The Association Between Substance Use and Intimate Partner Violence Within Black Male Same-Sex Relationships

Abstract

Compared with the extant research on heterosexual intimate partner violence (IPV)—including the knowledge base on alcohol and illicit drug use as predictors of such IPV—there is a paucity of studies on IPV among men who have sex with men (MSM), especially Black MSM. This study investigates the prevalence of experiencing and perpetrating IPV among a sample of Black MSM couples and examines whether heavy drinking and/or illicit substance use is associated with IPV. We conducted a secondary analysis on a data set from 74 individuals (constituting 37 Black MSM couples) screened for inclusion in a couple-based HIV prevention pilot study targeting methamphetamine-involved couples. More than one third (n= 28, 38%) reported IPV at some point with the current partner: 24 both experiencing and perpetrating, 2 experiencing only, and 2 perpetrating only. IPV in the past 30 days was reported by 21 (28%) of the participants: 18 both experiencing and perpetrating, 1 experiencing only, and 2 perpetrating only. Heavy drinking and methamphetamine use each was associated significantly with experiencing and perpetrating IPV throughout the relationship as well as in the past 30 days. Rock/crack cocaine use was significantly associated with any history of experiencing and perpetrating IPV. Altogether, IPV rates in this sample of Black MSM couples equal or exceed those observed among women victimized by male partners as well as the general population of MSM. This exploratory study points to a critical need for further efforts to understand and address IPV among Black MSM. Similar to heterosexual IPV, results point to alcohol and illicit drug use treatment as important avenues to improve the health and social well-being of Black MSM.

Keywords

substance use partner violence men who have sex with men African American Black syndemic

Introduction

Individuals in nonheterosexual relationships are affected by intimate partner violence (IPV) at a comparable or higher rate than those in heterosexual relationships (Greenwood et al., 2002; Seelau, Seelau, & Poorman, 2003; Tjaden, Thoennes, & Allison, 1999). From published studies, the IPV rate among men who have sex with men (MSM) ranges from 12% to 39% (Herek & Sims, 2007; Stephenson, Khosropour, & Sullivan, 2010; Stephenson, Rentsch, Salazar, & Sullivan, 2011; Tjaden et al., 1999; Waldner-Haugrud, Gratch, & Magruder, 1997; Waterman, Dawson, & Bologna, 1989), with most reporting lower rates than the range (between 17% and 52%) reported among lesbians (Brand & Kidd, 1986; Coleman, 1994; Lockhart, White, Causby, & Isaac, 1994; Perry, 1995; Schilit, Lie, & Montagne, 1990; Waldner-Haugrud et al., 1997) but comparable with rates experienced by heterosexual women (between 8% and 22%; Greenwood et al., 2002; Seelau et al., 2003). However, compared with the existing research on IPV among heterosexuals (generally IPV perpetrated by men toward women) and on lesbians to a lesser extent, there is a striking paucity of IPV research focused on MSM. For example, a literature search failed to identify any couple-based studies of IPV among MSM.

Studies on IPV among MSM have begun to move beyond prevalence. Of the studies focused on MSM, only a few report race/ethnicity as an independent variable in the current literature about IPV among MSM. Some studies reported no difference according to racial/ethnic demographic characteristics (Houston & McKirnan, 2007; Merrill & Wolfe, 2000). However, other studies found higher rates of IPV among non-White participants; for example, two studies that focused exclusively on the Latino MSM population found a higher prevalence rate of IPV (51%-52%) than the rate reported in the general population of MSM noted earlier (Feldman, Diaz, Ream, & El-Bassel, 2007; Nieves-Rosa, Carballo-Dieguez, & Dolezal, 2000). In light of such findings, the present study addresses the need for an increased focus on racial/ethnic minority MSM in general and the gap in the knowledge base on Black MSM in particular.

In addition to demographic characteristics, research with nonheterosexual couples has found that—similar to heterosexual IPV (Caetano, McGrath, Ramisetty-Mikler, & Field, 2005; Friend, Langhinrichsen-Rohling, & Eichold, 2011; Leonard, 2001; Lipsey, Wilson, Cohen, & Derzon, 1997; McCarroll, Fan, & Bell, 2009; Murphy, Winters, O’Farrell, Fals-Stewart, & Murphy, 2005; Quigley & Leonard, 2000; Rothman, McNaughton Reyes, Johnson, & LaValley, 2012; Taft et al., 2010)—recent alcohol use is significantly related to occurrence of any type of IPV (Kelly, Izienicki, Bimbi, & Parsons, 2011; Peterman & Dixon, 2003; Stermac, Sheridan, Davidson, & Dunn, 1996). The literature with heterosexual couples on the association between use of other drugs and IPV is extensive (see Moore et al., 2008, for a review); thus, it may not be surprising that drug use has also been shown to correlate with higher instances of IPV among the MSM population (Cruz & Firestone, 1998; Stermac et al., 1996; Zierler, Cunningham, & Andersen, 2000). Recent literature suggests that the types and combination of substances used may be significant in the types of IPV that occur within same-sex couples (Kelly et al., 2011).

In examining IPV among MSM populations, the existing research suggests the need to consider HIV (Heintz & Melendez, 2006; Kalichman et al., 2001; Kalichman & Rompa, 1995; Relf, Huang, Campbell, & Catania, 2004). HIV seropositivity has been linked to battering victimization among MSM (Nieves-Rosa et al., 2000; Relf, 2001). Another study with only HIV-positive MSM (Pantalone, Schneider, Valentine, & Simoni, 2011) found high IPV prevalence rates (up to 78%); this rate not only exceeds the rates among studies with HIV-positive women reviewed by the authors of that study, but we also note that it is higher than the rates reported among the IPV studies with MSM summarized earlier in this article.

We recently conducted a small scale, pilot study of a behavioral HIV/sexually transmitted infections (STI) preventive intervention for Black MSM couples presenting multiple risks—methamphetamine use, concurrent sexual partners, unprotected anal sex—that included a screening assessment for IPV. This presented the opportunity to address several important gaps in the IPV literature on MSM: (a) a primary focus on predominantly HIV-positive, Black MSM; (b) use of reports from both partners constituting a couple; (c) assessment of both experience and perpetration of IPV; and (d) the ability to examine the potential association with IPV for different substances separately. Consequently, this study explores the following research questions:

Research Question 1: What is the prevalence of IPV among this sample of Black MSM couples?

Research Question 2: What is the concordance in one partner’s report of experiencing (or perpetrating) IPV compared with his partner’s report of perpetrating (or experiencing) IPV?

Research Question 3: What is the prevalence of bidirectional IPV within this sample of Black MSM couples?

Research Question 4: Is there an association between use of specific substances and IPV among this sample of Black MSM couples?

Method

Study Design and Sample

This study utilized data obtained during the screening portion of a pilot test of a couple-based, behavioral, sexual and drug risk reduction preventive intervention for methamphetamine-involved, Black MSM couples (Wu et al., 2011). The parent study sought to enroll a sample of methamphetamine-using, Black MSM couples at elevated risk for sexual transmission of HIV/STIs. Recruitment was conducted from November 2004 to April 2005 at local service agencies, bars, clubs, and community events frequented by MSM in the New York City area; the study also held monthly open/drop-in group social event that was provided for Black MSM couples in the community. Potential participants screened for inclusion in the parent study were informed that the intervention consisted of seven weekly sessions in which both partners conjointly worked with a facilitator to address threats (e.g., HIV, drugs such as methamphetamine) to the well-being, physical health, and sexual health of Black men in same-sex relationships.

Screening protocols, data collection procedures, and implementation are described in more detail elsewhere (Wu et al., 2011); the article also presents evidence supporting the intervention’s success in facilitating significant reductions in sexual risk and drug use (i.e., lower number of male sexual partners, fewer unprotected acts of anal intercourse with the main partner, greater proportion of condom-protected anal intercourse with the main partner, lower methamphetamine and illicit drug use frequencies; fewer types of illicit drugs use) among couples who received the intervention. Men and their male sexual partners who met the following criteria were eligible for the parent study: (1) at least 18 years old; (2) report having a “primary main male partner” operationalized as (a) a male with whom he has had an ongoing sexual relationship over the prior 6 months, and (b) a male with whom the participant has an emotional relationship/bond more than with any other person; (3) self-identify as African American and/or Black, or identify having a main partner who self-identifies in this manner; (4) Identify each other as their main partner; (5) report having had unprotected anal sex with a man who is a nonmain partner in the past 60 days (or whose main partner meets this criterion); (6) report using methamphetamine at least once in the past 60 days (or whose main partner meets this criterion); (7) report not being either in or seeking drug treatment; and (8) not be newly diagnosed as HIV-positive within the last 6 months. Screenings were conducted in a private office in a research clinical space dedicated to the study or by phone after the study staff member instructed and confirmed that the respondent was speaking privately. Study staff did not share nor reveal responses given by a respondent’s partner to the respondent. For this secondary analysis of screening data, we use all cases from the screening database for which we have data from both partners who meet the Criteria 1 to 4 (N= 74 individuals from 37 couples).

The Institutional Review Boards from both the funding agency and the investigative team’s institution approved all protocols, materials, and information used in this study, including the process for obtaining and documenting verbal consent before screening.

Measures

The screening questionnaire included items to prompt participants to self-report sociodemographic information (i.e., age, race/ethnicity, sexual orientation identity, education, housing situation, income, and HIV status) as well as the length of the relationship and whether they have had unprotected insertive or receptive anal intercourse with their primary male partner. All measures used in this study were derived from multiple-choice or close-ended questions, with the exception of “Other, specify”: open-ended options for some items such as race, sexual orientation (though we note that these did not have to be coded in this study due to no respondents selecting/specifying that option). Substance use was assessed using an abbreviated version of the drug use portion of the National Institute on Drug Abuse Risk Behavior Assessment (National Institute on Drug Abuse, 1993) with the following substances: heavy drinking (operationalized as “five or more drinks in a single period”), marijuana, powdered cocaine, rock/crack cocaine, heroin, and methamphetamine. IPV was assessed using the Revised Conflict Tactics Scale (CTS2; Straus, Hamby, BoneyMcCoy, & Sugarman, 1996). The reliability of the CTS2 was assessed for the set of items falling within each of the CTS2 categories (i.e., psychological, physical, sexual, and injurious) using Cronbach’s α; results from this sample of predominantly HIV-positive, Black MSM suggest that the reliability was “acceptable” to “excellent” (Cronbach’s α = .78-.93) and lend confidence that the items in each scale are measuring the same, single construct. These estimates of internal consistency of the CTS2 with this sample are comparable with those reported by the originators of the CTS2 (Straus et al., 1996). Items related to minor psychological violence (e.g., “shouted at partner,” “stomped out of room”) were not included due to concerns about low specificity with respect to IPV. Finally, to report/estimate prevalence for each of the IPV categories in the CTS2, responses were dichotomized, summing items within their corresponding category and coding as 0 if the sum of the items was 0, which corresponds to responding “never” to all the relevant items.

Analyses

Statistical analyses were performed using Stata/SE Version 10.1. Concordance of IPV reports was examined by comparing a participant’s responses to experiencing IPV with his partner’s responses to perpetration of IPV. Multivariate logistic regression was used to assess the strength of association between the focal independent variable of substance use on the dependent variable of IPV while controlling for sociodemographic and relationship characteristics; each substance was entered in its own regression model. Inferential hypothesis testing relied on the adjusted odds ratios (ORs), their associated standard errors, and corresponding p values. Although the participants were recruited as couples, the unit of analysis was the individual. The relatively small sample size and the attendant impact on variance prohibited a rigorous application of multilevel modeling. However, concerns about the dyadic nature of the data may be mitigated given that there were no significant correlations between partners with respect to reports of substance use; the largest chi-square (for heavy drinking) was .92 with 1 degree of freedom. The criterion level used to determine significance was p< .05, though as an exploratory study, p< .10 was taken as “suggestive.”

Results

Characteristics of the Sample

The characteristics of the 74 individuals—representing both partners of 37 Black MSM couples screened for inclusion in the parent couple-based HIV intervention study targeting methamphetamine-involved, Black MSM—are presented in Table 1. The age of participants ranged from 21 to 59 years old. The sample predominantly self-identified as gay or homosexual (n = 63, 85%), followed by bisexual (n = 9, 12%); only a small number (n = 2, 3%) identified as straight or heterosexual (e.g., consistent with Black men being on the “down low”). The majority of couples (30 of 37, 82%) consisted of partners who were both Black, with 6 of the remaining 7 couples composed of a Black and Latino interracial relationship. The reported length of the relationship with the main partner in the sample ranged from 6 months to 12 years. The majority of participants (n= 68, 92%) reported engaging in unprotected anal sex with their main partners.

Table 1.

Characteristics of the 74 Individuals Constituting the Sample of 37 Methamphetamine-Using, Black Men Who Have Sex With Men Couples in New York City.

Age (years)	M = 41.8 (SD = 8.4)
Sexual orientation
Gay/homosexual	n = 63 (85%)
Bisexual	n = 9 (12%)
Straight/heterosexual	n = 2 (3%)
Race
Black/African American	n = 67 (91%)
Latino/Hispanic/Chicano	n = 6 (8%)
Mixed	n = 1 (1%)
Has HS diploma/GED or more education	n = 61 (82%)
Recent homelessness	n = 14 (19%)
Income over past 12 months (× US$1,000)	M = 12.6 (SD = 9.9)
HIV-positive	n = 70 (95%)
Length of relationship (years)	M = 1.9 (SD = 3.4)
Substance use
Heavy drinking	n = 47 (64%)
Marijuana	n = 66 (89%)
Methamphetamine	n = 57 (77%)
Powdered cocaine	n = 48 (65%)
Rock/crack cocaine	n = 43 (58%)
Heroin	n = 10 (14%)

Note. HS = high school and GED = General Education Development.

Just under two thirds (n= 47, 64%) of the sample reported heavy drinking. The vast majority (n= 72, 97%) of the sample reported use of at least one illicit substance. The most frequently reported illicit substance used was marijuana (n= 66, 89%), followed by methamphetamine use (n= 57, 77%).

IPV

More than one third (n= 26, 36%) of the sample reported ever experiencing some form of IPV from their main partners; about one fourth (n= 19, 26%) of the participants reported experiencing some form of IPV in the past 30 days from their main partners. With respect to perpetration of IPV against the current main partner, 26 (36%) reported ever engaging in such behavior, and 20 (28%) reported doing so in the past 30 days. The majority of reporting of IPV was concordant: 54 (73%) participants’ report of ever experiencing IPV was in agreement with the partners’ report of ever perpetrating IPV against that participant (n= 38 were in concordance with no IPV and 16 were in concordance for presence of IPV); 10 (14%) participants reported ever experiencing IPV, whereas their partners reported no history of IPV; and 10 (14%) participants reported not experiencing IPV whereas their partners reported perpetration of IPV. Concordance for IPV in the past 30 days was observed for 57 (77%) of the participants (n= 46 for no IPV, n= 11 for presence of IPV in the past 30 days); 8 (11%) reported experiencing IPV in the past 30 days, whereas their partners reported no perpetration of IPV in the past 30 days; and 9 (12%) reported not experiencing IPV the past 30 days whereas their partners reported perpetration of IPV in the past 30 days.

Table 2 presents the prevalence of specific types of IPV by direction (experienced vs. perpetrated) as well as time frame.

Table 2.

Prevalence of Intimate Partner Violence Among Partners in Methamphetamine-Using, Black Men Who Have Sex With Men Couples in New York City.

	Experienced		Perpetrated
	Ever	Past 30 Days	Ever	Past 30 Days
Form of IPV	n (%)	n (%)	n (%)	n (%)
Psychological	21 (28)	16 (22)	23 (31)	18 (24)
Physical	20 (27)	12 (16)	18 (24)	10 (14)
Sexual	11 (15)	7 (9)	11 (15)	6 (8)
Injurious	7 (9)	3 (4)	5 (7)	2 (3)

Although the same number of participants (n= 26) reported a history of ever experiencing and perpetrating IPV, they were not all the same individuals. Table 3 presents contingency tables for reports of experiencing and perpetrating IPV from each participant; results are presented separately for the two time frames (ever and past 30 days). Among the 28 individuals reporting presence of IPV in their relationship, the large majority (n = 24, 86%) reports both experiencing and perpetrating IPV; a similar finding is observed for IPV in the past 30 days (n= 18 of 21, 86%). Altogether, at the couple level, bidirectional IPV that is reported with concordance occurred in 16 (62%) of 26 couples.

Table 3.

Concurrency of “Direction”—Experienced Versus Perpetrated—IPV Among Partners in Methamphetamine-Using, Black Men Who Have Sex With Men Couples in New York City.

IPV: Ever				IPV: Past 30 Days
		Perpetrated				Perpetrated
		No	Yes			No	Yes
Experienced	No	44	2	Experienced	No	51	2
Experienced	Yes	2	24	Experienced	Yes	1	18

Note. IPV = intimate partner violence.

Substance Use and IPV

Table 4 summarizes the findings from multivariate models examining the association between use of different substances and IPV while controlling for sociodemographic and relationship characteristics. A significant increase in likelihood of ever experiencing IPV from the current main partner was observed for heavy drinking, rock/crack cocaine use, and methamphetamine use. Heavy drinking and methamphetamine use remained significantly associated with experiencing IPV in the past 30 days, while the association with rock/crack cocaine use was suggestive. Heavy drinking, rock/crack cocaine use, and methamphetamine use were significantly associated with ever perpetrating IPV against the current partner, and there was a suggestive association with heroin use. Heavy drinking and methamphetamine use were significantly associated with perpetration of IPV in the past 30 days, but the association with rock/crack cocaine use was no longer significant.

Table 4.

Associations^a Between Substance Use and IPV Among Partners in Methamphetamine-Using, Black Men Who Have Sex With Men Couples in New York City.

	Experienced Any IPV		Perpetrated Any IPV
	Ever	Past 30 Days	Ever	Past 30 Days
Heavy drinking	3.4* [1.0, 11.8]	5.0* [1.1, 21.7]	5.1* [1.3, 19.9]	6.7* [1.5, 30.2]
Marijuana	4.2 [0.4, 41.0]	3.1 [0.3, 30.2]	1.7 [0.3, 11.0]	1.2 [0.2, 7.5]
Powdered cocaine	2.5 [0.7, 9.5]	2.8 [0.7, 11.9]	2.2 [0.6, 8.0]	1.9 [0.5, 7.9]
Rock/crack cocaine	3.7* [1.1, 13.1]	3.0^† [0.8, 11.5]	3.7* [1.0, 13.1]	2.2 [0.6, 8.2]
Methamphetamine	9.7* [1.4, 65.6]	16.8* [1.4, 206.9]	22.9** [2.1, 248.1]	24.6* [1.8, 331.0]
Heroin	1.1 [0.2, 7.9]	1.4 [0.2, 10.9]	5.0^† [0.7, 33.9]	4.5 [0.7, 30.7]

Note. IPV = intimate partner violence.

Estimates are adjusted odds ratios (and 95% confidence intervals). Variables used for covariance adjustment included age, education, recent homelessness, income, length of relationship, HIV status, and whether the participant engaged in unprotected anal intercourse with his main partner.

†

p< .10. *p< .05. **p< .01.

Sensitivity analyses included using forward stepwise regression with all of the drug use variables. For three of the four outcome variables—experienced IPV in the past 30 days, perpetrated IPV ever, and perpetrated IPV in the past 30 days—significant associations were observed for heavy drinking and methamphetamine use; for experiencing IPV ever, significant associations were found for heavy drinking and crack cocaine use. We also examined drug use in the past 30 days. Many of these models did not reach significance with a 95% level of confidence. However, the point estimates were always in the same direction and generally within 10% to 25% of the point estimate shown in Table 4. Similar results were also obtained if participants identifying as straight/heterosexual were excluded from the analyses. Thus, we posit that the essential relationships, and thus our conclusions, remain unchanged and that the lack of significance stems from the limited statistical power due to the small sample size.

Discussion

These findings indicate that IPV was prevalent among this sample of predominantly HIV-positive, Black MSM couples to a substantial degree: More than a third reported either perpetrating IPV, experiencing IPV, or both at some point in the relationship with their current main partner; more than a quarter reported IPV occurring within this relationship in the past 30 days. Findings also support that substance use—particularly heavy drinking, methamphetamine use, and rock/crack cocaine use—and IPV are linked among this sample of Black MSM couples.

Several crucial limitations prompt caution regarding the generalizability of findings from this study. As the parent study focused on enrolling methamphetamine-using Black MSM who are engaging in sexual risk behavior, this sample should not be considered representative of Black MSM couples; this may also include possible overrepresentation of methamphetamine use due to the focus of the parent study and recruitment materials although we note that methamphetamine use was not required nor known at the time of screening. Concomitantly, the potential lower frequency of use of other substances may increase the likelihood of Type II error (i.e., failure to reject the null hypothesis when in fact there is a relationship between use of a particular substance and IPV). The use of the CTS2 does not include power and controlling behaviors that might be more unique or particularly salient for MSM and/or Black MSM; such behaviors might include threatening to disclose a partner’s sexuality or HIV status to his family, coworkers, and so forth, or threatening to exclude a partner from the local network of gay Black men. The lack of event-level data and temporal precision prohibit inference on causality or direction of the relationship between substance use and IPV. The small sample size is also a limitation; while the caution regarding generalizability has already been noted, the resultant large confidence intervals also prompt us to not interpret the actual magnitude or value of the adjusted ORs in multivariate models. Future studies with larger sample sizes and more sophisticated sampling procedures will also allow for more appropriate inference, such as the ability to use multilevel statistical analyses that can model intraclass correlations arising from individuals reporting on dyadic behaviors and generate more accurate standard errors.

While the limitations underscore the exploratory/preliminary nature of this study, the findings support the importance and need for additional research on IPV among Black MSM. As this study only assessed IPV among current partners, the observed IPV prevalence rates of 38% represent a lower limit; IPV assessed across all other partners/relationships can only increase the measured prevalence. If IPV rates across [male] partners were no higher than observed in this study with the current partner, that could suggest that Black MSM might be more likely to remain in or less able to dissolve a violent relationship; if IPV rates across partners were higher, then it is possible that prevalence rates of IPV among Black MSM may exceed those for MSM in general as well as women in heterosexual relationships given the rates noted in the introduction. Possible causes and attendant implications may be lack of attention and/or visible, positive models for Black MSM that same-sex relationship can and should be free of violence, as well as lack of resources to help Black MSM leave or end violent relationships. The findings may also suggest a need for batterer intervention programs to be developed and made available for Black MSM and their male partners. These gaps in turn may arise or be perpetuated by both presumed heterosexuality and a dominant heterosexual paradigm in education and portrayal of intimate relationships. Of course, it could also reflect the historical nature of the IPV movement based on redressing patriarchy and misogyny as fundamental to IPV. All these issues underscore the importance of future research examining IPV across partners that could better establish prevalence rates among Black MSM compared with existing research with other populations as well as validate or refine putative theories on IPV; this would be a crucial step to better understand the social dynamics that lead to IPV rather than potentially undermining the belief in the quality and health of Black MSM relationships.

Several theories and accompanying models have been proposed to explain the link between substance use and IPV. The psychoactive effects of substance use—such as impaired judgment, cognitive processing, decreased inhibition from alcohol use; excitatory/stimulant properties of methamphetamine use—may increase the likelihood of use of violence in response to conflict, stress, or desire to gain/maintain control in the relationship as well as the inability to remove oneself from or de-escalate impending IPV. Similarly, neurological and psychological effects from substance abuse/dependency—such as depression and/or aggressive tendencies from chronic alcohol use; paranoia from chronic methamphetamine use—may foster IPV. Substance use may lead to IPV indirectly. For example, conflict and stress between partners may arise due to differences in desire to abstain, seek treatment, and/or go into recovery. Relapse was also noted as a cause of contention in a qualitative study with methamphetamine-involved Black MSM couples (Wu, El-Bassel, McVinney, Fontaine, & Hess, 2010). It is also possible that substance use might arise in response to IPV, such as to alleviate pain from experiencing IPV and/or to de-escalate or distract a violent partner. Finally, there may be “third variables” or common causes that are associated with both substance use and IPV, such as early experience or witnessing of violence and trauma (J. B. Cohen et al., 2003; M. Cohen et al., 2000; Ehrensaft et al., 2003; Gilbert et al., 2009) and a structural environment that fosters both substance use and violence (Iritani et al., 2013; Waller et al., 2013).

In this study, perpetration of IPV was corroborated by the reports of experiencing IPV and vice versa from 76% to 77% of the couples. These concordance rates are in line with the highest rates of concurrence in reports among studies of heterosexual couples that used a comparable measure of IPV, whereas the majority of analyses from those studies reveal lower rates (some as low as 10%) of concordance, most often with males not reporting perpetration of IPV versus their female partners reporting experiencing IPV (Caetano, Field, Ramisetty-Mikler, & Lipsky, 2009; Caetano, Schafer, Field, & Nelson, 2002; Marshall, Panuzio, Makin-Byrd, Taft, & Holtzworth-Munroe, 2011; Panuzio et al., 2006). The 62% bidirectional IPV rate observed in this study is at the higher end of the 46% to 69% rate of bidirectional IPV reported in studies with larger samples of heterosexual couples (Langhinrichsen-Rohling, Selwyn, & Rohling, 2012). Altogether, the concordance and bidirectional reporting rates that are relatively high (vis-à-vis those reported with heterosexual couples) may be more consistent with the conflict and family systems theories of IPV rather than the patriarchal/gender-based putative explanations. However, it may be that MSM couples are not comparable (over and beyond sex of partners) with the majority of heterosexual couples. We are not arguing that patriarchal and misogynistic roots of IPV are invalid, as such a position may hamper valuable research and intervention efforts worldwide (Reed, Raj, Miller, & Silverman, 2010); rather, they may be less applicable to same-sex couples, especially racial/ethnic minorities, as discussed below.

We start by noting that all of the aforementioned theories are not necessarily mutually exclusive. Some may be more salient for certain individuals, regions, and historical and/or socioeconomic factors. Given that the vast majority of the empirical IPV literature focuses on heterosexuals, we present additional considerations regarding those who are both racial and sexual minorities. The concept of minority stress may be particularly relevant (Balsam & Szymanski, 2005; Lewis, Milletich, Kelley, & Woody, 2012; I. H. Meyer, 1995). Difficulties both within and between partners with respect to coping with such stressors such as homophobia and racism, being “out,” level of connection with the local Black or gay communities, and mistrust of law enforcement and service providers can lead to relationship conflict and instability, which can compound the impact of substance use, increase the likelihood of IPV, and limit the ability to avoid, interrupt, or end IPV in the relationship.

While this was a smaller scale study that had findings consistent with an alcohol, methamphetamine, and IPV interrelationship on a backdrop of HIV prevention, a systematic review by Vosburgh, Mansergh, Sullivan, and Purcell (2012) suggests that these findings may be a finding and dynamic that is generalizable to MSM in general; the review of 23 independent studies culled from more than 1,600 articles published after 1995 on substance abuse and HIV risk among MSM that provided event-level measures found that across 11 substances measured, only heavy alcohol use and methamphetamine use were found to be associated with sexual risk behavior in all of the studies. Taken together, another perspective has emerged to posit that—like that posited for women in inherently or historically patriarchal societies like the United States—IPV, substance abuse, and other prominent issues such as HIV are a set of intersecting and interacting epidemics, that is, a “syndemic” (J. P. Meyer, Springer, & Altice, 2011; Stall, Friedman, & Catania, 2007). The syndemic can be thought of as being driven by the minority stress and its consequences throughout the developmental life span (see Figure 9-1 in Stall et al., 2007), from internalized homophobia and racism during childhood, to threats to well-being on seeking contact and acceptance by various communities (e.g., exposure to violence, alcohol/drugs, hypersexualization of Black males/MSM, exchange/commercial sex) often during adolescence and early adulthood, to institutional and cultural racism, homophobia, and heterocentrism experienced in adulthood and later life at the workplace, civil organizations, and service systems.

The findings and consequent discussion also underscore a need for IPV services among drug-involved Black MSM. Arguably first and foremost is the need to increase the visibility of Black MSM couples as a societally sanctioned social institution worthy of having services for issues that threaten their well-being. Service providers—especially those in the fields of substance abuse and HIV—should be resourced and trained to assess, refer, and address IPV among MSM of color with the same diligence needed for male-to-female perpetrated IPV. The syndemic understanding that ties substance use, IPV, and HIV may initially be daunting to interventionists in that any one of the issues requires consideration and sophistication to mitigate the influence of the other problem. However, it does suggest that successfully intervening in one issue may confer additional benefits in the other domains. There is a burgeoning body of research with heterosexual couples that provide empirical support that substance abuse treatment can reduce IPV (see Stuart, O’Farrell, & Temple, 2009, and Murphy & Ting, 2010 for reviews): nonexperimental and quasi-experimental studies have observed moderate effect size reductions (Cohen’s d = .41) in IPV; although experimentally controlled studies have smaller and/or nonsignificant effects (Easton et al., 2007; Kraanen, Vedel, Scholing, & Emmelkamp, 2013), some aspects of design of these studies (e.g., highly active/attentive control groups, small sample size) may have undermined the ability to detect a reduction in IPV. Thus, drug treatment, even with no or minimal additional attention paid to IPV may still confer a reduction in IPV. Another study found preliminary promise and some additional benefit by adding a single, 90-min alcohol intervention to a standard (male-to-female) IPV/batterers intervention program on outcomes both for alcohol use and severe/injurious form of IPV (Stuart et al., 2013).

In summary, this study demonstrates that Black MSM couples may be likely to be confronted with intersecting and interacting epidemics that threaten the well-being of the individual partners as well as their relationship. At the same time, these findings indicate that these issues can be identified among a wide range of service systems as well as possibly more effectively addressed in an integrated or coordinated manner, especially among drug treatment, IPV, and HIV services. These are important avenues to enhancing the health, relationship well-being, and rights of men who are both racial and sexual minorities.

Footnotes

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The data presented in this manuscript were obtained from a study funded by the Centers for Disease Control and Prevention (CDC), grant # UR6PS000300.

Author Biographies

Elwin Wu, PhD, is an associate professor at the Columbia University School of Social Work (CUSSW), an associate director of the CUSSW Social Intervention Group (SIG), and the codirector of the HIV Intervention Science Training Program for Racial/Ethnic Minority New Investigators (HISTP). He conducts both services research and intervention research with populations residing at the nexus of substance abuse, violence, and HIV.

Nabila El-Bassel, DSW, is a professor at CUSSW, the director of SIG, and the director of HISTP. She is also the director of the Columbia University Global Health Research Center in Central Asia. She has been studying the co-occurring problems on of HIV, violence/trauma, and substance abuse in the United States and internationally.

L. Donald McVinney, MS, is the director of training at Harlem United. He has been involved in providing community-based services addressing substance use issues within lesbian, gay, bisexual, and transgender (LGBT) communities and also how substance use intersects with HIV/AIDS.

Leona Hess, PhD, was the project director for the parent study. She has been providing services and studying health and developmental issues among LGBT populations.

Mark V. Fopeano, MS, was a research assistant at SIG and assisted with data analyses.

Hyesung G. Hwang, MS, was a research assistant at SIG and assisted with interpretation of findings and writing of this manuscript.

Mahnaz Charania, PhD, was an associate service fellow at the Centers for Disease Control and Prevention (CDC).

Gordon Mansergh, PhD, is a senior behavioral scientist at the CDC.

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