future research on the partnership-health association in AAMSM couples. Further, and more broadly, understanding more about the larger social context surrounding AAMSM relationships may help explain the weak and inconsistent partnership-health link demonstrated here, and thus represents a critical direction for future research.
These data revealed marginally higher hard drug use among partnered AAMSM. This finding could be interpreted using the lens of cognitive escape (McKirnan, Ostrow, & Hope, 1996). Partnered AAMSM may be using hard drugs more than their single counterparts, to cope with negotiating [End Page 44] a MSM partnership within a broader social context that may not support such a relationship. Past research has showed that African American sexual minority individuals experience low support and acceptance from both the African American community (Kertzner et al., 2009; Lewis, 2003), and sexual minority community (Han, 2007; Ward, 2008). Such support, or lack thereof, relates to the functioning and relationship satisfaction of sexual minority couples (Elizur & Mintzer, 2003; Smith & Brown, 1997). More broadly, AAMSM may face significant minority stress stemming from their multiple, intersectional minority identities of being African American and MSM (Kertzner, Meyer, Frost, & Stirratt, 2009). Generally, individuals facing minority stress may use substances to cope with this stress (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014).
Notably however, psychological distress in our sample did not differ across groups. This suggests either that our “distress” index did not accurately or wholly assess stress; and/or, that indeed stress may not relate to differential drug use across groups. Instead, AAMSM partners may use hard drugs together for other reasons, e.g. sexual pleasure, intimacy-building, or socializing with others. Concordance between health behaviors, e.g. substance use, is common among romantic partners; a systematic review on this topic found high correlations for drug use behaviors among those in romantic relationships (Meyler, Stimpson, & Peek, 2007). And more specifically, in a sample of partnered gay men, partners’ drug use was found to be interdependent, with implications for sexual risk behaviors (Parsons & Starks, 2014).
To follow up on the above, we conducted a post hoc analysis testing hard drug use as a predictor of sexual risk behaviors in the partnered sample. Inconsistent with some recently reported findings from a sample of AAMSM (Tobin, Yang, King, Latkin, & Curriero, 2016), hard drug use did not relate to sexual risk behaviors in this sample of AAMSM. This may be because the Tobin study aggregated single and partnered AAMSM, whereas we examined this association among partnered men only. Alternatively, it is possible that hard drug use and sexual risk are not significantly correlated among AAMSM; this would be consistent with past findings comprising an HIV paradox, i.e., that HIV prevalence remains high among AAMSM despite this group reporting fewer risky HIV-related behaviors compared to their other-race counterparts (Bing, Bingham, & Millett, 2008; Centers for Disease Control, 2017). Future studies should continue to assess drug use among partnered AAMSM specifically (see, e.g. Operario, Smith, Arnold, &Kegeles, 2011), [End Page 45] to elucidate further the role of drug use as it relates to sexual risk in this population. This is an important research question moving forward, given that HIV seroconversion is relatively common in the context of serious MSM relationships (Sullivan et al., 2009).
Partnered AAMSM reported marginally fewer female sexual partners than sample men without a primary male partner. This provides validation of sorts for our grouping variable. That is, we would expect those with a primary male partner to engage in sexual activity with fewer women, compared to those without a primary male partner; and indeed, our data support this. Other interpretations of this finding—those beyond the psychometrically-based one we report here— are speculative at best, as they go beyond the scope of this study. For example, fewer female partners could be interpreted as advantageous to health, insofar as fewer sexual partners can relate to better sexual health outcomes (e.g. McFarlane, Bull, & Rietmeijer, 2000; for counter-evidence, see an exception to the rule for Black MSM; Millet, Peterson, Flores, et al., 2012). Indeed, participation in down-low culture, and the concomitant bisexual behavior for many men involved, may increase HIV transmission risk for AAMSM and their male and female partners (Millett, Malebranche, Mason, & Spikes, 2005; Operario, Smith, Arnold, & Kegeles, 2011). However, depending on contextual factors to sex outside the MSM relationship, e.g. condom usage with other partners, and agreements to engage in extradyadic sex (LaSala, 2004; Parsons et al., 2013), increasing one’s number of sexual partners may not indeed be risky in itself.
This study has some limitations that suggest directions for future research. First, these data are cross-sectional and cannot speak to causality. It is possible, for example, that those lower in social isolation and higher in hard drug use may be more likely to be partnered, due in part to being less isolated or using more hard drugs. To elucidate causality and directionality among these key variables, future research should conduct longitudinal examinations of AAMSM, tracking health outcomes as they enter and exit relationships. Additionally, we used a single item to assess primary partnership. Multiple items from well-validated scales should be used in future research to assess primary partnership, along with obtaining more information about the relationship, such as monogamy and commitment levels. Next, because the original intervention aimed to reduce sexual risk behavior, we recruited men who had multiple recent sex partners—at least one of whom was male and with whom condomless sex [End Page 46] was engaged. Therefore, our findings do not generalize to all samples of AAMSM, especially those who have not recently engaged in condomless sex. Indeed, perhaps health differences would emerge between partnered and single AAMSM in a different sample. Finally, this study did not assess social support from different relationship contexts (i.e., family, friend, partner, coworkers). Disentangling the source, and quality, of social support experienced in different relationship contexts represents a critical future research direction to understand the partnership-health link in this group with multiple marginalized identities.
This research has important applied implications. First, couple-level health and psychoeducational interventions could be useful for AAMSM, to facilitate and maximize partnership-health associations in AAMSM couples. Such interventions could be designed and implemented by academic researchers; health providers that serve this population; or, using a Community-Based Participatory Research (CBPR) model, a combination of researchers and community members (Hergenrather, Geishecker, Clark, & Rhodes, 2013). Next, we suggest that for clinicians providing couple therapy to AAMSM, two points of focus include: ways of promoting healthful relationships, and stressors within and outside the relationship that may attenuate the positive impact of the relationship. Lastly, individual-level work with AAMSM might explore an individual’s own role in their partnership, and the internal and external stressors of negotiating an AAMSM identity.
AAMSM maintain their importance as a continued population of focus in health research— in terms of not only curbing HIV transmission, but also understanding the intersection of partnership, health, and culture. While the former has very reasonably, and thankfully, received much research attention, this study takes preliminary steps to address the latter, which remains relatively under-explored. [End Page 47]
Steve N. Du Bois, PhD, is a Licensed Clinical Psychologist and Assistant Professor of Psychology at the Illinois Institute of Technology. His research focuses on health behaviors (sex, HIV-treatment adherence); partnership and health (among men who have sex with men; within long-distance relationships); and health research methodology among African Americans.
Arryn A. Guy, MS, is a PhD candidate in the Clinical Psychology PhD program at the Illinois Institute of Technology. Her research interests primarily focus on the cognitive and emotional factors that influence the self-regulation of health behaviors in sexual, gender, and ethnic minority groups
Nicole Legate, PhD, is an Assistant Professor in the Department of Psychology at Illinois Institute of Technology. Her research focuses on how social environments can promote resilience in stigmatized groups, as well as the costs of hurting others.