Couple-Based Intervention May Reduce Sexual Risk Behavior

Couple-based intervention may reduce sexual risk behavior and curb the HIV epidemic among men in community supervision programs, a new study suggests.

Results of the randomized clinical trial of the 5-session, couple-based PACT intervention, which stands for protect and connect, were published in the journal JAMA Network Open. The study found that participants in the PACT intervention reported fewer sexual partners, were less likely to be under the influence of drugs or alcohol during sex, and were less likely to engage in condomless intercourse.

"Couple-based approach provides an opportunity for the couple to recognize their mutual responsibility for protecting each other from HIV transmission and other STIs and to be able to work together to stay healthy," study author, Nabila El-Bassel, PhD, professor at the Columbia University School of Social Work and director of the Social Intervention Group and the Global Health Research Center of Central Asia, told Contagion^®.

Participants in the PACT intervention had 33% fewer acts of condomless intercourse with their main partners, 70% fewer acts with other partners, and 40% fewer acts with all partners. They also reported 26% fewer sexual partners and were less likely to report being under the influence of drugs or alcohol during intercourse.

El-Bassel said the couple-based intervention method creates a safe environment for couples to discuss taboo topics such as sexual concurrency, power imbalances in the relationship, couple's sexual preferences, and sexual coercion.

"A couple-based modality allows the pair to learn together, in vivo with a third party (a facilitator), skills in couple communication, negotiation, problem-solving, and couple goal setting as well as technical skills in condom use," she said. "Joint processing with the facilitator promotes accountability and increases commitment to change."

The study involved 230 men remanded to community supervision programs in New York for drug involvement along with their partners. The study was conducted between July 2013 and May 2016, and participants were divided between the PACT group and a control group that participated in 1-session of counseling, testing, and referral (CTR) program.

Investigators collected data on biomarkers at baseline and at 12 months, with no new HIV infections reported and 18 new cases of STIs identified at 12 months, including 10 among the PACT group and 8 among the control group. The difference isn't statistically significant, the study noted.

The study noted that condom use is the key tool for preventing HIV and STI transmission. Many practitioners recommend condom use even though antiretroviral therapy and pre-exposure prophylaxis (PrEP) have proven effective at preventing HIV transmission, according to a recent study. Receipt of PrEP was associated with increased incidence of STI, according to another study that examined STI risk among gay and bisexual men.

"Men in the study more than their female partners had limited knowledge about sexually infectious diseases, reproductive health issues and how to communicate about safe sex and finally had limited social and communication skills about safe sex partners," El-Bassel told Contagion^®. "But, I also was so surprised to see men eager to participate in the intervention and learn together with their female partners and build health relationship. Unfortunately, we focus less on men health, and couple-based approaches. Most STIs and HIV focus on the individual on women and less on men. Moreover, couple-based intervention for men in criminal justice systems such as in community supervision programs are rare."

El-Bassel's goal is to get funding to promote the PACT intervention in criminal justice facilities and primary care settings and conduct further research to understand barriers to implementing the intervention.

"Men who use drugs and involved in the criminal justice system are hungry and eager to have the opportunity to learn about sexually infectious disease, HIV risk and reproductive health," she said. "They are also willing to attend sessions with their partners if they are treated with respect, and feel safe and welcomed to the service settings. Clinicians and health care providers must learn to treat the couple as a unit and not only focus on an individualistic approach. This requires training and ideological shift from an individualistic approach to more couple and dyadic approach."