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Objective Dual threats of injection drug use and risky sexual practices continue to increase transmission of HIV and other sexually transmitted Infections (STIs) among drug-using couples in low-income communities in the United States. Two hypotheses were tested: (1) "intervention effect"-whether the HIV risk-reduction intervention provided to the couple or individual partners would be more efficacious in decreasing number of unprotected sexual acts and having a lower cumulative incidence of biologically confirmed STIs over the 12-month follow-up period compared with the attention control condition; and (2) "modality effect"-whether the HIV risk-reduction intervention would be more likely to decrease the number of unprotected sexual acts and have a lower cumulative STI incidence when delivered to a couple compared with the same intervention delivered to an individual. Design Using a randomized controlled trial, 282 HIV-negative drug-using couples (564 individuals) were randomly assigned to receive either of the following: (1) couple-based risk reduction; (2) individual-based HIV risk reduction, or (3) couple-based wellness promotion, which served as an attention control condition. Results Over 12-month follow-up, there was a 30% reduction in the incidence rate of unprotected acts of intercourse with the study partners compared with participants in the attention control arm. Moreover, over 12-month follow-up there was a 29% reduction in the same outcome in the couple arm compared with the individual arm with a 41% reduction at the 12-month follow-up. Conclusion A couple-based approach that addresses drug and sexual risks and targets low-income active drug users may help curb the HIV epidemic.

This article presents an overview of couple-based HIV prevention research to date, advantages of using and core components of couple-based interventions, gaps in the current understanding of couple-based HIV prevention, status of dissemination research and the transportability of effective couple-based HIV prevention and treatment to real-world settings, and recommendations for future directions in couple-based prevention and treatment. Couple-based studies conducted among several populations—heterosexuals, men who have sex with men, and drug users—reported in the research literature were reviewed. Commonalities and limitations were noted in customary focus areas of the couple-based approaches: sexual and drug risk reduction, HIV testing behaviors, adherence to HIV treatment, and prevention of mother-to-child transmission. Couple-based intervention strategies have been rigorously tested and are a valuable addition to the arsenal of HIV prevention strategies. Immediate needs and opportunities include couple-based intervention strategies for prevention of HIV and other sexually transmitted infections among serodiscordant couples, couples who do not know their HIV status, and couples in whom both partners are HIV negative, but at risk of HIV infection. There is a particular need to develop couple-based intervention strategies for men who have sex with men and for drug-involved couples.

CONTEXT: Individuals’ accurate assessment of their exposure to the risk of HIV and other STDs requires awareness of their sexual partners’ risk behaviors and disease status. METHODS: In a sample of 217 couples enrolled in a risk intervention trial in 1997–2002, both partners reported on their own risk behaviors and their perceptions of their partner's behavior; concordance of partners’ reports was examined using kappa statistics. Individual and relationship characteristics predicting lack of awareness of a partner's risk behavior were explored using multivariate logistic regression. RESULTS: Three percent of women and 14% of men were unaware that their partner had recently had a concurrent partner. Eleven percent and 12%, respectively, were unaware that their partner had ever injected drugs; 10% and 12% were unaware that their partner had recently received an STD diagnosis; and 2% and 4% were unaware that their partner was HIV-positive. Women's lack of awareness of partner risk was associated with increasing age (odds ratio, 1.1), being of a race or ethnicity other than black or Latina (15.8) and having a Latino partner (3.7); it was positively associated with a man's report that he was married (4.4) and with relationship satisfaction as reported by both the woman and her partner (1.2 for each). Among men, lack of awareness was positively associated with partner's age (1.1) and with having a partner who was formerly married (8.2). CONCLUSIONS: Couple-based interventions that assess each partner's awareness of the other's risk behavior may help programs better target couples’ STD prevention needs.

Objectives: Assessments undertaken as part of couple-based HIV/sexually transmitted infection (STI) prevention intervention studies offer opportunities to expand our understanding of couple reporting of sexual and HIV/STI risk behavior. Increases in heterosexual transmission of HIV worldwide support more attention on the quality and use of couple-level sexual risk assessment. Study Design: This study examined interpartner concordance of self-reported sexual behaviors and HIV/STI risk behaviors among 217 women and their main male sexual partners at high risk for HIV/STI transmission and further explored specific individual and relationship characteristics by partner gender associated with discordant reporting of sexual and HIV/STI risk behaviors. Results: Consistent with prior studies, findings suggest fair to substantial agreement between partners on reports of most sexual and HIV/STI risk behavior, but only poor to fair agreement on reports of concurrent sexual behaviors and drug or alcohol use. Factors significantly associated with discordant reporting of sexual behaviors included length of couple relationship, level of relationship satisfaction, female partner’s marital status, and male partner’s HIV status, ethnicity, and age. Conclusions: Individual- and relationship-level factors predicting discordant partner reports of sexual and sexual risk behaviors highlight an opportunity to improve couple assessment by anticipating such discrepancies and developing effective mechanisms of quality assurance to avoid, address, or better explain such discordance in couple data sets.

This randomized clinical trial examined the relative efficacy of a relationship-based HIV/STI prevention intervention for women and their regular male sexual partners at 12 months post-intervention. A total of 217 couples were randomized to (1) a six-session intervention provided to the woman and her sexual partner together (n = 81); (2) the same intervention provided to the woman alone (n = 73); or (3) a one-session health information education “control” provided to the woman alone (n = 63). Findings suggest the intervention was efficacious in reducing unprotected sex at 12 months post-intervention, compared with the education control group. No significant differences were observed when comparing whether couples received the intervention together or when the woman received it alone.

Background: In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex. Methods: To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women’s HIV prevention intervention (the Western Cape Women’s Health CoOp) to include components of an evidence-based couple’s intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability. Results: The new intervention is called the Couples’ Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples’ Health CoOp also includes “voices” from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants’ suggestions made during formative work and pilot testing. Conclusions: The Couples’ Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa.Keywords: HIV Heterosexual couples Intervention adaptation Substance abuse Gender-based violence Sex risk behaviors South Africa