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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                    <jats:italic>n\u2009=<\/jats:italic>\n                    \u20091389), 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 (\n                    <jats:italic>OR<\/jats:italic>\n                    \u2009=\u20093.064,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;.001) and have an undetectable VL (\n                    <jats:italic>OR<\/jats:italic>\n                    \u2009=\u20092.595,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;.001) compared to single SMM. Among non-monogamous SMM with sero-discordant partners, relationship quality was positively associated with ART adherence (\n                    <jats:italic>OR<\/jats:italic>\n                    \u2009=\u20091.065,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;.001) and having an undetectable VL (\n                    <jats:italic>OR<\/jats:italic>\n                    \u2009=\u20091.046,\n                    <jats:italic>p<\/jats:italic>\n                    =.003). Among monogamous SMM with sero-concordant partners, the effect of relationship quality on ART adherence (\n                    <jats:italic>OR<\/jats:italic>\n                    =0.855,\n                    <jats:italic>p<\/jats:italic>\n                    =.007) and having an undetectable VL (\n                    <jats:italic>OR<\/jats:italic>\n                    =0.909,\n                    <jats:italic>p<\/jats:italic>\n                    =.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 (\n                    <jats:italic>OR<\/jats:italic>\n                    =0.956,\n                    <jats:italic>p<\/jats:italic>\n                    =.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.\n                  <\/jats:p>","DOI":"10.1007\/s10461-026-05050-4","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T12:15:35Z","timestamp":1773231335000},"page":"2256-2267","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1007","volume":"30","author":[{"given":"Joseph R.","family":"Hillesheim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0746-3844","authenticated-orcid":false,"given":"Tyrel J.","family":"Starks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"#cr-split#-5050_CR1.1","unstructured":"Centers for Disease Control and Prevention. 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