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Couple-Based HIV Counseling and Testing: a Risk Reduction Intervention for US Drug-Involved Women and Their Primary Male Partners

Abstract

To help reduce the elevated risk of acquiring HIV for African-American and Latina women drug users in primary heterosexual relationships, we developed a brief couple-based HIV counseling and testing prevention intervention. The intervention was based on an integrated HIV risk behavior theory that incorporated elements of social exchange theory, the theory of gender and power, the stages-of-change model, and the information-motivation-behavior skills model. In this article, we describe the development, content, and format of the couple-based HIV testing and counseling intervention, and its delivery to 110 couples (220 individuals) in a randomized effectiveness trial, the Harlem River Couples Project, conducted in New York City from 2005 to 2007. Components of the couple-based intervention included a personalized dyadic action plan based on the couple’s risk profile and interactive exercises designed to help build interpersonal communication skills, and facilitated discussion of social norms regarding gender roles. The couple-based HIV testing and counseling intervention significantly reduced women’s overall HIV risk compared to a standard-of-care individual HIV testing and counseling intervention. Experiences and perceptions of the intervention were positive among both clients and interventionists. The study was the first to demonstrate the effectiveness and feasibility of delivering a brief couple-based HIV counseling and testing intervention to reduce risk among drug-using heterosexual couples in high HIV prevalent urban communities in the USA. The intervention can be expanded to include new HIV prevention strategies, such as pre-exposure prophylaxis. Further research is needed to evaluate cost-effectiveness and implementation of the intervention in clinical settings.

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References

  • Allen, M., Emmers-Sommer, T., & Crowell, T. (2002). Couples negotiating safer sex behaviors: A meta-analysis of the impact of conversation and gender. In M. Allen, R. Preiss, B. Gayle, & N. Burrell (Eds.), Interpersonal communication research: Advances through meta-analysis (pp. 263–280). Mahwah: Lawrence Erlbaum.

    Google Scholar 

  • Anderson, J. E., Wilson, R. W., Barker, P., Doll, L., Jones, T. S., & Holtgrave, D. (1999). Prevalence of sexual and drug-related HIV risk behaviors in the U.S. adult population: Results of the 1996 National Household Survey on Drug Abuse. Journal of Acquired Immune Deficiency Syndromes, 21, 148–156.

    CAS  Article  PubMed  Google Scholar 

  • Bowleg, L., Lucas, K. J., & Tschann, J. M. (2004). “The ball was always in his court”: An exploratory analysis of relational scripts, sexual scripts, and condom use among African American women. Psychology of Women Quarterly, 28, 70–82.

    Article  Google Scholar 

  • Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., & Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morbidity and Mortality Weekly Report, 55, 1–17.

    Google Scholar 

  • Canary, D. J., & Emmers-Sommer, T. M. (1997). Sex and gender differences in personal relationships. New York: Guilford.

    Google Scholar 

  • Centers for Disease Control and Prevention. (1993). Technical guidance on HIV counseling. Morbidity and Mortality Weekly Report, 42, 5–9.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2009). HIV/AIDS surveillance report. (No. 19). Atlanta, GA.

  • Centers for Disease Control and Prevention. (2013). HIV/AIDS surveillance report. (No. 23). Atlanta, GA.

  • Connell, R. W. (1987). Gender and power. Stanford: Stanford University Press.

    Google Scholar 

  • El-Bassel, N., Witte, S., Gilbert, L., Sormanti, M., Moreno, C., Pereira, L., & Steinglass, P. (2001). HIV prevention for intimate couples: A relationship-based model. Families, Systems and Health, 19, 379–395.

    Article  Google Scholar 

  • Emerson, R. M. (1976). Social exchange theory. Annual Review of Sociology, 2, 335–363.

    Article  Google Scholar 

  • Emmers-Sommer, T. M., & Allen, M. (2005). Safer sex in personal relationships: The role of sexual scripts in HIV infection and prevention. Mahwah: Lawrence Erlbaum Associates.

    Google Scholar 

  • Emmers-Sommer, T. M., Maier, M., & Allen, M. (2014). Condom use and conflict in heterosexual relationships. In N. Burrell, M. Allen, B. Gayle, & R. Preiss (Eds.), Managing interpersonal conflict: Advances through meta-analysis (pp. 255–270). New York: Routledge.

    Google Scholar 

  • Finer, L. B., Darroch, J. E., & Singh, S. (1999). Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases. Family Planning Perspectives, 31, 228–236.

    CAS  Article  PubMed  Google Scholar 

  • Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS risk behavior. Psychological Bulletin, 111, 455–474.

    CAS  Article  PubMed  Google Scholar 

  • Higgins, J. A., Hoffman, S., & Dworkin, S. L. (2010). Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. American Journal of Public Health, 100, 435–445.

    PubMed Central  Article  PubMed  Google Scholar 

  • Holmberg, S. D. (1996). The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. American Journal of Public Health, 86, 642–654.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  • Houston, A. M., Fang, J., Husman, C., & Peralta, L. (2007). More than just vaginal intercourse: Anal intercourse and condom use patterns in the context of “main” and “casual” sexual relationships among urban minority adolescent females. Journal of Pediatric and Adolescent Gynecology, 20, 304.

    Article  Google Scholar 

  • Jemmott, L. S., Jemmott, J. B., Hutchinson, M. K., Cederbaum, J. A., & O'Leary, A. (2008). Sexually transmitted infection/HIV risk reduction interventions in clinical practice settings. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37, 137–145.

    Article  PubMed  Google Scholar 

  • Johnson, B. T., Scott-Sheldon, L. A. J., Smoak, N. D., LaCroix, J. M., Anderson, J. R., & Carey, M. P. (2009). Behavioral interventions for African Americans to reduce sexual risk of HIV: A meta-analysis of randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 51, 492–501.

    Article  Google Scholar 

  • Kalichman, S. C., Rompa, D., Luke, W., & Austin, J. (2002). HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships. International Journal of STD and AIDS, 13, 677–682.

    Article  PubMed  Google Scholar 

  • Kamb, M. L., Fishbein, M., Douglas, J. M., Jr., Rhodes, F., Rogers, J., Bolan, G., & Peterman, T. A. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Journal of the American Medical Association, 280, 1161–1167.

    CAS  Article  PubMed  Google Scholar 

  • Koblin, B. A., Hoover, D. R., Xu, G., Frye, V., Latka, M. H., Lucy, D., & Bonner, S. (2010). Correlates of anal intercourse vary by partner type among substance-using women: Baseline data from the UNITY study. AIDS and Behavior, 14, 132–140.

    Article  PubMed  Google Scholar 

  • LaCroix, J. M., Pellowski, J. A., Lennon, C. A., & Johnson, B. T. (2013). Behavioral interventions to reduce sexual risk for HIV in heterosexual couples. Sexually Transmitted Infections, 89, 620–627. doi:10.1136/sextrans-2013-051135.

    Article  PubMed  Google Scholar 

  • Markman, H. J., Stanley, S. M., & Blumberg, S. L. (1994). Fighting for your marriage: Positive steps for a loving and lasting relationship. San Francisco: Ossey Bass.

    Google Scholar 

  • McMahon, J.M., & Tortu, S. (2003). Evaluation of HIV intervention scenarios targeted to drug-using women from East Harlem: A mathematical modeling approach. In U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse (Eds.), Strategies to Improve the Replicability, Sustainability, and Durability of HIV Prevention Interventions for Drug Users (pp. 51–62).

  • McMahon, J. M., Tortu, S., Torres, L., Pouget, E. R., & Hamid, R. (2003). Recruitment of heterosexual couples in public health research: A study protocol. BMC Medical Research Methodology, 3, 24. doi:10.1186/1471-2288-3-24.

    PubMed Central  Article  PubMed  Google Scholar 

  • McMahon, J. M., Tortu, S., Pouget, E. R., Hamid, R., & Torres, L. (2004, July). Increased sexual risk behavior and high HIV seroincidence among drug-using low-income women with primary heterosexual partners. Paper presented at the XV International AIDS Conference, Bangkok, Thailand. Abstract retrieved from http://www.iasociety.org/Abstracts/A2168225.aspx.

  • McMahon, J. M., Tortu, S., Rodriguez, W., & Hamid, R. (2006). Couples HIV counseling and testing. A manual for an enhanced HIV-CT intervention for substance-using heterosexual couples. New York: Chaucer Press.

    Google Scholar 

  • McMahon, J. M., Tortu, S., Pouget, E. R., Torres, L., Rodriquez, W. R., & Hamid, R. (2013). Effectiveness of couples-based HIV counseling and testing for women substance users and their primary male partners: A randomized trial. Advances in Preventive Medicine, 286207, 15. doi:10.1155/2013/286207.

    Google Scholar 

  • Meader, N., Li, R., Des Jarlais, D. C., & Pilling, S. (2010). Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. Cochrane Database of Systematic Reviews, Art. No.: CD007192.(1) doi:10.1002/14651858.CD007192.pub2.

  • Miller, M., & Neaigus, A. (2001). Networks, resources and risk among women who use drugs. Social Science and Medicine, 52, 967–978.

    CAS  Article  PubMed  Google Scholar 

  • Misovich, S. J., Fisher, J. D., & Fisher, W. A. (1997). Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes. Review of General Psychology, 1, 72–107.

    Article  Google Scholar 

  • National Institute on Drug Abuse. (2000). The NIDA community-based outreach model: A manual to reduce the risk of HIV and other blood-borne infections in drug users. Washington: NIH Publication No. 00–4812.

    Google Scholar 

  • National Institute on Drug Abuse. (2002). Principles of HIV prevention in drug-using populations: A research-based guide. Washington: NIH Publication No. 02–4733.

    Google Scholar 

  • Pilowsky, D. J., Hoover, D., Hadden, B., Fuller, C., Ompad, D. C., Andrews, H. F., & Latkin, C. (2007). Impact of social network characteristics on high-risk sexual behaviors among non-injection drug users. Substance Use and Misuse, 42, 1629–1649.

    Article  PubMed  Google Scholar 

  • Prochaska, J. O., Redding, C. A., Harlow, L. L., Rossi, J. S., & Velicer, W. F. (1994). The transtheoretical model of change and HIV prevention: A review. Health Education and Behavior, 21, 471–486.

    CAS  Article  Google Scholar 

  • Rietmeijer, C. A. (2007). Risk reduction counselling for prevention of sexually transmitted infections: How it works and how to make it work. Sexually Transmitted Infections, 83, 2–9.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  • Scott-Sheldon, L. A., & Johnson, J. B. (2006). Eroticizing creates safer sex: A research synthesis. The Journal of Primary Prevention, 27, 619–640.

    Article  PubMed  Google Scholar 

  • Semaan, S., Des Jarlais, D. C., Sogolow, E., Johnson, W. D., Hedges, L. V., Ramirez, G., & Needle, R. (2002). A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 30, S73–S93.

    Article  Google Scholar 

  • Stanley, S. M., Markman, H. J., & Blumberg, S. L. (1997). The speaker-listener technique. The Family Journal, 5, 82–83.

    Article  Google Scholar 

  • Strathdee, S. A., & Sherman, S. G. (2003). The role of sexual transmission of HIV infection among injection and non-injection drug users. Journal of Urban Health, 80, 7–14.

    Article  Google Scholar 

  • Van Tieu, H., & Koblin, B. A. (2009). HIV, alcohol, and noninjection drug use. Current Opinion in HIV and AIDS, 4, 314–318.

    Article  PubMed  Google Scholar 

  • Wilson, S. R., Lavori, P. W., Brown, N. L., & Kao, Y. M. (2003). Correlates of sexual risk for HIV infection in female members of heterosexual California Latino couples: An application of a Bernoulli process model. AIDS and Behavior, 7, 273–290.

    Article  PubMed  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27, 539–565.

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by a grant from the National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) to Dr. McMahon (R01DA15641) and by the University of Rochester Center for AIDS Research (CFAR) (NIH P30AI078498).

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The authors declare that they have no conflict of interest.

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Correspondence to James M. McMahon.

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McMahon, J.M., Pouget, E.R., Tortu, S. et al. Couple-Based HIV Counseling and Testing: a Risk Reduction Intervention for US Drug-Involved Women and Their Primary Male Partners. Prev Sci 16, 341–351 (2015). https://doi.org/10.1007/s11121-014-0540-9

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  • DOI: https://doi.org/10.1007/s11121-014-0540-9

Keywords

  • HIV prevention
  • Voluntary HIV testing and counseling
  • Women’s health
  • Substance use