Persistence of Intimate Partner Violence and Its Relationship to HIV Prevention Behaviors and Attitudes

Attitudes toward and use of pre-exposure prophylaxis (PrEP) by coupled sexual minority men (SMM) may be influenced by exposure to intimate partner violence (IPV) and sexual agreements regarding non-monogamy. We examined IPV (victimization and perpetration) persistence over 12 months and its association with HIV prevention behaviors and attitudes among 271 coupled, HIV-negative SMM, and the moderating role of sexual agreements. The sample had diverse race/ethnicity (64% were non-White) and was from across all regions of the USA. Participants completed a self-administered, Web-based survey at baseline, 6 months, and 12 months, and reported having the same main partner throughout. Repeated measures regression analysis showed that the level of IPV persistence was unrelated to PrEP use; however, persistent (i.e., present at all three assessments) IPV victimization and perpetration both predicted lower perceived partner support for PrEP use among those not using PrEP, as well as greater PrEP stigma. Persistent IPV victimization and perpetration were both predictive of more frequent HIV testing. The presence of a sexual agreement for non-monogamy (i.e., sex outside the primary relationship), which was a significant independent predictor of more HIV testing and PrEP use, moderated the relationships between IPV and HIV testing and partner support for PrEP, albeit in mixed ways: In non-monogamous relationships, persistent IPV victimization and perpetration were both associated with less HIV testing, but greater perceived partner support for PrEP use. In one of the first longitudinal studies of IPV and HIV prevention among SMM, these findings suggest a complex and nuanced influence of IPV on HIV prevention behaviors and attitudes and the key role that open communication and agreements related to extradyadic sex partners may have for HIV prevention among coupled SMM.