There are many ways to show someone you love him. You could write him a song or have his name tattooed on your bicep. But how about getting tested for HIV with him?
Since 2008, Dr. Patrick Sullivan and I at the Rollins School of Public Health at Emory University have been developing an innovative HIV-prevention strategy: couples HIV testing for gay men.
Men who have sex with men are the only risk group in the United States to be experiencing an increase in HIV infections, and recent studies show that one- to two-thirds are infected by their main partners, a proportion that is significantly higher among young men.
Meanwhile, for the last 30 years of the HIV epidemic, we in public health have focused our prevention messaging on the risks of casual sex. Some campaigns, like the ABCs of prevention (Abstinence, Be faithful, use Condoms) even imply that a committed relationship is a prevention strategy. But monogamy doesn't protect you if your partner has undiagnosed HIV.
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 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 men who have sex with men don't talk about their relationship status - recent research showed that 90 percent report discussing sexual agreements with their main partner and 64 percent decide to be monogamous. But there is a high risk that men are entering relationships in which one, or both, are HIV-positive. The prevalence of HIV among gay men in the United States is almost as high as the prevalence among heterosexual couples in African countries with the worst epidemics.
There is a solution to this: couples testing that allows both partners to get counseling and learn the results together. This simple act removes the need for either partner to disclose his status, prevents risky behaviors based on assumptions and ignorance, and allows the couple to work together on a prevention plan built on both their HIV statuses.
This approach 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 by about 50 percent, compared with individual testing. (In a serodiscordant couple, one partner is HIV-positive and the other is HIV-negative.)
With funding from the National Institutes of Health and the MAC AIDS Fund, we at Emory have worked with community-based organizations to test more than 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 more than 50 HIV-testing agencies now trained to provide couples testing across the United States, we are finding that, typically, one in 10 male couples - in some places, it's as high as one in five - are newly identified as serodiscordant.
Some in the prevention sciences argue that testing two men together leads to relationship dissolution or 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 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.
However, 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 toward 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, why not perform one of the greatest acts of love: Get tested for HIV together, find out your status, and work together to keep your relationship healthy.