SEATTLE - A growing HIV testing program is rebelling against a culture of medical privacy by screening gay couples together.
While traditional HIV testing is done individually and in private, Testing Together allows men in relationships to learn their HIV status with their partner. Counselors develop a customized HIV prevention and care strategy catered to a couple's specific circumstances so they can work together to prevent or treat the infection.
The program was developed by Dr. Patrick Sullivan and Dr. Rob Stephenson of Emory University based on research they conducted with the U.S. Centers for Disease Control and Prevention. In 2009, they discovered one-third to two-thirds of new HIV infections came from main partners among gay couples.
"That was surprising," Sullivan said. "It changed the way we thought about preventative services and intervention."
Sullivan and Stephenson also discovered a significant number of men in longer-term relationships were unaware of their partner's HIV status. In fact, many gay men in relationships believed they were less at risk for HIV and were therefore less likely to have been recently tested for HIV, Sullivan said.
In 2011, Testing Together began training HIV community-support organizations in Seattle and four other major cities on testing and counseling skills specifically for gay couples. They addressed how to cope with an HIV-positive status, maintaining safer behaviors between partners and helping couples navigate treatment when one or both partners is found to be HIV-positive.
"Think about the message it sends to couples being responsible and coming in together," Sullivan said. "Being tested separately implies they have secrets. We recognize the strength the couple shows by coming in together."
Gay City in Seattle has been testing couples together since December and plans to continue the practice. Today, about 10 percent of patients at their center are tested with a partner.
"A lot of people are interested in the opportunity to have a facilitated conversation with their partner about their sexual health," said Fred Swanson, executive director of Gay City. "For many of the guys who have come here it's been a great opportunity to establish a foundation of trust for their relationship."
Swanson said it can be easier for people to cope with an HIV-positive status when they have a loved one by their side.
"You're walking out with a support network whether result is positive or negative," he said. "In many ways it's a lot less isolating."
In situations where one partner is HIV-negative and the other is HIV-positive, Sullivan said counselors can help the partners learn how to best care for each other.
"It's a very high-priority situation in which we want to be able to provide good information. Having both men in the room and facilitating that discussion with all the right information makes the counselor's job easier."
If both couples are HIV-negative, Sullivan said counselors encourage the partners to talk about creating a "sexual agreement" detailing whether or not they plan to be monogamous.
"We encourage them to think about how they would handle it if one person stepped outside of that agreement. Most couples never have the chance to have that discussion."
For couples to be tested together, both partners are individually asked to sign consent forms, to avoid situations where one person might pressure another.
Since the program began, Sullivan has investigated whether testing couples at the same time could lead to domestic violence or more relationship break-ups, but saw no differences between those who were tested individually or as a couple.
Soon after Testing Together started in 2011, the CDC got involved and expanded training to additional major U.S. cities with high HIV prevalence. To date, more than 300 HIV counselors have been trained at 73 testing sites in 21 cities, and more than 450 gay couples have learned their HIV status together.
As a result, more than 8 percent of men tested were HIV-positive with at least 10 percent in previously undiagnosed relationships where one partner is HIV positive and the other is not.
The CDC is now expanding Testing Together to more major cities in the United States with funding from the MAC Aids Fund.