596038 research-article2015
JMHXXX10.1177/1557988315596038Mitchell and SophusAmerican Journal of Men’s Health
Article
Perceptions and Definitions of Power Within the Context of HIV-Negative Male Couples’ Relationships
American Journal of Men’s Health 1–10 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988315596038 ajmh.sagepub.com
Jason W. Mitchell, PhD, MPH1, and Amber I. Sophus, BS1
Abstract Examining dynamics within relationships is critical for development of effective HIV prevention interventions for male couples. The dynamic of power has received little attention in research with male couples, though power has been reported to affect HIV risk among heterosexual couples. To help address this knowledge gap, the present cross-sectional analysis used mixed methods with dyadic data from 142 HIV-negative male couples to (1) assess partnered men’s perception of who has the most power in their relationship and why, (2) examine whether partners concur about who has the most power and their reasoning for this selection, and (3) assess whether male couples’ concurrence about who has the most power is associated with their engagement of condomless anal sex within and/ or outside the relationship, type of relationship, and aspects of their sexual agreement. Individual- and couple-level responses about who has the most power were quantitatively assessed, whereas for why, their responses were coded qualitatively. Fifty-six percent of couples concurred about who has the most power in their relationship and of these, many said it was equal. Regarding why, themes of responses ranged from “compromise” and “shared responsibility” for those who concurred about who has the most power versus “dominant/compliant personality” and “money” among the couples who disagreed about who has the most power in their relationship. Concordance about who has the most power was only associated with condomless anal sex within the relationship. Further research is warranted to examine how power may affect other dynamics of male couples’ relationships and risk-related behaviors. Keywords perceptions of power, defining power, male couples, HIV risk
Introduction The need to study couple-level variables associated with condomless anal sex (CAS) among men who have sex with men (MSM)—the primary sexual risk behavior for HIV acquisition and/or transmission for this population (Coates, 2008)—has been raised by HIV prevention researchers (Burton, Darbes, & Operario, 2010; El-Bassel et al., 2010; Grossman et al., 2011; Herbst et al., 2007). One particular context is the dyad, or more specifically, male couples. In the United States, between one third and two thirds of MSM acquire HIV from their primary same-sex relationship partners (i.e., male couples; Goodreau, Carnegie, Vittinghoff, Lama, & Sanchez, 2012; Sullivan, Salazar, Buchbinder, & Sanchez, 2009). The number of HIV prevention studies that have examined the behaviors, characteristics, and dynamics of male couples’ relationships has increased to address these statistics for development of novel dyadic sexual health and HIV prevention programs. Prior HIV prevention studies have identified a number of behaviors, relationship characteristics, and dynamics
associated with HIV-negative male couples’ risk for HIV acquisition and/or transmission. Within the context of HIVnegative male couples’ relationships, increases in HIV risk are attributed to a number of behavioral factors, including lack of confirmation of both partners’ HIV-status (as negative) before having CAS, higher number of anal sex acts, more frequent receptive roles, and lower rates of condom use during anal sex (Goodreau et al., 2012; Sullivan et al., 2009). While studies have noted that >80% of U.S. HIVnegative male couples practice CAS within their relationships (Chakravarty, Hoff, Neilands, & Darbes, 2012; Mitchell, 2014; Mitchell, Harvey, Champeau, & Seal, 2012), CAS within these relationships does not necessarily 1
University of Miami Miller School of Medicine, Miami, FL, USA
Corresponding Author: Jason W. Mitchell, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1021, Miami, FL 33136, USA. Email: [email protected]
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increase couples’ risk for HIV when both men test and know they are HIV-negative, and refrain from having CAS with casual MSM partners outside their relationship (i.e., “negotiated safety”; Crawford, Rodden, Kippax, & Van de Ven, 2001). However, HIV-negative male couples’ risk for HIV and other sexually transmitted infections may increase when one of the partnered men has CAS with a casual MSM partner—either with or without the knowledge of their main partner—while CAS is practiced within the primary relationship (Chakravarty et al., 2012; Davidovich, de Wit, & Stroebe, 2000; Mitchell, 2014; Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a, 2012b, 2013). In a nation-wide U.S. study with 275 HIV-negative male couples, 83% practiced CAS within the relationship and among the quarter of men who had sex outside their relationship, 53% had CAS with one or more casual MSM partners during the same timeframe (Mitchell & Petroll, 2012b). Testing rates for HIV and sexually transmitted infections among HIV-negative concordant male couples and HIV-negative partnered men are also low despite their engagement of CAS within and/or outside the relationship (Chakravarty et al., 2012; Mitchell & Horvath, 2013; Mitchell & Petroll, 2012a, 2012b). Studies have also examined gay male couples’ relationship characteristics and dynamics for HIV prevention. A relationship characteristic pertains to a demographic or descriptor about the couple (e.g., race of the couple, relationship length, type of relationship) whereas a relationship dynamic requires both partners to interact to create that specific dynamic (e.g., trust, communication patterns, sexual agreement). Male couples who report having more positive levels of trust, relationship commitment, communication patterns, and investment in their sexual agreement are less likely to have either partners having had CAS outside their relationship (i.e., with a casual MSM partner; Darbes, Chakravarty, Beougher, Neilands, & Hoff, 2014; Hoff, Chakravarty, Beougher, Neilands, & Darbes, 2012; Mitchell, Harvey, Champeau, & Seal, 2012). Thus, having more positive relationship dynamics appears to reduce HIV-negative male couples’ risk for HIV. Furthermore, the establishment and adherence to a sexual agreement also helps reduce concordant HIV-negative male couples’ risk for HIV (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012). Despite these advances in our understanding of how certain relationship dynamics may affect male couples’ HIV risk, other dynamics may exist that warrant attention to investigate. One such dynamic, which has gained attention in the sexual health and HIV prevention literature with women and heterosexual couples, is power. However, within the context of male couples’ relationships, little is known about power. Lennon, Stewart, and Ledermann (2012)
suggest power is a common dynamic of intimate relationships and has been defined in a number of ways, including dominance or control over others and influence over others. Among heterosexual relationships, Bruhin (2003) argues that most individuals do not report having equal power within their relationship, and that the levels of power, whether symmetrical (i.e., equal—balanced between partners) or asymmetrical, may be dependent on the societal norms that exist for the couple. Differences in power between men and women have been identified in a variety of studies such that men have more power in virtually every society (Lee, Pratto, & Johnson, 2011). With respect to HIV prevention, prior studies have noted that women are constrained in negotiating safer sex because of gender-based imbalances in relationship power (Pulerwitz, Gortmaker, & De Jong, 2000), which may increase their risk for HIV and other sexually transmitted infections. Although a gender-based imbalance of power may not be relevant for gay male couples’ relationships, how partnered gay men and male couples define power and who they perceive to have power in their relationships may affect their behaviors (e.g., CAS) and risk for HIV. Prior HIV prevention studies have reported that other relationship characteristics and dynamics affect one or both partnered men’s behaviors and risk for HIV, thereby warranting the investigation of whether power is associated with male couples’ risk for HIV via engagement in CAS. Our understanding of how partnered men within male couples’ relationships perceive and define power is in its nascent stage. Little is known about how partnered men perceive whether power is balanced (i.e., symmetrical) or more one-sided, and whether both partners concur about who has the most power in their relationship. Data about male couples’ perceptions and definitions of power may be useful for development of future preventive interventions. Given the lack of CDC-approved HIV prevention interventions available for male couples (Burton et al., 2010; El-Bassel et al., 2010; Grossman et al., 2011; Herbst et al., 2007), examining how other dynamics—such as power—may influence their risk for HIV acquisition and/or transmission is timely and necessary to help fill this gap in HIV prevention. The present study uses dyadic data to explore the context of power within male couples’ relationships. Our aims are to (1) assess partnered men’s perception of who has the most power in their relationship and why, (2) examine whether partners within the couple (i.e., comparing partners’ responses) concur about who has the most power in their relationship as well as their reasoning for this selection, (3) assess whether male couples’ concurrence about which partner has the most power was associated with their engagement of CAS within and/or outside the relationship, and (4) assess whether male
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Mitchell and Sophus couples’ concurrence about which partner has the power was associated with the couples’ type of relationship, and establishment of and adherence to a sexual agreement. Our findings will provide preliminary insights about power within the context of male couples’ relationships, which may be used to help advance efforts toward developing sexual health and HIV prevention programs for this population.
Method A cross-sectional study design paired with a standard reciprocal dyadic data collection method was used to assess a variety of characteristics and behaviors among gay male couples’ relationships. The institutional review board at Oregon State University reviewed and approved all procedures for this original study, which have been reported in depth elsewhere (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a; Mitchell & Petroll, 2013).
Recruitment, Eligibility, and Procedure A convenience sample of 142 gay male couples was recruited in 2009 from Portland, Oregon and Seattle, Washington. Recruitment methods included passive and active strategies, which targeted gay male couples. All eligible study participants had to have met the following criteria: (1) be English speaking; (2) be HIV negative or have unknown HIV status; (3) self-identify as gay, bisexual, queer, or homosexual; (4) be 18 years of age or older; (5) be able to follow simple online instructions to complete an electronic survey on a computer; (6) be in a sexual relationship for at least 3 months with another man who also identified as gay, bisexual, homosexual, or queer; and (7) have had anal intercourse within the 3 months prior to study recruitment. Both members of the gay couple had to meet all inclusion criteria to enroll in the study. At a prearranged appointment that occurred at a local health center, coffee shop, or couples’ home, each qualified male of the couple provided consent electronically and completed the 25-minute self-administered, anonymous, Internet survey simultaneously, yet independently. For each couple, an identification system was used to help link the two partners’ responses to the survey to one another. Post hoc analysis was also used to help further validate couples’ relationship (e.g., age, relationship duration) by comparing partners’ responses with one another on predetermined variables (e.g., age, relationship duration). Personal identifying information was not collected to help decrease measurement error and participation bias (Fenton, Johnson, McManus, & Erens, 2001). The survey was hosted, and participant data were
collected and stored securely and confidentially by the host server surveymonkey.com.
Characteristics of the Study Sample This sample of 142 concordant HIV-negative male couples (N = 284 MSM) lived in Portland, Oregon or Seattle, Washington. Participants’ average age was 34.1 years (SD = 8.4). Most men identified as gay (95%, n = 236), nonHispanic (92%, n = 228), White (85%, n = 211), earned a bachelor’s degree or higher (68%, n = 169), and/or earned more than $30,000 per year (79%, n = 196). Fifty-eight percent (n = 82) of couples had been in their relationship for 5 years or less, and 82% (n = 116) cohabitated.
Measures Outcome Variables. To better understand the concept of “power” within male couples’ relationships, participants were asked two specific questions regarding who they perceived to have the most power in their relationship and their reasoning for that choice. With categorical responses of “Myself,” “My partner,” and “Equal,” participants were asked, “Thinking about the relationship you have with your boyfriend/partner, who would you say has the most power in your relationship?” The proceeding question had an open response: “Given your answer to who has the most power in your relationship, why did you say this person has the most power?” Independent Variables. In the original study, a variety of demographic, behavioral, and relational measures were reported about male couples’ relationships and risk for HIV (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a; Mitchell & Petroll, 2013). This secondary analysis analyzed whether certain variables that have been identified in the literature as relevant to HIV prevention, such as CAS within and/or outside the relationship, type of relationship, and aspects of a sexual agreement, were associated with male couples’ perception of who had the most power in their relationship. Men were asked if they previously had CAS with their main partner and any casual partners, respectively, within the 3 months prior to assessment. Both dichotomous variables contained a “yes” or “no” response. The other items were assessed categorically. Type of relationship referred to whether the participants had a strictly monogamous relationship or some form of an open relationship. The establishment of a sexual agreement assessed whether participants had made an agreement with their main partner about what sexual and relational behaviors were permitted to occur and with whom, and the specific type of sexual agreement they had established in their relationship.
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Data Analysis Quantitative dyadic data from concordant HIV-negative 142 gay male couples were analyzed using Stata Version 13 (StataCorp LP, College Station, TX). Couple-level dummy variables were created to compare and describe whether relationship partners’ responses concurred or disagreed on the following items: who had the most power in the relationship, engagement in CAS by partner type, relationship type, establishment and type of sexual agreement, and age difference between partners. Using only couple-level variables, Pearson’s chi-square comparative statistic was computed to assess whether couples’ concurrence about who had the most power was associated with CAS by partner type, relationship type, establishment and type of sexual agreement, and age difference between partners. Couples were categorized based on participants’ selection of who they thought had the most power in their relationship: “My partner,” “Myself,” or “Equal.” Couples who chose “Equal” or had a “One-sided” agreement about who held power within the relationship (e.g., Partner 1 chose “Myself” and Partner 2 chose “My partner”) were labeled as concurring about who had the most power in their relationship; the remaining categories were considered to be in disagreement. Using a step-by-step iterative process (Frost, McClelland, Clark, & Boylan, 2014), both research team members read and identified any overarching themes regarding participant’s responses on why they chose who had the most power in their relationship. Then, each team member reread and coded the open-ended responses for these themes. During meetings, the research team compared and discussed their coding for these themes and made adjustments as needed before creating the codebook. The codebook provided a description of the themes for coding along with their corresponding definitions. Each team member then used the codebook to code the responses once again. This process was applied for all responses and each team member reviewed one another’s coding to ensure that consistency was achieved for the themes identified. Themes about why which partner had the most power in the couples’ relationship were then compared within couples (i.e., between partners’ responses) and across the sample of couples on whether they concurred or disagreed about who had power in their relationship.
Results Perceptions of Who Had the Most Power Regarding participants’ responses to who in the relationship had the most power, 19.7% (n = 56) chose “Myself,”
Table 1. Couple-Level Concurrence About Who Had the Most Power in the Relationship Among 142 HIV-Negative Male Couples. Who has most power? Concurred/disagreed Percentage (n) One-sided: Myself/My partner Equal My partner/My partner Myself/Myself Myself/Equal My partner/Equal
Concurred
15.5 (22)
Concurred Disagreed Disagreed Disagreed Disagreed
40.8 (58) 2.8 (4) 1.4 (2) 21.1 (30) 18.3 (26)
19.7% (n = 56) “My partner” and 61% (n = 172) selected “Equal.” Comparing partners’ responses revealed that a little more than half of the male couples concurred (56%, n = 80 couples) while 44% (n = 62 couples) disagreed about who had the most power in their relationship (Table 1). Among the 80 couples who concurred about who held power in their relationship, 28% (n = 22) stated one partner held the most power (i.e., one-sided) while 72% (n = 58) concurred that power was “Equal” [between partners] in the relationship. Of the 62 couples who reported differences about who had the most power in the relationship, 3% (n = 2) of couples included men who stated themselves (i.e., Myself/Myself), 6% (n = 4) chose their partner (i.e., My partner/My partner), 48% (n = 30) had one partner who selected power was equal while the other partner stated he had the most power (i.e., Myself/Equal), and 42% (n = 26) had one partner who stated power was equal in the relationship while the other partner selected that his partner had the most power (My partner/Equal).
Couples’ Rationale to Who Had the Most Power Analysis of responses between partners of the couple (i.e., at the couple-level) revealed several key themes about why they thought who had the most power in their relationship (Figures 1 and 2). Among the 80 couples who concurred about who had the most power in their relationship, the most prevalent themes identified about their reasoning were “personality” (e.g., dominance or being compliant), “compromise” (e.g., one partner gives up something to please the other), “shared responsibility” (each person mutually agrees on important aspects of the relationship, such as chores and paying bills), “assertive” and “money” (see Figure 1). Among couples who concurred that power was “Equal” within the relationship, “compromise” was the most commonly reported reason. For example, Peter (31 years old) said, “We communicate about everything and if we don’t agree whole heartedly, we compromise. If we have compromise, we do our best
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Couple concur, N=80
Equal, N=58
One-sided, N=22
Ra onal decision making, N=2
Compromise, N=50
Shared responsibility, N=4
High maintenance, N=1
Compromise / Compromise, N=41
Asser ve, N=4
Compromise / Other, N=9
Selflessness / No response, N=1
No response, N=1
Communica on, N=1
Shared decision making / Age, N=1
Mul ple factors, N=2
Money, N=6
Established in life, N=3
Personality, N=4
Figure 1. Male couples who concurred about which partner(s) had power in relationship, by classified reason at couple level.
Note. Dyadic data represent responses from both partners of 80 concordantly HIV-negative male couples who concurred about which partner(s) had the most power in the relationship, broken down by reasons given for their selection.
to be on the same page,” while his partner Joel (28 years old) reported, “Our relationship is give and take. We share.” In contrast, couples who concurred about power being “One-sided” in their relationship had more diverse responses ranging from “assertive,” “money,” “established in life,” and “personality” (dominant or compliant) as themes about why they thought who had the most power in their relationships. For example, Steve (31 years old; My partner) shared, “He earns more financially and I equate money with power,” while his partner, Viktor (37 years old; Myself) reported, “Because I am more established, own property, have a degree and he does not, which he dislikes.” Figure 2 illustrates differences in the rationale provided by partners among the couples who disagreed about who had the most power in their relationship. Among the 62 couples who disagreed about this aspect of their relationship, “personality” (dominant or compliant) and “age” were the most common themes identified. Thirty of these couples reported “personality” (dominant or compliant) and “rational decision making” as differed reasons for who had the most power in the relationship. For example, Juan (28 years old; Myself) stated, “I find that I tend to be more extroverted, anal retentive and organized,
so I naturally fall into this role” while his partner Jason (30 years old, Equal) reported, “I think our personalities complement each other very well in that it keeps both of us balanced.” Conversely, 26 couples reported “personality” (dominant or compliant) and “money” as differed reasons for who had the most power in the relationship. For example, Larry (37 years old; My partner) reported “In relationships such as a boyfriend, I tend to be a follower and allow the partner to take control,” while his partner Brad (40 years old, Equal) reported “We are both independent people and I think we are empowered to live together or separate.”
Association Between Perception of Who Had the Most Power and Other Relationship Factors The majority of male couples practiced CAS within their relationship (90%, n = 223). Among the couples, a subset of partnered men had engaged in CAS both within and outside their relationship (i.e., with both primary and a casual MSM partner; 8%, n = 23). Compared with couples who disagreed about who had the most power in the relationship, a higher proportion of male couples who concurred
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Couple disagree, N=62
My partner / My partner, N= 4
Age / Resource dependency, N=1
Complying personality / Other , N=3
My partner / Equal, N=26
Myself / Equal, N=30
Myself / Myself, N=2
Personality / Equal, N=5
Established / Compliant personality, N=1
Age / Ra onale decision making, N=1
Mul ple factors / Equal, N=3
Personality / Equal, N=1
Lacking asser veness/ Equal, N=2
Ra onal decision making / Equal, N=4
Compliant personality / Equal, N=8
Sexual dominance / Equal, N=3
Ra onal decision making /Equal, N=1
Dominant personality / Equal, N=3
Resource dependency / Equal, N=3
Established / Equal, N=1
Rela onship agreement / Equal, N=1
Age / Equal, N=1
Experience / Equal, N=1
Infidelity / Equal, N=1
Age / Equal, N=3
Resource dependency / Equal, N=2
Asser veness/ Equal, N=2
Rela onship agreement / Equal, N=1
Experience / Equal, N=1
Power is already had / Equal, N=2
Money / Equal, N=4 Money / Equal, N=1
Love / Equal, N=1
Other / Equal, N=1
Figure 2. Male couples who disagree about who had the most power in the relationship, by reason at the couple level.
Note. Dyadic data in Figure 2 represent responses from both partners of 62 concordantly HIV-negative male couples who did not concur about which partner(s) had the most power in the relationship, broken down by reasons given for their selection.
about who had the most power in the relationship practiced CAS within their relationship, χ2(1) = 7.61, p < .01. No association was found between couples’ perception of who had the most power in the relationship and whether one or both partners had had CAS outside their relationship, χ2(1) = 2.97, p < .10, or within and outside their relationship, χ2(1) = 2.60, p < .10. However, a slightly higher proportion
of couples who concurred about who had the most power in the relationship had more partners who had concurrent CAS (i.e., within and outside the relationship) than those who did not concur about who had the most power in the relationship (16% vs. 10%). Table 2 provides more information about these results. Aspects of sexual agreements (e.g., establishment, adherence) and type of relationship
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Mitchell and Sophus Table 2. Differences in Couples’ Responses to Who Has Power in the Relationship and Engagement in CAS. Couple concurred who Couples’ concurrence had most power of who had power in relationship associated with CAS Sample size Relationship power
Practiced CAS Within relationship, main partner*
80 dyads
Percentage (n)
One-sided: Myself/My partner
N = 76 dyads 54
22
N = 15 dyads
Outside relationship, casual MSM partner†
a
19.7 (15)
Within and outside relationship, both partner types†
Couple disagreement of who had power associated with CAS
62 dyads Equal
95 (76)
Couple disagreed who had most power in relationship
10
c
5
My partner/ My partner Percentage (n) 85 (53)
8b
5c
My partner/ Myself/ Equal Equal
N = 53 dyads 3
2
25
23
5d
2f
4e
2f
N = 7 dyads 11.3 (7)
—
N = 13 dyads 16.3 (13)
Myself/ Myself
—
N = 6 dyads 9.7 (6)
—
—
Note. CAS = condomless anal sex; MSM = men who have sex with men. One-sided: Myself/My partner indicates power was held by one partner in the couple. a In 7 of the 10 couples, only one partner engaged in CAS outside the relationship; for the other 3 couples, both partners engaged in CAS outside the relationship. bIn 6 of the 8 couples, only one partner engaged in CAS outside the relationship; for the other 2 couples, both partners engaged in CAS outside the relationship. cIn 4 of the 5 couples, the partner who stated “Myself” as having the most power in the relationship had engaged in CAS outside and within and outside the relationship; for the other couple it was the partner who stated “My partner” who had engaged in CAS outside and within and outside the relationship. dIn 4 of the 5 couples, the partner who stated “My partner” as having the most power in the relationship had engaged in CAS outside the relationship; for the other couple it was the partner who stated “Equal” who had engaged in CAS outside the relationship. eIn 3 of the 4 couples, the partner who stated “My partner” as having the most power in the relationship had engaged in CAS within and outside the relationship; for the other couple it was the partner who stated “Equal” who had engaged in CAS within and outside the relationship. fFor both couples, the partner who stated “Myself” as having the most power within the relationship had engaged in CAS outside and within and outside the relationship. † p < .10. *p < .05.
were not associated with couples’ perception of who had the most power in their relationship (data not reported).
Discussion The present analysis is one of the first investigations to examine the concept of power within male couples’ relationships. Understanding how male couples’ perceive and define power within their relationships may be an important dynamic to consider when developing future sexual health and HIV preventive interventions. In our sample, couples generally fell into two broad categories regarding who they thought had the most power in their relationship: those who concurred and those who disagreed about who had the most power. Furthermore, why partners thought who had the most power in their relationship varied, both within couples’ relationships (i.e., between partners) and among the sample of couples. Though differences were noted regarding who had the most power
and why, our analyses also identified common themes among each group of couples as well as within their relationships. Among the 80 couples who concurred about who had the most power in their relationship, the majority reported “Equal,” implicating that power was essentially the same or shared equally between both partners of the couple. The primary theme identified regarding why most of these men chose “Equal” pertained to “compromise.” These findings suggest that partnered men in these relationships had a mutual understanding of who had power in their relationship (i.e., both) and that this power was shared or balanced. Zukoski, Harvey, Oakley, and Branch (2011) reported similar findings among a sample of young Heterosexual Latino couples, such that, when power is balanced in the relationship it is associated with compromise. The majority of the couples who stated power was “Equal” had engaged in CAS within their primary relationship. Interestingly, about one fifth of these
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couples also had one or both partners who engaged in CAS outside their relationship and/or had concurrent CAS. Prior studies with male couples have reported that when less positive relationship dynamics exist, the likelihood of CAS occurring outside the relationship (i.e., with a casual MSM partner) increases (Darbes et al., 2014; Hoff et al., 2012; Mitchell, Harvey, Champeau, & Seal, 2012). Although power may be perceived as “Equal” between the two primary partners, other relationship dynamics may play an influential role in their decision to engage in CAS outside the relationship. For instance, couples who do not have a sexual agreement or lack clarity about what’s permitted to occur per their agreement (e.g., CAS with outside partners) may affect their decision to engage in CAS outside their relationship (Mitchell, 2014). Additional research is needed to determine whether other dynamics exist to help explain why some partnered MSM engage in CAS outside their relationship when power is “Equal” and about “compromise” with their primary partner. A quarter of the couples concurred that power was “One-sided” in their relationship. Themes for why this particular partner had the most power in this subgroup of couples varied, though “money” and “assertiveness” were some of the common reasons reported. Many of the partnered men in this one-sided power group of couples engaged in CAS outside their relationship. This preliminary finding suggests that an imbalance of power may increase the couples’ risk for HIV. Partnered men who have the most power in their relationship may use this dynamic role to fulfill their own needs and desires without considering how these actions may affect their partner or relationship; this rationale may be particularly true if the power partner is also the caretaker of the relationship due to financial and/or life experience reasons. However, future qualitative research is warranted to investigate whether this imbalance of power directly influences that partner with power to engage in CAS with outside partners or if it is due to other attributes of their relationship (e.g., allowed behavior per their sexual agreement). In our sample, 44% of male couples disagreed about who had the most power in their relationship. Not surprisingly, partners’ reasons for why they selected who had the most power in their relationship varied greatly and often differed from their partners’ response. Despite these variations in response, “age” and “personality” (dominant or compliant) emerged as two of the most common themes about why partners within these couples indicated who had the most power in their relationships. These differences may reflect why an inequality in power may exist in their relationship. Other studies have reported similar results about the disagreement of who had the most power among heterosexual relationships and why. For example, Zukoski et al. (2011) noted that two thirds of couples (in
their sample) disagreed about who had the most power in their relationship due to an imbalance of communication, willingness to compromise, and decision making. In a different study, less than half of 413 heterosexual couples perceived their relationship to be equal in the distribution of power (Felmlee, 1994). Our findings suggest that male couples may not be all that different from some heterosexual couples with respect to perceiving and disagreeing about who has the most power and why in their relationships. To better understand these inequalities, additional research that uses qualitative methods is needed to further explore how and why partnered men define power within the context of their relationship, and how these meanings may affect other characteristics and behaviors of the couples’ relationship, including their engagement in CAS and potential risk for acquisition and/or transmission of HIV. In addition to using qualitative methods, HIV prevention researchers may also want to consider using the Sexual Relationship Power Scale (SRPS) to further study the concept of power within male couples’ relationships. The SRPS was developed to measure two conceptual dimensions of relationship power, relationship control and decision-making dominance, to help advance HIV prevention among women and heterosexual couples. This validated, theoretically derived scale has been used in the United States and abroad with females and heterosexual couples; SRPS has also been used to a lesser extent with males, but not with male couples (McMahon, Volpe, Klostermann, Trabold, & Xue, 2015). Our findings suggest that the SRPS may be beneficial to use to further understand how power affects male couples’ relationships and risk for HIV. For example, SRPS could help highlight how relationship control and decision-making dominance may differ among male couples who concur that power is “Equal” or “One-sided,” and among those who disagreed about who had power in their relationship. Data about these differences could help illuminate how best to intervene and promote a more balanced (i.e., “Equal”) power distribution regarding decisions about couples’ sexual health and prevention of HIV. Future studies that include a quantitative dyadic data collection method should consider using SRPS to help advance HIV prevention efforts for male couples.
Limitations Limitations of the present analysis include the use of a convenience sample and a cross-sectional study design that prohibits causal inference and generalizability. Other important limitations include the lack of data to confirm HIV serostatus (i.e., using biological measures instead of self-report), number of casual MSM partners, number of CAS acts per partner type, as well as measuring perceptions
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Mitchell and Sophus of HIV risk among the participants. The main strength of this analysis was the use of mixed methods with dyadic data to examine partners’ and couples’ perceptions of who had the most power in their relationship and why. Such data are currently lacking in the literature and may be helpful toward development of sexual health and HIV prevention strategies for male couples. To further examine the concept of power and how power may relate to HIV risk among male couples, researchers should use mixed methods with a larger generalizable-type of sample. Future studies should also examine whether SRPS could be used to better understand power within male couples’ relationships.
Conclusion Our understanding of how power is perceived, defined, and enacted within male couples’ relationships is in its nascent stage. Findings from the present study provide some preliminary insight about power among HIVnegative male couples’ relationships. Additional research is needed to examine how power may relate to other dynamics of male couples’ relationships and partners’ behaviors, including those associated with HIV acquisition and/or transmission. This type of information may be useful toward developing preventive interventions and programs which consider the complexities of gay male couples’ relationships. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References Bruhin, E. (2003). Power, communication and condom use: Patterns of HIV-relevant sexual risk management in heterosexual relationships. AIDS Care, 15, 389-401. Burton, J., Darbes, L. A., & Operario, D. (2010). Couplesfocused behavioral interventions for prevention of HIV: Systematic review of the state of evidence. AIDS and Behavior, 14, 1-10. Chakravarty, D., Hoff, C. C., Neilands, T. B., & Darbes, L. A. (2012). Rates of testing for HIV in the presence of serodiscordant UAI among HIV-negative gay men in committed relationships. AIDS and Behavior, 16, 1944-1948. Coates, T. J. (2008). What is to be done? AIDS, 22, 1079-1080. Crawford, J. M., Rodden, P., Kippax, S., & Van de Ven, P. (2001). Negotiated safety and other agreements between men in relationships: Risk practiced redefined. International Journal of STDs & AIDS, 12, 164-170.
Darbes, L. A., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Hoff, C. C. (2014). Sexual risk for HIV among gay male couples: A longitudinal study of the impact of relationship dynamics. Archives of Sexual Behavior, 43, 47-60. Davidovich, U., de Wit, J. B. F., & Stroebe, W. (2000). Assessing sexual risk behavior of young gay men in primary relationships: The incorporation of negotiated safety and negotiated safety compliance. AIDS, 14, 701-706. El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Hunt, T., & Remien, R. H. (2010). Couples-based HIV prevention in the United States: Advantages, gaps and future directions. Journal of Acquired Immune Deficiency Syndrome, 55(Suppl. 2), S98-S101. Felmlee, D. H. (1994). Who’s on top—Power in romantic relationships. Sex Roles, 31, 275-295. Fenton, K. A., Johnson, A. M., McManus, S., & Erens, B. (2001). Measuring sexual behaviour: Methodological challenges in survey research. Sexually Transmitted Infections, 77, 84-92. Frost, D. M., McClelland, S. I., Clark, J. B., & Boylan, E. A. (2014). Phenomenological research methods in the psychological study of sexuality. In D. L. Tolman & L. M. Diamond (Eds.), APA handbook of sexuality and psychology: Vol. 1. Person-based approaches (pp. 121-141). Washington, DC: American Psychological Association. Retrieved from http://dx.doi.org/10.1037/14193-006 Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., & Sanchez, J. (2012). What drives the US and Peruvian epidemics in men who have sex with men (MSM)? PLoS One, 7, e50522. Grossman, C. I., Forsyth, A., Purcell, D. W., Allison, S., Toledo, C., & Gordon, C. M. (2011). Advancing novel HIV prevention intervention research with MSM—Meeting report. Public Health Reports, 126, 472-479. Herbst, J. H., Beeker, C., Mathew, A., McNally, T., Passin, W. F., Kay, L. S., . . . Task Force on Community Preventive Services. (2007). The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men. American Journal of Preventive Medicine, 32(Suppl. 4), 38-67. Hoff, C. C., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Darbes, L. A. (2012). Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS Patient Care and STDs, 26, 738-745. Lee, I., Pratto, F., & Johnson, B. T. (2011). Intergroup consensus/disagreement in support of group-based hierarchy: An examination of socio-structural and psycho-cultural factors. Psychological Bulletin, 137, 1029-1064. Lennon, C. A., Stewart, A. L., & Ledermann, T. (2012). The role of power in intimate relationships. Journal of Social and Personal Relationships, 30, 95-114. McMahon, J. M., Volpe, E. M., Klostermann, K., Trabold, N., & Xue, Y. (2015). A systematic review of the psychometric properties of the sexual relationship power scale in HIV/ AIDS research. Archives of Sexual Behavior, 44, 267-294. doi:10.1007/s10508-014-0355-6
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Mitchell, J. W. (2014). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51, 316-328. Mitchell, J. W., Harvey, S. M., Champeau, D., Moskowitz, D., & Seal, D. (2012). Relationship factors associated with gay male couples’ concordance on aspects of their sexual agreements: Establishment, type, and adherence. AIDS and Behavior, 16, 1560-1569. Mitchell, J. W., Harvey, S. M., Champeau, D., & Seal, D. (2012). Relationship factors associated with HIV risk among a sample of gay male couples. AIDS and Behavior, 16, 404-411. Mitchell, J. W., & Horvath, K. J. (2013). Factors associated with regular HIV testing among a sample of US MSM with HIV-negative main partners. Journal of Acquired Immune Deficiency Syndrome, 64, 417-423. Mitchell, J. W., & Petroll, A. E. (2012a). HIV testing rates and factors associated with recent HIV testing among male couples. Sexually Transmitted Diseases, 39, 379-381.
Mitchell, J. W., & Petroll, A. E. (2012b). Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases, 39, 871-876. Mitchell, J. W., & Petroll, A. E. (2013). Factors associated with men in HIV-negative gay couples who practiced UAI within and outside of their relationship. AIDS and Behavior, 17, 1329-1337. Pulerwitz, J., Gortmaker, S. L., & De Jong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42, 637-660. Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23, 1153-1162. Zukoski, A. P., Harvey, S. M., Oakley, L., & Branch, M. (2011). Exploring power and sexual decision making among young Latinos residing in rural communities. Women’s Health Issues, 21, 450-457.
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JMHXXX10.1177/1557988315596038Mitchell and SophusAmerican Journal of Men’s Health
Article
Perceptions and Definitions of Power Within the Context of HIV-Negative Male Couples’ Relationships
American Journal of Men’s Health 1–10 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988315596038 ajmh.sagepub.com
Jason W. Mitchell, PhD, MPH1, and Amber I. Sophus, BS1
Abstract Examining dynamics within relationships is critical for development of effective HIV prevention interventions for male couples. The dynamic of power has received little attention in research with male couples, though power has been reported to affect HIV risk among heterosexual couples. To help address this knowledge gap, the present cross-sectional analysis used mixed methods with dyadic data from 142 HIV-negative male couples to (1) assess partnered men’s perception of who has the most power in their relationship and why, (2) examine whether partners concur about who has the most power and their reasoning for this selection, and (3) assess whether male couples’ concurrence about who has the most power is associated with their engagement of condomless anal sex within and/ or outside the relationship, type of relationship, and aspects of their sexual agreement. Individual- and couple-level responses about who has the most power were quantitatively assessed, whereas for why, their responses were coded qualitatively. Fifty-six percent of couples concurred about who has the most power in their relationship and of these, many said it was equal. Regarding why, themes of responses ranged from “compromise” and “shared responsibility” for those who concurred about who has the most power versus “dominant/compliant personality” and “money” among the couples who disagreed about who has the most power in their relationship. Concordance about who has the most power was only associated with condomless anal sex within the relationship. Further research is warranted to examine how power may affect other dynamics of male couples’ relationships and risk-related behaviors. Keywords perceptions of power, defining power, male couples, HIV risk
Introduction The need to study couple-level variables associated with condomless anal sex (CAS) among men who have sex with men (MSM)—the primary sexual risk behavior for HIV acquisition and/or transmission for this population (Coates, 2008)—has been raised by HIV prevention researchers (Burton, Darbes, & Operario, 2010; El-Bassel et al., 2010; Grossman et al., 2011; Herbst et al., 2007). One particular context is the dyad, or more specifically, male couples. In the United States, between one third and two thirds of MSM acquire HIV from their primary same-sex relationship partners (i.e., male couples; Goodreau, Carnegie, Vittinghoff, Lama, & Sanchez, 2012; Sullivan, Salazar, Buchbinder, & Sanchez, 2009). The number of HIV prevention studies that have examined the behaviors, characteristics, and dynamics of male couples’ relationships has increased to address these statistics for development of novel dyadic sexual health and HIV prevention programs. Prior HIV prevention studies have identified a number of behaviors, relationship characteristics, and dynamics
associated with HIV-negative male couples’ risk for HIV acquisition and/or transmission. Within the context of HIVnegative male couples’ relationships, increases in HIV risk are attributed to a number of behavioral factors, including lack of confirmation of both partners’ HIV-status (as negative) before having CAS, higher number of anal sex acts, more frequent receptive roles, and lower rates of condom use during anal sex (Goodreau et al., 2012; Sullivan et al., 2009). While studies have noted that >80% of U.S. HIVnegative male couples practice CAS within their relationships (Chakravarty, Hoff, Neilands, & Darbes, 2012; Mitchell, 2014; Mitchell, Harvey, Champeau, & Seal, 2012), CAS within these relationships does not necessarily 1
University of Miami Miller School of Medicine, Miami, FL, USA
Corresponding Author: Jason W. Mitchell, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1021, Miami, FL 33136, USA. Email: [email protected]
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increase couples’ risk for HIV when both men test and know they are HIV-negative, and refrain from having CAS with casual MSM partners outside their relationship (i.e., “negotiated safety”; Crawford, Rodden, Kippax, & Van de Ven, 2001). However, HIV-negative male couples’ risk for HIV and other sexually transmitted infections may increase when one of the partnered men has CAS with a casual MSM partner—either with or without the knowledge of their main partner—while CAS is practiced within the primary relationship (Chakravarty et al., 2012; Davidovich, de Wit, & Stroebe, 2000; Mitchell, 2014; Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a, 2012b, 2013). In a nation-wide U.S. study with 275 HIV-negative male couples, 83% practiced CAS within the relationship and among the quarter of men who had sex outside their relationship, 53% had CAS with one or more casual MSM partners during the same timeframe (Mitchell & Petroll, 2012b). Testing rates for HIV and sexually transmitted infections among HIV-negative concordant male couples and HIV-negative partnered men are also low despite their engagement of CAS within and/or outside the relationship (Chakravarty et al., 2012; Mitchell & Horvath, 2013; Mitchell & Petroll, 2012a, 2012b). Studies have also examined gay male couples’ relationship characteristics and dynamics for HIV prevention. A relationship characteristic pertains to a demographic or descriptor about the couple (e.g., race of the couple, relationship length, type of relationship) whereas a relationship dynamic requires both partners to interact to create that specific dynamic (e.g., trust, communication patterns, sexual agreement). Male couples who report having more positive levels of trust, relationship commitment, communication patterns, and investment in their sexual agreement are less likely to have either partners having had CAS outside their relationship (i.e., with a casual MSM partner; Darbes, Chakravarty, Beougher, Neilands, & Hoff, 2014; Hoff, Chakravarty, Beougher, Neilands, & Darbes, 2012; Mitchell, Harvey, Champeau, & Seal, 2012). Thus, having more positive relationship dynamics appears to reduce HIV-negative male couples’ risk for HIV. Furthermore, the establishment and adherence to a sexual agreement also helps reduce concordant HIV-negative male couples’ risk for HIV (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012). Despite these advances in our understanding of how certain relationship dynamics may affect male couples’ HIV risk, other dynamics may exist that warrant attention to investigate. One such dynamic, which has gained attention in the sexual health and HIV prevention literature with women and heterosexual couples, is power. However, within the context of male couples’ relationships, little is known about power. Lennon, Stewart, and Ledermann (2012)
suggest power is a common dynamic of intimate relationships and has been defined in a number of ways, including dominance or control over others and influence over others. Among heterosexual relationships, Bruhin (2003) argues that most individuals do not report having equal power within their relationship, and that the levels of power, whether symmetrical (i.e., equal—balanced between partners) or asymmetrical, may be dependent on the societal norms that exist for the couple. Differences in power between men and women have been identified in a variety of studies such that men have more power in virtually every society (Lee, Pratto, & Johnson, 2011). With respect to HIV prevention, prior studies have noted that women are constrained in negotiating safer sex because of gender-based imbalances in relationship power (Pulerwitz, Gortmaker, & De Jong, 2000), which may increase their risk for HIV and other sexually transmitted infections. Although a gender-based imbalance of power may not be relevant for gay male couples’ relationships, how partnered gay men and male couples define power and who they perceive to have power in their relationships may affect their behaviors (e.g., CAS) and risk for HIV. Prior HIV prevention studies have reported that other relationship characteristics and dynamics affect one or both partnered men’s behaviors and risk for HIV, thereby warranting the investigation of whether power is associated with male couples’ risk for HIV via engagement in CAS. Our understanding of how partnered men within male couples’ relationships perceive and define power is in its nascent stage. Little is known about how partnered men perceive whether power is balanced (i.e., symmetrical) or more one-sided, and whether both partners concur about who has the most power in their relationship. Data about male couples’ perceptions and definitions of power may be useful for development of future preventive interventions. Given the lack of CDC-approved HIV prevention interventions available for male couples (Burton et al., 2010; El-Bassel et al., 2010; Grossman et al., 2011; Herbst et al., 2007), examining how other dynamics—such as power—may influence their risk for HIV acquisition and/or transmission is timely and necessary to help fill this gap in HIV prevention. The present study uses dyadic data to explore the context of power within male couples’ relationships. Our aims are to (1) assess partnered men’s perception of who has the most power in their relationship and why, (2) examine whether partners within the couple (i.e., comparing partners’ responses) concur about who has the most power in their relationship as well as their reasoning for this selection, (3) assess whether male couples’ concurrence about which partner has the most power was associated with their engagement of CAS within and/or outside the relationship, and (4) assess whether male
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Mitchell and Sophus couples’ concurrence about which partner has the power was associated with the couples’ type of relationship, and establishment of and adherence to a sexual agreement. Our findings will provide preliminary insights about power within the context of male couples’ relationships, which may be used to help advance efforts toward developing sexual health and HIV prevention programs for this population.
Method A cross-sectional study design paired with a standard reciprocal dyadic data collection method was used to assess a variety of characteristics and behaviors among gay male couples’ relationships. The institutional review board at Oregon State University reviewed and approved all procedures for this original study, which have been reported in depth elsewhere (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a; Mitchell & Petroll, 2013).
Recruitment, Eligibility, and Procedure A convenience sample of 142 gay male couples was recruited in 2009 from Portland, Oregon and Seattle, Washington. Recruitment methods included passive and active strategies, which targeted gay male couples. All eligible study participants had to have met the following criteria: (1) be English speaking; (2) be HIV negative or have unknown HIV status; (3) self-identify as gay, bisexual, queer, or homosexual; (4) be 18 years of age or older; (5) be able to follow simple online instructions to complete an electronic survey on a computer; (6) be in a sexual relationship for at least 3 months with another man who also identified as gay, bisexual, homosexual, or queer; and (7) have had anal intercourse within the 3 months prior to study recruitment. Both members of the gay couple had to meet all inclusion criteria to enroll in the study. At a prearranged appointment that occurred at a local health center, coffee shop, or couples’ home, each qualified male of the couple provided consent electronically and completed the 25-minute self-administered, anonymous, Internet survey simultaneously, yet independently. For each couple, an identification system was used to help link the two partners’ responses to the survey to one another. Post hoc analysis was also used to help further validate couples’ relationship (e.g., age, relationship duration) by comparing partners’ responses with one another on predetermined variables (e.g., age, relationship duration). Personal identifying information was not collected to help decrease measurement error and participation bias (Fenton, Johnson, McManus, & Erens, 2001). The survey was hosted, and participant data were
collected and stored securely and confidentially by the host server surveymonkey.com.
Characteristics of the Study Sample This sample of 142 concordant HIV-negative male couples (N = 284 MSM) lived in Portland, Oregon or Seattle, Washington. Participants’ average age was 34.1 years (SD = 8.4). Most men identified as gay (95%, n = 236), nonHispanic (92%, n = 228), White (85%, n = 211), earned a bachelor’s degree or higher (68%, n = 169), and/or earned more than $30,000 per year (79%, n = 196). Fifty-eight percent (n = 82) of couples had been in their relationship for 5 years or less, and 82% (n = 116) cohabitated.
Measures Outcome Variables. To better understand the concept of “power” within male couples’ relationships, participants were asked two specific questions regarding who they perceived to have the most power in their relationship and their reasoning for that choice. With categorical responses of “Myself,” “My partner,” and “Equal,” participants were asked, “Thinking about the relationship you have with your boyfriend/partner, who would you say has the most power in your relationship?” The proceeding question had an open response: “Given your answer to who has the most power in your relationship, why did you say this person has the most power?” Independent Variables. In the original study, a variety of demographic, behavioral, and relational measures were reported about male couples’ relationships and risk for HIV (Mitchell, Harvey, Champeau, Moskowitz, & Seal, 2012; Mitchell, Harvey, Champeau, & Seal, 2012; Mitchell & Petroll, 2012a; Mitchell & Petroll, 2013). This secondary analysis analyzed whether certain variables that have been identified in the literature as relevant to HIV prevention, such as CAS within and/or outside the relationship, type of relationship, and aspects of a sexual agreement, were associated with male couples’ perception of who had the most power in their relationship. Men were asked if they previously had CAS with their main partner and any casual partners, respectively, within the 3 months prior to assessment. Both dichotomous variables contained a “yes” or “no” response. The other items were assessed categorically. Type of relationship referred to whether the participants had a strictly monogamous relationship or some form of an open relationship. The establishment of a sexual agreement assessed whether participants had made an agreement with their main partner about what sexual and relational behaviors were permitted to occur and with whom, and the specific type of sexual agreement they had established in their relationship.
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Data Analysis Quantitative dyadic data from concordant HIV-negative 142 gay male couples were analyzed using Stata Version 13 (StataCorp LP, College Station, TX). Couple-level dummy variables were created to compare and describe whether relationship partners’ responses concurred or disagreed on the following items: who had the most power in the relationship, engagement in CAS by partner type, relationship type, establishment and type of sexual agreement, and age difference between partners. Using only couple-level variables, Pearson’s chi-square comparative statistic was computed to assess whether couples’ concurrence about who had the most power was associated with CAS by partner type, relationship type, establishment and type of sexual agreement, and age difference between partners. Couples were categorized based on participants’ selection of who they thought had the most power in their relationship: “My partner,” “Myself,” or “Equal.” Couples who chose “Equal” or had a “One-sided” agreement about who held power within the relationship (e.g., Partner 1 chose “Myself” and Partner 2 chose “My partner”) were labeled as concurring about who had the most power in their relationship; the remaining categories were considered to be in disagreement. Using a step-by-step iterative process (Frost, McClelland, Clark, & Boylan, 2014), both research team members read and identified any overarching themes regarding participant’s responses on why they chose who had the most power in their relationship. Then, each team member reread and coded the open-ended responses for these themes. During meetings, the research team compared and discussed their coding for these themes and made adjustments as needed before creating the codebook. The codebook provided a description of the themes for coding along with their corresponding definitions. Each team member then used the codebook to code the responses once again. This process was applied for all responses and each team member reviewed one another’s coding to ensure that consistency was achieved for the themes identified. Themes about why which partner had the most power in the couples’ relationship were then compared within couples (i.e., between partners’ responses) and across the sample of couples on whether they concurred or disagreed about who had power in their relationship.
Results Perceptions of Who Had the Most Power Regarding participants’ responses to who in the relationship had the most power, 19.7% (n = 56) chose “Myself,”
Table 1. Couple-Level Concurrence About Who Had the Most Power in the Relationship Among 142 HIV-Negative Male Couples. Who has most power? Concurred/disagreed Percentage (n) One-sided: Myself/My partner Equal My partner/My partner Myself/Myself Myself/Equal My partner/Equal
Concurred
15.5 (22)
Concurred Disagreed Disagreed Disagreed Disagreed
40.8 (58) 2.8 (4) 1.4 (2) 21.1 (30) 18.3 (26)
19.7% (n = 56) “My partner” and 61% (n = 172) selected “Equal.” Comparing partners’ responses revealed that a little more than half of the male couples concurred (56%, n = 80 couples) while 44% (n = 62 couples) disagreed about who had the most power in their relationship (Table 1). Among the 80 couples who concurred about who held power in their relationship, 28% (n = 22) stated one partner held the most power (i.e., one-sided) while 72% (n = 58) concurred that power was “Equal” [between partners] in the relationship. Of the 62 couples who reported differences about who had the most power in the relationship, 3% (n = 2) of couples included men who stated themselves (i.e., Myself/Myself), 6% (n = 4) chose their partner (i.e., My partner/My partner), 48% (n = 30) had one partner who selected power was equal while the other partner stated he had the most power (i.e., Myself/Equal), and 42% (n = 26) had one partner who stated power was equal in the relationship while the other partner selected that his partner had the most power (My partner/Equal).
Couples’ Rationale to Who Had the Most Power Analysis of responses between partners of the couple (i.e., at the couple-level) revealed several key themes about why they thought who had the most power in their relationship (Figures 1 and 2). Among the 80 couples who concurred about who had the most power in their relationship, the most prevalent themes identified about their reasoning were “personality” (e.g., dominance or being compliant), “compromise” (e.g., one partner gives up something to please the other), “shared responsibility” (each person mutually agrees on important aspects of the relationship, such as chores and paying bills), “assertive” and “money” (see Figure 1). Among couples who concurred that power was “Equal” within the relationship, “compromise” was the most commonly reported reason. For example, Peter (31 years old) said, “We communicate about everything and if we don’t agree whole heartedly, we compromise. If we have compromise, we do our best
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Couple concur, N=80
Equal, N=58
One-sided, N=22
Ra onal decision making, N=2
Compromise, N=50
Shared responsibility, N=4
High maintenance, N=1
Compromise / Compromise, N=41
Asser ve, N=4
Compromise / Other, N=9
Selflessness / No response, N=1
No response, N=1
Communica on, N=1
Shared decision making / Age, N=1
Mul ple factors, N=2
Money, N=6
Established in life, N=3
Personality, N=4
Figure 1. Male couples who concurred about which partner(s) had power in relationship, by classified reason at couple level.
Note. Dyadic data represent responses from both partners of 80 concordantly HIV-negative male couples who concurred about which partner(s) had the most power in the relationship, broken down by reasons given for their selection.
to be on the same page,” while his partner Joel (28 years old) reported, “Our relationship is give and take. We share.” In contrast, couples who concurred about power being “One-sided” in their relationship had more diverse responses ranging from “assertive,” “money,” “established in life,” and “personality” (dominant or compliant) as themes about why they thought who had the most power in their relationships. For example, Steve (31 years old; My partner) shared, “He earns more financially and I equate money with power,” while his partner, Viktor (37 years old; Myself) reported, “Because I am more established, own property, have a degree and he does not, which he dislikes.” Figure 2 illustrates differences in the rationale provided by partners among the couples who disagreed about who had the most power in their relationship. Among the 62 couples who disagreed about this aspect of their relationship, “personality” (dominant or compliant) and “age” were the most common themes identified. Thirty of these couples reported “personality” (dominant or compliant) and “rational decision making” as differed reasons for who had the most power in the relationship. For example, Juan (28 years old; Myself) stated, “I find that I tend to be more extroverted, anal retentive and organized,
so I naturally fall into this role” while his partner Jason (30 years old, Equal) reported, “I think our personalities complement each other very well in that it keeps both of us balanced.” Conversely, 26 couples reported “personality” (dominant or compliant) and “money” as differed reasons for who had the most power in the relationship. For example, Larry (37 years old; My partner) reported “In relationships such as a boyfriend, I tend to be a follower and allow the partner to take control,” while his partner Brad (40 years old, Equal) reported “We are both independent people and I think we are empowered to live together or separate.”
Association Between Perception of Who Had the Most Power and Other Relationship Factors The majority of male couples practiced CAS within their relationship (90%, n = 223). Among the couples, a subset of partnered men had engaged in CAS both within and outside their relationship (i.e., with both primary and a casual MSM partner; 8%, n = 23). Compared with couples who disagreed about who had the most power in the relationship, a higher proportion of male couples who concurred
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Couple disagree, N=62
My partner / My partner, N= 4
Age / Resource dependency, N=1
Complying personality / Other , N=3
My partner / Equal, N=26
Myself / Equal, N=30
Myself / Myself, N=2
Personality / Equal, N=5
Established / Compliant personality, N=1
Age / Ra onale decision making, N=1
Mul ple factors / Equal, N=3
Personality / Equal, N=1
Lacking asser veness/ Equal, N=2
Ra onal decision making / Equal, N=4
Compliant personality / Equal, N=8
Sexual dominance / Equal, N=3
Ra onal decision making /Equal, N=1
Dominant personality / Equal, N=3
Resource dependency / Equal, N=3
Established / Equal, N=1
Rela onship agreement / Equal, N=1
Age / Equal, N=1
Experience / Equal, N=1
Infidelity / Equal, N=1
Age / Equal, N=3
Resource dependency / Equal, N=2
Asser veness/ Equal, N=2
Rela onship agreement / Equal, N=1
Experience / Equal, N=1
Power is already had / Equal, N=2
Money / Equal, N=4 Money / Equal, N=1
Love / Equal, N=1
Other / Equal, N=1
Figure 2. Male couples who disagree about who had the most power in the relationship, by reason at the couple level.
Note. Dyadic data in Figure 2 represent responses from both partners of 62 concordantly HIV-negative male couples who did not concur about which partner(s) had the most power in the relationship, broken down by reasons given for their selection.
about who had the most power in the relationship practiced CAS within their relationship, χ2(1) = 7.61, p < .01. No association was found between couples’ perception of who had the most power in the relationship and whether one or both partners had had CAS outside their relationship, χ2(1) = 2.97, p < .10, or within and outside their relationship, χ2(1) = 2.60, p < .10. However, a slightly higher proportion
of couples who concurred about who had the most power in the relationship had more partners who had concurrent CAS (i.e., within and outside the relationship) than those who did not concur about who had the most power in the relationship (16% vs. 10%). Table 2 provides more information about these results. Aspects of sexual agreements (e.g., establishment, adherence) and type of relationship
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Mitchell and Sophus Table 2. Differences in Couples’ Responses to Who Has Power in the Relationship and Engagement in CAS. Couple concurred who Couples’ concurrence had most power of who had power in relationship associated with CAS Sample size Relationship power
Practiced CAS Within relationship, main partner*
80 dyads
Percentage (n)
One-sided: Myself/My partner
N = 76 dyads 54
22
N = 15 dyads
Outside relationship, casual MSM partner†
a
19.7 (15)
Within and outside relationship, both partner types†
Couple disagreement of who had power associated with CAS
62 dyads Equal
95 (76)
Couple disagreed who had most power in relationship
10
c
5
My partner/ My partner Percentage (n) 85 (53)
8b
5c
My partner/ Myself/ Equal Equal
N = 53 dyads 3
2
25
23
5d
2f
4e
2f
N = 7 dyads 11.3 (7)
—
N = 13 dyads 16.3 (13)
Myself/ Myself
—
N = 6 dyads 9.7 (6)
—
—
Note. CAS = condomless anal sex; MSM = men who have sex with men. One-sided: Myself/My partner indicates power was held by one partner in the couple. a In 7 of the 10 couples, only one partner engaged in CAS outside the relationship; for the other 3 couples, both partners engaged in CAS outside the relationship. bIn 6 of the 8 couples, only one partner engaged in CAS outside the relationship; for the other 2 couples, both partners engaged in CAS outside the relationship. cIn 4 of the 5 couples, the partner who stated “Myself” as having the most power in the relationship had engaged in CAS outside and within and outside the relationship; for the other couple it was the partner who stated “My partner” who had engaged in CAS outside and within and outside the relationship. dIn 4 of the 5 couples, the partner who stated “My partner” as having the most power in the relationship had engaged in CAS outside the relationship; for the other couple it was the partner who stated “Equal” who had engaged in CAS outside the relationship. eIn 3 of the 4 couples, the partner who stated “My partner” as having the most power in the relationship had engaged in CAS within and outside the relationship; for the other couple it was the partner who stated “Equal” who had engaged in CAS within and outside the relationship. fFor both couples, the partner who stated “Myself” as having the most power within the relationship had engaged in CAS outside and within and outside the relationship. † p < .10. *p < .05.
were not associated with couples’ perception of who had the most power in their relationship (data not reported).
Discussion The present analysis is one of the first investigations to examine the concept of power within male couples’ relationships. Understanding how male couples’ perceive and define power within their relationships may be an important dynamic to consider when developing future sexual health and HIV preventive interventions. In our sample, couples generally fell into two broad categories regarding who they thought had the most power in their relationship: those who concurred and those who disagreed about who had the most power. Furthermore, why partners thought who had the most power in their relationship varied, both within couples’ relationships (i.e., between partners) and among the sample of couples. Though differences were noted regarding who had the most power
and why, our analyses also identified common themes among each group of couples as well as within their relationships. Among the 80 couples who concurred about who had the most power in their relationship, the majority reported “Equal,” implicating that power was essentially the same or shared equally between both partners of the couple. The primary theme identified regarding why most of these men chose “Equal” pertained to “compromise.” These findings suggest that partnered men in these relationships had a mutual understanding of who had power in their relationship (i.e., both) and that this power was shared or balanced. Zukoski, Harvey, Oakley, and Branch (2011) reported similar findings among a sample of young Heterosexual Latino couples, such that, when power is balanced in the relationship it is associated with compromise. The majority of the couples who stated power was “Equal” had engaged in CAS within their primary relationship. Interestingly, about one fifth of these
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couples also had one or both partners who engaged in CAS outside their relationship and/or had concurrent CAS. Prior studies with male couples have reported that when less positive relationship dynamics exist, the likelihood of CAS occurring outside the relationship (i.e., with a casual MSM partner) increases (Darbes et al., 2014; Hoff et al., 2012; Mitchell, Harvey, Champeau, & Seal, 2012). Although power may be perceived as “Equal” between the two primary partners, other relationship dynamics may play an influential role in their decision to engage in CAS outside the relationship. For instance, couples who do not have a sexual agreement or lack clarity about what’s permitted to occur per their agreement (e.g., CAS with outside partners) may affect their decision to engage in CAS outside their relationship (Mitchell, 2014). Additional research is needed to determine whether other dynamics exist to help explain why some partnered MSM engage in CAS outside their relationship when power is “Equal” and about “compromise” with their primary partner. A quarter of the couples concurred that power was “One-sided” in their relationship. Themes for why this particular partner had the most power in this subgroup of couples varied, though “money” and “assertiveness” were some of the common reasons reported. Many of the partnered men in this one-sided power group of couples engaged in CAS outside their relationship. This preliminary finding suggests that an imbalance of power may increase the couples’ risk for HIV. Partnered men who have the most power in their relationship may use this dynamic role to fulfill their own needs and desires without considering how these actions may affect their partner or relationship; this rationale may be particularly true if the power partner is also the caretaker of the relationship due to financial and/or life experience reasons. However, future qualitative research is warranted to investigate whether this imbalance of power directly influences that partner with power to engage in CAS with outside partners or if it is due to other attributes of their relationship (e.g., allowed behavior per their sexual agreement). In our sample, 44% of male couples disagreed about who had the most power in their relationship. Not surprisingly, partners’ reasons for why they selected who had the most power in their relationship varied greatly and often differed from their partners’ response. Despite these variations in response, “age” and “personality” (dominant or compliant) emerged as two of the most common themes about why partners within these couples indicated who had the most power in their relationships. These differences may reflect why an inequality in power may exist in their relationship. Other studies have reported similar results about the disagreement of who had the most power among heterosexual relationships and why. For example, Zukoski et al. (2011) noted that two thirds of couples (in
their sample) disagreed about who had the most power in their relationship due to an imbalance of communication, willingness to compromise, and decision making. In a different study, less than half of 413 heterosexual couples perceived their relationship to be equal in the distribution of power (Felmlee, 1994). Our findings suggest that male couples may not be all that different from some heterosexual couples with respect to perceiving and disagreeing about who has the most power and why in their relationships. To better understand these inequalities, additional research that uses qualitative methods is needed to further explore how and why partnered men define power within the context of their relationship, and how these meanings may affect other characteristics and behaviors of the couples’ relationship, including their engagement in CAS and potential risk for acquisition and/or transmission of HIV. In addition to using qualitative methods, HIV prevention researchers may also want to consider using the Sexual Relationship Power Scale (SRPS) to further study the concept of power within male couples’ relationships. The SRPS was developed to measure two conceptual dimensions of relationship power, relationship control and decision-making dominance, to help advance HIV prevention among women and heterosexual couples. This validated, theoretically derived scale has been used in the United States and abroad with females and heterosexual couples; SRPS has also been used to a lesser extent with males, but not with male couples (McMahon, Volpe, Klostermann, Trabold, & Xue, 2015). Our findings suggest that the SRPS may be beneficial to use to further understand how power affects male couples’ relationships and risk for HIV. For example, SRPS could help highlight how relationship control and decision-making dominance may differ among male couples who concur that power is “Equal” or “One-sided,” and among those who disagreed about who had power in their relationship. Data about these differences could help illuminate how best to intervene and promote a more balanced (i.e., “Equal”) power distribution regarding decisions about couples’ sexual health and prevention of HIV. Future studies that include a quantitative dyadic data collection method should consider using SRPS to help advance HIV prevention efforts for male couples.
Limitations Limitations of the present analysis include the use of a convenience sample and a cross-sectional study design that prohibits causal inference and generalizability. Other important limitations include the lack of data to confirm HIV serostatus (i.e., using biological measures instead of self-report), number of casual MSM partners, number of CAS acts per partner type, as well as measuring perceptions
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Mitchell and Sophus of HIV risk among the participants. The main strength of this analysis was the use of mixed methods with dyadic data to examine partners’ and couples’ perceptions of who had the most power in their relationship and why. Such data are currently lacking in the literature and may be helpful toward development of sexual health and HIV prevention strategies for male couples. To further examine the concept of power and how power may relate to HIV risk among male couples, researchers should use mixed methods with a larger generalizable-type of sample. Future studies should also examine whether SRPS could be used to better understand power within male couples’ relationships.
Conclusion Our understanding of how power is perceived, defined, and enacted within male couples’ relationships is in its nascent stage. Findings from the present study provide some preliminary insight about power among HIVnegative male couples’ relationships. Additional research is needed to examine how power may relate to other dynamics of male couples’ relationships and partners’ behaviors, including those associated with HIV acquisition and/or transmission. This type of information may be useful toward developing preventive interventions and programs which consider the complexities of gay male couples’ relationships. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
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