The Male Factor: Outcomes from a Cluster Randomized Field Experiment with a Couples-Based HIV Prevention Intervention in a South African Township

Highlights

• Men in the couples arm were less likely to report heavy drinking at 6-months.
• Men in the couples arm were more likely to report past-month consistent condom use.
• Women tested at twice the prevalence of HIV (26%) as men (13%).
• At 6-months, HIV incidence was significantly lower among women in the intervention.
• Couples-based interventions focusing on intersecting HIV risks can improve outcomes.

BACKGROUND:

This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence.

METHODS:

Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners.

RESULTS:

At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm.

CONCLUSIONS:

A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.

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By:  Wechsberg WM1, Zule WA2, El-Bassel N3, Doherty IA4, Minnis AM5, Novak SD2, Myers B6, Carney T7.

• 1RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States. Electronic address: wmw@rti.org.
• 2RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States.
• 3Columbia University School of Social Work, New York, NY, United States.
• 4RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States.
• 5RTI International, 351 California Street, San Francisco, CA, United States.
• 6Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 7Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. 
• Drug Alcohol Depend. 2016 Apr 1;161:307-15. doi: 10.1016/j.drugalcdep.2016.02.017. Epub 2016 Feb 18.

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