Power relations in sexual agreements among male couples in Southern Africa

Essack, Zaynab; Lynch, Ingrid; Kaunda, Chammah J.; Stephenson, Rob; Darbes, Lynae A.; Rooyen, Heidi van

doi:10.1080/13691058.2019.1636291

Cited by 12 publications

(9 citation statements)

References 48 publications

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“…Given that outside exposures do happen even with monogamous agreements, prevention efforts should help couples mutually agree to integrate HIV testing into their sexual agreement [ 87 ]. A qualitative study of MSM in South Africa found sexual agreements permitting non-monogamy with female partners only, suggesting heteronormative societal pressures [ 88 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sharkey

Wall

Parker

et al. 2021

Contemporary Clinical Trials Communications

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sharkey

Wall

Parker

et al. 2021

Contemporary Clinical Trials Communications

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show abstract

“…This supports research from other African contexts where childbearing through heterosexual sex transfers a measure of belonging to persons deviating from gendered norms in other ways, such as through same-sex practices (Epprecht, 2006; Tamale, 2007). For instance, Southern African same-sex practicing men in research by Essack et al. (2019: 10–11) describe the compelling influence of a procreative imperative, in that ‘procreative sex with women becomes intertwined with normative notions of sexuality and kinship, where for many male couples siring children is linked with recuperating full personhood’.…”

Section: Methodsmentioning

confidence: 99%

‘Having to use English others us': South African terminologies of sexual and gender diversity

2021

Self Cite

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The linguistic coding of sexual and gender diversity remains highly contested in African contexts. While English language terminologies reflecting rights-based talk proliferate, such terms fail to fully reflect the lived realities of African queerness. This paper engages existing South African research on indigenous terminologies to describe sexual and gender diversity, focusing on representations of male same-sex sexualities. Our findings show that local terminologies serve not only to ‘other’ sexual and gender diversity, but also hold the potential to render those existing outside of normative sex/gender binaries as socially intelligible. Two core themes emerged: (i) the persistence of heterogendered subjectivities, where sexual dissidence is mapped onto a normative male/female binary; and (ii) a procreative imperative focused on communitarian norms that privilege heterosexual childbearing. The findings highlight the limitations of global terminologies of sexual and gender diversity by engaging the ways in which local African terminologies provide social recognition for same-sex sexualities in generally heteronormative community spaces. We discuss the implications of this gendered encoding of sexual dissidence in terms of advocacy strategies for the greater social inclusion of sexual and gender minorities.

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“…Couples who have agreements where sex with outside partners is not permitted (e.g., monogamous agreements) may have fewer parameters to negotiate but may be more vulnerable to broken agreements, which could potentially put the couple at risk for HIV [ 10 ]. Specifically, if an HIV-negative partner has condomless anal sex (CAS) with an outside partner who is HIV-positive or of unknown HIV status and then engages in CAS with his HIV-negative primary partner, both partners in the primary relationship could be at risk for HIV transmission [ 11 ] if the outside partner was HIV-positive with a detectable viral load, and neither of the HIV-negative partners were taking pre-exposure prophylaxis (PrEP) medications.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, HIV-prevention research has identified unique prevention needs for male couples across the world [ 2 , 11 , 12 , 13 , 14 ]. For example, positive relationship factors, such as satisfaction, trust, and commitment, are associated with less sexual risk with outside partners [ 11 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing Self-Efficacy and Communication Regarding Sexual Agreements among Men Who Have Sex with Men in the USA: Development and Validation of Two Novel Scales

Neilands

Chakravarty

Darbes

et al. 2021

IJERPH

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HIV disproportionately impacts men who have sex with men (MSM) in the USA. Building upon research on relationship constructs unique to MSM couples’ HIV-prevention needs, we developed two new scales measuring sexual agreement self-efficacy (SASE) and importance of sexual agreement communication (ISAC). Following qualitative item development, we used two large independent samples of MSM couples (N1 = 441, N2 = 388) to conduct scale validation. Exploratory factor analyses indicated both SASE and ISAC to be unidimensional with 7 and 5 items (eigenvalues = 5.68 and 3.50), respectively, with strong factor loadings. Confirmatory factor analyses yielded satisfactory model fit for SASE (CFI = 0.99; SRMR = 0.03) and ISAC (CFI = 0.99; SRMR = 0.05). Reliability was high for SASE (ω = 0.92) and ISAC (ω = 0.84). Predictive validity analysis revealed a protective association between higher scores on both scales and the outcomes of sexual risk behavior and agreement breaks. Convergent and discriminant validity analyses demonstrated associations in the expected directions between these scales and multiple measures of relationship quality. Therefore, SASE and ISAC are two brief, valid, and reliable scales that can facilitate more in-depth explorations of sexual agreements in MSM and thereby contribute greatly to improving our understanding of and ability to intervene on sexual agreements to improve health and relationship outcomes.

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Power relations in sexual agreements among male couples in Southern Africa

Cited by 12 publications

References 48 publications

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

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

‘Having to use English others us': South African terminologies of sexual and gender diversity

Assessing Self-Efficacy and Communication Regarding Sexual Agreements among Men Who Have Sex with Men in the USA: Development and Validation of Two Novel Scales

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