Relationship Status and Quality Associations with HIV Care Cascade Outcomes Among Sexual Minority Men Living with HIV in the US: Indications of a Dyadic Coping Paradox

Dyadic coping among sexual minority men (SMM) has been a focus of HIV prevention research for decades, but few studies have examined relationship quality as a covariate of HIV care cascade outcomes (ART adherence and an undetectable viral load (VL)). This study utilized a 5-category relationship status variable (single; non-monogamous, sero-discordant; non-monogamous, sero-concordant; monogamous, sero-discordant; monogamous, sero-concordant) to test the hypothesis that relationship quality would moderate associations between relationship status and HIV care outcomes. Adult SMM living with HIV (LWHIV) (n = 1389), recruited via social networking applications between January and December 2021, completed a cross-sectional, online survey. At average levels of relationship quality, only non-monogamous SMM with sero-discordant partners were more likely to be adherent to ART (OR = 3.064, p<.001) and have an undetectable VL (OR = 2.595, p<.001) compared to single SMM. Among non-monogamous SMM with sero-discordant partners, relationship quality was positively associated with ART adherence (OR = 1.065, p<.001) and having an undetectable VL (OR = 1.046, p=.003). Among monogamous SMM with sero-concordant partners, the effect of relationship quality on ART adherence (OR=0.855, p=.007) and having an undetectable VL (OR=0.909, p=.011) was significantly smaller compared to non-monogamous SMM with sero-discordant partners. Among non-monogamous SMM with sero-concordant partners, the effect of relationship quality on ART adherence (OR=0.956, p=.039) was also significantly smaller compared to non-monogamous SMM with sero-discordant partners. Results suggest non-monogamous SMM with sero-discordant partners in high-quality relationships may experience the greatest motivation to engage in HIV care. Messages enhancing motivation for care engagement to improve individual health for SMM LWHIV may augment treatment as prevention.