The Efficacy of a Relationship-Based HIV/STD Prevention Program for Heterosexual Couples

Sustained rates of heterosexually acquired HIV infection in the United States, particularly among African-American and Latina women, have mobilized efforts to develop alternative prevention strategies, including couple-oriented prevention models. Individual or group intervention efforts often fail to demonstrate increased barrier method use, particularly among women in long-term intimate relationships. New methods that recognize the context of relationship dynamics and focus on couple communication patterns may enable women to initiate and sustain condom use with long-term intimate partners.

Couple counseling has been found to be efficacious in promoting HIV counseling and testing, as well as condom use. However, most of the studies that reached this finding were conducted outside the United States. Relationship-based risk reduction interventions encourage collaboration to address mutual needs, and these may be more effective for intimate partners than non-relationship-based interventions.

Project Connect was a randomized clinical trial designed to examine two aims. The primary aim was to test whether a six-session HIV/STD relationship-based intervention would be equally, more, or less efficacious in increasing condom use, decreasing STD transmission, and reducing the number of sexual partners among heterosexual couples in comparison with a control condition consisting of a single session of HIV/STD education. The secondary aim was to examine whether the intervention would be more efficacious when the woman and her partner received the relationship-based intervention together or when the woman received it alone.

The study was conducted between 1997 and 2001. Women were recruited from hospital-based outpatient clinics in Bronx, N.Y. Bilingual recruiters approached women in waiting rooms. Those interested completed a 10-minute face-to-face eligibility screening. Eligible women were asked to recruit their regular male sexual partners. To gain his cooperation, the woman was given a letter describing the project that could be shared with her partner. At baseline, simultaneous but separate interviews with gender-matched interviewers took place with each partner. Couples were then randomly assigned to one of three study conditions: the couple condition, six weekly relationship-based sessions in which both a woman and her partner received the intervention; the woman-alone condition, in which only the woman received the same intervention; or the education control condition, in which a woman alone took part in one HIV/STD information session. All women and men were asked to return for follow-up assessment three months after the final intervention or control session. Trained interviewers administered an assessment, which covered sociodemographic characteristics, HIV serostatus, and HIV/STD risk behaviors.

The findings show that six sessions of a relationship-based HIV/STD prevention intervention were efficacious in reducing the number of unprotected sexual acts and increasing the proportion of protected sexual acts in comparison with a control condition consisting of one session of HIV/STD information. No significant differences in outcomes were observed between women who received the intervention together with a partner and women who received the intervention alone.

The results of the study lend support to the desirability of delivering relationship-based HIV/STD interventions in primary care settings to African-American and Latino couples at elevated risk for HIV/STD transmission. These study findings have considerable public health implications because they provide two alternative methods for an efficacious HIV/STD prevention intervention for women in long-term relationships. The public health implications are important because reductions in numbers of unprotected sexual acts have been linked to reductions in HIV transmission and lower levels of STD incidence. Moreover, the study demonstrated that it is feasible to conduct a couple-based intervention among African-American and Latino women and their regular male sexual partners and that these men are willing to participate in an HIV/STD intervention with their partners.

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