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

El‐Bassel, Nabila; Witte, Susan S.; Gilbert, Louisa; Wu, Elwin; Chang, Mingway; Hill, Jennifer; Steinglass, Peter

doi:10.2105/ajph.93.6.963

Cited by 217 publications

(207 citation statements)

References 41 publications

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“…27,28 While the few couple-based HIV/STI prevention interventions that have been developed to date have shown promise in reducing unprotected sex within couples and with outside partners, [38][39][40][41][42] a number of gaps in the literature exist, including a need for testing of interventions with theoretical frameworks to identify potential mediators, 28 greater focus on adolescents and young adults, primary prevention among at-risk seroconcordant negative couples, 28 and measurement of biological outcomes. 27,28 Results from our study suggest that among STI clinic attendees, men and women recognize and attempt to minimize risk, though current strategies may be ineffective.…”

Section: Limitationsmentioning

confidence: 99%

Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

Hotton¹,

French

Hosek

et al. 2015

AIDS Patient Care and STDs

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Few studies have examined risk-reduction alternatives to consistent condom use for HIV prevention among heterosexual young adults. We used qualitative methodology to explore risk reduction strategies and contextual factors influencing attempts to reduce risk in an urban, high morbidity sexually transmitted infection (STI) clinic. Focus groups were conducted October-December 2014 with heterosexually identified men (n = 13) and women (n = 20) aged 18-29 seeking STI screening at an urban clinic. Groups were audio recorded, transcribed verbatim, and analyzed for thematic content using Atlas.ti software. Quantitative information included sociodemographics, HIV/STI testing history, and 6-month sexual behaviors. Among 33 predominantly AfricanAmerican participants with a median age of 22, risk-reduction strategies included monogamy agreements, selective condom use with casual and high-risk partners, and frequent HIV/STI testing, though testing was commonly used as a post-hoc reassurance after risk exposure. Many men and women used implicit risk assessment strategies due to mistrust or difficulty communicating. Concurrency was common but rarely discussed within partnerships. Despite attempts to reduce risk, monogamy agreements were often poorly adhered to and not openly discussed. Alcohol and substance use frequently interfered with safer sexual decisions. Participants were aware of HIV/STI risk and commonly practiced risk-reduction strategies, but acknowledged faulty assumptions and poor adherence. This work provides insights into risk-reduction approaches that are already used and may be strengthened as part of effective HIV/STI prevention interventions.

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Section: Limitationsmentioning

confidence: 99%

Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

Hotton¹,

French

Hosek

et al. 2015

AIDS Patient Care and STDs

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show abstract

“…To date, couple or relationship interventions have had limited success in promoting safe sexual practices and have not addressed the need of adolescents to form intimate and trusting relationships. 26,27 Additionally, sexual/reproductive health interventions rarely address expectations for healthy adolescent and young adult relationships.…”

Section: Implications For Public Health Practicementioning

confidence: 99%

In Their Own Words: Romantic Relationships and the Sexual Health of Young African American Women

et al. 2013

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Objective. We assessed young African American women's understanding of "dual protection" (DP) (i .e ., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods .Methods. We conducted 10 focus groups with African American women (n551) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use . Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors . We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP .Results. From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible ." Focus group data suggested that most participants understood what DP was but thought it was not always feasible . Relationship factors (e .g ., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP . Social influences (e .g ., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships .Conclusions. Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior . The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women .

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“…Many of these criteria have been used and/or are analogous to the investigative team's prior HIV intervention research studies with [heterosexual] couples, drug-involved couples, and African American couples [19,23] except for the following: eligibility criteria 3c and 7 were agreed upon and used by all of the sites participating in the Cooperative Agreement that provided funding for this study. Since the intervention is designed to be delivered conjointly to both members of a couple, an additional requirement was that both partners had to be willing to attend the focus group together.…”

Section: Samplementioning

confidence: 99%

Adaptation of a Couple-Based HIV Intervention for Methamphetamine- Involved African American Men who have Sex with Men

Wu¹

2010

TOAIDJ

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In the U.S., incidence of HIV infection among men who have sex with men (MSM) has steadily increased since the 1990s. This points to a need for innovation to address both emerging trends as well as longer-standing disparities in HIV risk and transmission among MSM, such as the elevated rates of HIV/STIs among African American MSM and methamphetamine users. While couple-based sexual risk reduction interventions are a promising avenue to reduce HIV/STI transmission, prior research has been almost exclusively with heterosexual couples. We sought to adapt an existing, evidence-based intervention-originally developed and tested with heterosexual couples-for a new target population consisting of African American MSM in a longer-term same-sex relationship where at least one partner uses methamphetamine. The adaptation process primarily drew from data obtained from a series of focus groups with 8 couples from the target population. Attention is given to the methods used to overcome challenges faced in this adaptation process: limited time, a lead investigator who is phenotypically different from the target population, a dearth of descriptive information on the experiences and worldviews among the target population, and a concomitant lack of topical experts. We also describe a visualization tool used to ensure that the adaptation process promotes and maintains adherence to the theory that guides the intervention and behavior change. The process culminated with an intervention adapted for the new target population as well as preliminary indications that a couple-based sexual-risk reduction intervention for African American, methamphetamine-involved male couples is feasible and attractive.

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

Abstract: This study demonstrates the efficacy of a relationship-based prevention program for couples at risk for HIV infection.

Cited by 217 publications

References 41 publications

Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

In Their Own Words: Romantic Relationships and the Sexual Health of Young African American Women

Adaptation of a Couple-Based HIV Intervention for Methamphetamine- Involved African American Men who have Sex with Men

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