September 27th was National Gay Men's HIV Awareness Day, a day aimed at encouraging gay men to test for HIV and to adopt risk reducing behaviors. After more than 30 years since the emergence of HIV/AIDS, the US epidemic remains concentrated in gay men and other men who have sex with men. Gay men are the only group in the US to show continued increases in rates of HIV, and rates of HIV infection are particularly high among African American gay men and gay men aged under 24. Getting tested for HIV remains our greatest prevention weapon. For those who test positive there are treatment and care options that can significantly improve longevity and health and reduce the risk of them transmitting HIV to others. And getting tested provides an opportunity for all to learn about risk reducing behaviors.
But throughout the HIV epidemic we in the prevention community have focused largely on providing HIV testing to individuals. It is therefore surprising to many that between one and two thirds of new HIV infections among gay men actually come from their main sex partners. While partying has its risks, falling in love does, too: compared to a hook up, you have more sex with your main partner, you have more penetrative sex, and you are less likely to be using condoms. Both partners may enter a relationship assuming they are HIV-negative. As a volunteer HIV counselor and tester, I can't tell you how many times I have had a client tell me "If he was HIV positive he would tell me: he loves me." But this assumes he knows his own status.
Discussions of HIV are not easy: "Where shall we eat tonight, and by the way, should we get tested for HIV?" is likely to elicit suspicion. It's not that gay men don't talk about sex in their relationships--our recent research showed that 90% report discussing sexual agreements with their main partner and 64% decide to be monogamous. But given that the prevalence of HIV among gay men in the US is almost as high as the prevalence among heterosexual couples in African countries with the worst epidemics, there is a high risk that men are entering relationships in which one, or both, are HIV positive.
But there is a solution to this. Since 2008, Dr. Patrick Sullivan and I (both from the Rollins School of Public Health at Emory University), have been developing an innovative HIV prevention strategy to tackle this problem: couples HIV testing for gay men (often referred to as CHTC (Couples HIV Counseling and Testing)). Couples' testing allows both men to get counseling and learn the results together. This simple act removes the need for either partner to disclose their status, prevents risky behaviors based on assumptions and ignorance of status, and allows the couple to work together on a prevention plan built on both their HIV statuses. This has achieved incredible success in Africa where it was first developed in the 1980s: studies show that it reduces HIV transmission among sero-discordant heterosexual couples (in which one is HIV positive and one is HIV negative) by about 50% compared to individual testing.
With funding from the National Institutes of Health and the MAC AIDS Fund, we at Emory have worked with community based organizations to test over 300 male-male couples so far. The response has been overwhelming. Clients report that it provides an opportunity for them to address issues that are often hard to discuss and to build a prevention plan tailored to suit the circumstances of their relationship. With over 73 HIV testing agencies in 21 cities now trained to provide couples testing across the US, we are finding that around 10 percent of couples tested are newly identified as sero-discordant. The Centers for Disease Control (CDC) has now recognized CHTC as an effective intervention and is bringing this service to scale as part of their national HIV programming. With the support of CDC, couples HIV testing will be increasingly available in more cities across the US.
There are some in the prevention sciences who argue that testing two men together leads to relationship dissolution or, worse still, violence brought about by discovering a partner's HIV status. But there is no evidence of any of these negative effects (nor was there for heterosexual couples in Africa). Others in HIV prevention have concerns about confidentiality. But we can protect couples with consent forms adapted specifically for couples. Testing for HIV together is a big decision: couples who do it have likely talked about the risks and the results before they go for testing. Couples' testing is not for everyone, and it is not a replacement for individual testing, which should remain at the foundation of HIV prevention efforts.
Testing a couple together provides validity that may encourage the couple to be more proactive about their health. Furthermore, providing services to same-sex couples is a crucial step in the progression towards marriage equality. The HIV prevention community must recognize the role of couples in the HIV epidemic, and provide services tailored specifically for couples: a crucial first step is to encourage gay men to test for HIV with their partners.
So, if you are a man with a husband, a boyfriend, a boo, or just a friend with benefits, why not take time on this National Gay Men's HIV Awareness Day to talk about your HIV status and get tested for HIV together, and work together to keep your relationship healthy.
Rob Stephenson is an Associate Professor of Global Health and a Public Voices Fellow with The Op-Ed Project. Patrick Sullivan is a Professor of Epidemiology in the Rollins School if Public Health at Emory University