Thriving Together: Examining the Dyadic Coping Process Among Chinese HIV Serodiscordant Same-sex Male Couples

Abstract

Human immunodeficiency virus (HIV) has claimed an estimated 42.3 million lives worldwide and remains a critical global public health challenge. HIV serodiscordant same-sex male couples, where one partner is HIV-positive and the other is HIV-negative, encounter complex social and relational difficulties, including potential cross-partner transmission risks and dual stigma related to both HIV status and sexual orientation. HIV can be viewed as a form of dyadic stress that profoundly affects the adjustment of both partners in the relationship. Therefore, it is necessary to examine the dyadic coping process among HIV serodiscordant same-sex male couples.

There are several critical knowledge gaps in existing studies. First, there is a theoretical gap concerning the operational definition of the dyadic coping process. Existing literature has predominantly examined this as a mutual influence operating as partner effects in the Actor-Partner Interdependence Model. However, these models posit that dyadic coping process may be conceptualised beyond mutual influence, potentially manifesting as complex shared configurations that transcend individual-level interactions. Second, there is a population and empirical gap where Chinese HIV serodiscordant same-sex male couples are an under-researched demographic in this area. While existing literature has mostly focused on non-clinical couples and, more recently, clinical populations such as those with cancer, diabetes, and cardiovascular conditions, research on same-sex couples, particularly within the context of HIV, remains limited. Studying this demographic advances couple research by addressing unique cultural, biomedical, and minority stress factors that shape illness management, thereby refining dyadic coping theories and informing tailored, culturally sensitive interventions to improve health and relationship outcomes in this underserved population. Such work also broadens the applicability of couple-based models to stigmatised and clinical populations. Third, there is a practical and evidence gap because very few practical studies have addressed the relational and psychological needs of HIV serodiscordant same-sex male couples. As a marginalised and highly stigmatised group in China, very few community services are evidence-based and tailored for this population. Aligned with principles of social justice, this research aims to advance psychological science by addressing the unique challenges faced by this vulnerable population with the ultimate goal of supporting couples in navigating adversity and thriving amid it.

Guided by Bodenmann’s Systemic Transactional Model and Berg’s developmental-contextual model of couples coping with chronic illness, this research adopts three studies to examine the dyadic coping process. It focuses on three core components among Chinese serodiscordant same-sex male couples: we-disease appraisal, common dyadic coping, and adjustment. Dyadic coping is conceptualised as a shared process, operationalised through the Common Fate Model (CFM), which allows for a more in-depth understanding of couple-level interactions in the context of HIV. Three interconnected research objectives are pursued. One, to assess the associations between we-disease appraisal and adjustment outcomes via common dyadic coping among Chinese serodiscordant same-sex male couples (Study One: Descriptive Mapping, N = 222 dyads, cross-sectional design). Two, to delineate how dyadic coping manifests in everyday life, exploring both within-dyad and between-dyad associations between we-disease appraisal and adjustment outcomes via common dyadic coping among Chinese serodiscordant same-sex male couples (Study Two: Longitudinal Process Analysis, N = 141 dyads, fourteen-day daily diary design). Three, to assess the preliminary efficacy and feasibility of implementing a theory-driven, culturally sensitive, couple-based intervention designed to improve the dyadic coping process among Chinese serodiscordant same-sex male couples (Study Three: Intervention Development and Evaluation, N = 44 dyads, randomized controlled trial).

Dyadic coping models propose that we-disease appraisal is a crucial step that triggers common dyadic coping, which in turn facilitates successful adjustment for couples managing a chronic illness. HIV represents a typical dyadic stressor due to the risks of cross-partner transmission and stigma by association, both of which impact both partners. However, the relationship can act as a protective factor against negative effects. Therefore, Study One adopted a cross-sectional design to assess the associations between we-disease appraisal and adjustment outcomes via common dyadic coping among serodiscordant same-sex male couples in China. It adopted the CFM to quantify the dyadic coping process as a shared process. This part of the research found that the dyadic coping process could be effectively conceptualised as a shared phenomenon, evidenced by moderate-to-large standardised factor loadings across we-disease appraisal, common dyadic coping, and adjustment outcomes. Also, the direct effects of we-disease appraisal on relationship satisfaction and quality of life were not significant. In addition, common dyadic coping significantly mediated the association between we-disease appraisal and relationship satisfaction, though this effect was not observed in the relationship between we-disease appraisal and quality of life.

The dyadic coping process is conceptualised in models as a developmental journey that spans a lifetime. This involves the temporal progression of managing various aspects of illness and unfolds sequentially through specific moments during conversations or across days. To effectively capture its dynamic nature, research must adopt a microanalytical, process-oriented approach such as an idiographic design that can track these changes in daily life. Accordingly, Study Two aligns more closely with the theoretical assumptions of dyadic coping models and addresses the limitations of the cross-sectional design used in Study One. Study Two employs a daily diary design to assess how it manifests in everyday life. It explores within-dyad and between-dyad associations between we-disease appraisal and adjustment outcomes via common dyadic coping in this demographic. A multilevel CFM is utilised to quantify dyadic coping as a shared process at the within-dyad and between-dyad levels. It showed that daily we-disease appraisal was significantly and positively related to quality of life and relationship satisfaction only at the between-dyad level. In contrast, daily common dyadic coping showed significant positive associations with these outcomes exclusively at the within-dyad level. Common dyadic coping emerged as a key mediator, bridging we-disease appraisal and quality of life and relationship satisfaction at the within-dyad level. Furthermore, daily we-disease appraisal positively predicted relationship satisfaction and quality of life at follow-up assessment.

Drawing upon the insights from the previous two studies, Study Three adopted a randomised controlled trial design to assess the preliminary efficacy and implementation feasibility of a theory-driven, culturally sensitive, couple-based intervention designed to improve the dyadic coping process for this group. Forty-four couples were randomly assigned to either the dyadic coping (intervention) or the usual care (control) group, with an allocation ratio of 1:1. They participated in three weekly sessions that included psychoeducation aimed at fostering we-disease appraisal and skill-building exercises focused on communication and common dyadic coping within the context of HIV. An assessment was conducted before the intervention, immediately after, and one-month post-intervention. A dyadic latent growth model was employed to evaluate the intervention’s immediate and long-term effects. The findings of this study were that the intervention arm showed immediate and significant improvements compared to the usual care group. HIV-positive partners experienced notable enhancements in couple communication and quality of life, and HIV-negative partners showed marked improvements across multiple domains, including we-disease appraisal, couple communication, common dyadic coping, relationship satisfaction, and quality of life. However, no significant changes were observed in antiretroviral therapy adherence or condomless sex. From pre-intervention to follow-up, the intervention group maintained sustained benefits over time, with continued improvements relative to the usual care arm in couple communication, common dyadic coping, relationship satisfaction, and quality of life for both HIV-positive and HIV-negative partners. Again, though, no significant effects were found for ART adherence or condomless sex. Moreover, most HIV-positive and HIV-negative partners expressed a willingness to recommend the intervention to others.

This thesis provides a comprehensive examination of the dyadic coping process among HIV serodiscordant same-sex couples in China, offering both theoretical and practical contributions to our understanding of couple-level health management. Theoretically, it demonstrates that the dyadic coping process can be conceptualised and statistically modelled as a complex common fate phenomenon that extends beyond traditional partner influence frameworks. Furthermore, the critical mediating role of common dyadic coping between we-disease appraisal and adjustment is identified. The innovative approach used in this study is exemplified by the development of a theory-driven, culturally sensitive, couple-based intervention that produced significant positive effects on HIV-positive partners’ couple communication and quality of life, as well as on HIV-negative partners’ we-disease appraisal, couple communication, common dyadic coping, relationship satisfaction, and quality of life. Practically, the effects of this intervention were sustained over time across both partners’ couple communication, common dyadic coping, relationship satisfaction, and quality of life. By systematically illuminating the dyadic coping process in HIV serodiscordant same-sex partnerships, this thesis not only offers a novel theoretical perspective, modelling dyadic coping as a complex common fate phenomenon, but also develops a theory-driven, cost-effective couple-based intervention, advancing a more inclusive and effective response to the HIV epidemic within a highly stigmatised society.

Date of Award	12 Aug 2025
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Xiaonan Nancy YU (Supervisor)