Behavioral interventions have
utilized a variety of strategies and components to reduce HIV risk. This
article describes the partner intervention, a couple-based group HIV risk
reduction intervention implemented in 6 urban community health clinics in
Lusaka, Zambia, and examines the components of the intervention and their
relationship with condom use.
Couple members completed assessments on condom
use, acceptability, willingness to use condoms, communication, intimate partner
violence (IPV), self-efficacy, and HIV information at baseline and 6 months'
follow-up. This study examined the relative impact of elements of the
intervention as predictors of condom use. Changes in acceptability had the
greatest overall influence on condom use, followed by social support,
relationship consensus, and willingness to use condoms. Changes in
self-efficacy, IPV, negotiation, and information had no influence.
Results
support the use of multidimensional approaches in behavioral interventions and
highlight the importance of identifying critical elements of interventions to
maximize risk reduction outcomes.
…Changes in acceptability had the greatest overall influence
on sexual barrier use, followed by social support, relationship consensus, and
willingness to use sexual barriers. Self-efficacy was associated with the use
of sexual barriers, but increased self-efficacy did not contribute to increased
barrier use in multivariable analysis. Finally, negotiation, IPV, and
information had no apparent influence on sexual barrier use.
Study results provide further support for the
predictive relationship between acceptability and self-reported willingness to
use barriers and sexual barrier use, in line with earlier findings by this team
using individual rather than dyadic analyses.28 One
of the key elements of CB therapy is the premise that attitudes influence
behavior, for example, acceptability of condoms will predict their use. In this
study, acceptability may have been increased by CB strategies designed to
promote positive attitudes and reduce negative opinions regarding condom use.
Condoms are highly effective in the prevention of HIV transmission, but their
impact as a prevention strategy has been limited by low acceptability and
inconsistent use. Meta-analyses of positive prevention studies in developing
countries have reported that interventions targeting HIV sero-positive
individuals are successful in increasing condom use, in both seroconcordant and
discordant relationships.29 Recent
studies, for example, microbicides and preexposure prophylaxis (PrEP), have
highlighted the importance of assessing the acceptability of prevention
strategies as a predictor of uptake. In fact, low product acceptability may be
the Achilles' heel of HIV prevention. Enhancement of product acceptability is
likely a critical intervention element and has important implications for the
uptake of existing prevention strategies as well as new strategies such as
PrEP.
Social support and relationship consensus also played
a key role in the uptake of sexual barrier products. In psychotherapy, the
group format is often used to increase the overall impact of the intervention
by providing a variety of viewpoints on interpersonal issues, but the group
format may also increase the perception of the availability of supportive
like-minded peers. In addition, the supportive nature of the group format may
be more comfortable for members of collective communities and cultures,
although results of previous research regarding the impact of the group format
on condom use are mixed.2 Although
no interaction was discovered, future studies should continue to explore the
association between social support and relationship consensus. Both the
elements of social support and the focus on achieving consensus appear to be
critical intervention elements…
Full article at: http://goo.gl/u4pTRv
By:
1Department of Pediatrics, University
Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
2Department of Psychiatry and Behavioral
Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
Corresponding Author: Deborah Jones, Department of
Psychiatry and Behavioral Sciences, University of Miami Miller School of
Medicine, 1400 NW 10th Ave, Suite 404A, Miami, FL 33136, USA, Email: ude.imaim.dem@senojd
More at: https://twitter.com/hiv insight
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