Intimate Partner Violence Influences HIV Prevention Behaviors in Male Couples

A U.S. study by San Diego State University and the RAND Corporation found that intimate partner violence among sexual minority men does not directly reduce PrEP use but can increase stigma and lower partner support for HIV prevention. The research also shows that relationships with agreed non-monogamy tend to have higher PrEP use and more frequent HIV testing.

Researchers from San Diego State University’s School of Public Health and the RAND Corporation have found that intimate partner violence can shape how sexual minority men approach HIV prevention. Their longitudinal study followed 271 HIV-negative men in relationships with other men across the United States for one year. The research explored how violence within relationships affects attitudes toward pre-exposure prophylaxis (PrEP), HIV testing habits, and partner support for prevention strategies. The study forms part of the Empowering Relationships and Opportunities for Safety (EROS) project, which examines how relationship dynamics influence sexual health among sexual minority men.

HIV Risk and the Role of Relationships

Sexual minority men continue to experience higher rates of HIV infection compared with other groups in the United States. Public health programs have increasingly promoted biomedical tools like PrEP, a medication that significantly reduces the risk of HIV when taken regularly. But decisions about prevention rarely happen in isolation. They often depend on communication, trust, and power dynamics between partners.

Researchers note that intimate partner violence is not uncommon in same-sex relationships. Past studies suggest that many men experience emotional, physical, or controlling behavior from a partner at some point. These experiences can influence how comfortable individuals feel discussing sexual health, seeking testing, or starting prevention medication. The new study aimed to better understand these connections by observing men and their relationships over time.

A Diverse National Study

Participants were recruited mainly through social media and mobile dating apps commonly used by sexual minority men, along with outreach in LGBTQ+ community spaces. Eligible participants were cisgender men aged 18 to 45 who were in relationships with other men and confirmed to be HIV-negative through home testing kits.

The final group of 271 participants represented different regions of the United States. The average age was around 33 years, and nearly two-thirds identified as racial or ethnic minorities. Most participants were employed and had completed college, and over 90 percent identified as gay. Many relationships were well established, with nearly one-third lasting more than seven years.

One important feature of the sample was the high rate of consensual non-monogamy. More than half of the participants reported having agreements with their partners that allowed sex with other people outside the relationship. These agreements turned out to play a major role in shaping HIV prevention behaviors.

What the Study Found

The study showed that intimate partner violence was relatively common but often occurred intermittently rather than continuously. About one-third of participants reported experiencing some form of victimization during the study period, while roughly one-fifth reported perpetrating violence against a partner. However, persistent violence throughout the entire year affected a smaller portion of the group.

When researchers examined the use of PrEP, they found that violence did not directly determine whether participants were taking the medication. PrEP use actually increased over the course of the study, regardless of exposure to violence. Overall use of the medication was relatively high, with more than 60 percent reporting they had used PrEP at some point and about 40 percent currently taking it at the start of the study.

Still, violence had indirect effects. Among participants who were not using PrEP, those experiencing persistent violence were more likely to believe their partners would disapprove of them starting the medication. They also reported stronger stigma around PrEP, including feelings of embarrassment or worry about being judged. These factors can make people less willing to consider prevention options even when they know the benefits.

The researchers also found that men experiencing persistent violence tended to test for HIV more often. This may reflect a greater awareness of potential risk within unstable or conflict-filled relationships.

The Impact of Non-Monogamous Agreements

Relationship agreements allowing sex outside the partnership played a significant role in prevention behaviors. Participants in these relationships were much more likely to use PrEP, report greater partner support for the medication, and undergo regular HIV testing.

These agreements may encourage open communication about sexual health and risk management. Couples who acknowledge the possibility of outside partners may be more proactive about protecting themselves and each other.

However, the relationship between violence and non-monogamy was complex. In some situations, violence within non-monogamous relationships was linked to less frequent HIV testing, suggesting that relationship stress or conflict can disrupt prevention routines.

Why the Findings Matter

The study highlights that HIV prevention among sexual minority men is closely tied to relationship dynamics. Intimate partner violence does not necessarily stop people from using prevention tools like PrEP, but it can influence the environment in which those decisions are made. Lower partner support and higher stigma can quietly discourage prevention behaviors.

Researchers say healthcare providers and prevention programs should pay closer attention to relationship factors when promoting HIV prevention. Screening for intimate partner violence during HIV testing or PrEP consultations could help identify individuals who may need additional support.

Encouraging open communication between partners about sexual agreements and prevention strategies may also strengthen both relationship health and HIV prevention efforts. As biomedical advances continue to expand prevention options, the study suggests that addressing relationship challenges remains an essential part of protecting public health.