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Couple-Based HIV Interventions: A Gender Specific Approach Nabila El- Bassel Columbia University International AIDS Conference July 2012, Washington, DC. Presentation Will Cover:.

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  1. Couple-Based HIV Interventions: AGender Specific ApproachNabila El-BasselColumbia UniversityInternational AIDS Conference July 2012, Washington, DC

  2. Presentation Will Cover: State of the science of couple-based behavioral HIV interventions from a recent systematic review (El-Bassel and Jiwatram, March, 2012) Lessons learned: advantages/benefits of couple modality and what makes it gender-specific Project Connect (New York) and Renaissance (Kazakhstan) for couples who use drugs

  3. Women and HIV Worldwide, 80% of new HIV cases among women are transmitted heterosexually, usually from a steady partner (UNAIDS, 2010) In Sub-Saharan Africa, the majority of HIV transmissions occur among serodiscordant co-habiting or married couples (UNAIDS, 2012) Outside Sub-Saharan Africa, the majority of HIV transmissions among women occur from steady partners who inject drugs and the woman’s own intravenous drug use (UNAIDS, 2010) i

  4. HIV Prevention for Couples Although most HIV infections occur in dyadic relationships (USAIDS, 2010), the majority of behavioral HIV prevention efforts for women: Target the women individually Rarely include the woman AND her partner together in the intervention

  5. Couple-Based HIV Intervention Studies Globally (N=23)

  6. % of Studies, by Type

  7. Couple-Based HIV Intervention Studies

  8. CHTC and Adherence

  9. Couple-Based HIV/STI Prevention Beyond CHTC

  10. Biomedical

  11. Couple-Based Studies, by Sexual Orientation

  12. Couple-Based HIV Intervention Studies, by Serostatus

  13. Advantages of HIV Couple-Based Behavioral Intervention Bringing the couple together for behavioral HIV prevention sessions sends the message that: Both members of the dyad can bring HIV to the relationship Both are responsible for HIV risk reduction Bringing the couple together: Increases male involvement and encourages male responsibility for risk reduction Increases the opportunity to integrate HIV, STI, and reproductive health issues

  14. Advantages of Bringing Couples Together for a Behavioral Intervention Provides a safe, non-judgmental, and supportive environment with a third party in order to: Discuss gender roles and expectations around safer sex, condom use, and reproductive heath Disclose and discuss sensitive issues: Sexual concurrency, survival sex, bisexuality Disclosure of HIV and STIs Fear and experience of IPV, contexts that lead to IPV, and explore and learn ways to deal with them

  15. Advantages of HIV Couple-Based Behavioral Intervention Provides a safe environment to: Learn ways to strengthen and improve the couple’s relationship Learn and practice communication skills Promote the use of female condoms Learn drug risk reduction skills together, learn to help each other cope with drug overdose in order to save each other’s life

  16. Findings from CHTC Couple-Based Studies Promotes the couple to disclose their HIV status and encourages support for each other if one or both are HIV positive Increases uptake and adherence to ART Reduces HIV infection rates and risk sexual behavior Recent systematic review (El-Bassel and Jiwatram, March, 2012)

  17. Findings: Couple-Based Behavioral Studies Beyond CHTC Increased condom use and reduced sexual and drug risks (e.g., sharing syringes and injection equipment) Increased communication, problem solving, help-seeking skills and promoted joint responsibility, and better informed reproductive health decisions regarding conception Reduced sexual and physical IPV Improved testing and access to care None of the behavioral studies demonstrated a reduced incidence of HIV/STI because of lack of statistical power Recent systematic review (El-Bassel and Jiwatram, March, 2012)

  18. Project Connect II: Aims Efficacy trial on HIV prevention with couples who use drugs to reduce sexual and drug risk behavior (NIDA funded) HIV prevention intervention is more efficacious in reducing sexual and drug risks when both members of the couple receive the intervention together than when one member receives it alone El-Bassel et al. JAIDS, 2011

  19. Project Connect II: Design Screened 1616 Individuals 865 Eligible Individuals (54%) Baseline 346 Couples (80%) Randomization 282 Couples (82%) Couple Wellness Promotion 7 Sessions (95) Couple HIV Risk Reduction 7 Sessions (95) Individual HIV Risk Reduction 7 Sessions (92) • Immediately Post-Treatment (IPT) • 6-Month Follow-Up • 12-Month Follow-Up • Immediately Post-Treatment (IPT) • 6-Month Follow-Up • 12-Month Follow-Up • Immediately Post-Treatment (IPT) • 6-Month Follow-Up • 12-Month Follow-Up

  20. Sociodemographics

  21. Major Hypothesis To determine whether the relationship-based prevention intervention is more efficacious when both members of the couple receive the intervention together than when one member receives it alone Randomization Couple Wellness Promotion Couple Risk Reduction Individual Risk Reduction vs.

  22. Multilevel Poisson and Logistic Regression Models † p<0.1; * p<0.05; ** p<0.01

  23. Project Renaissance:Almaty, Kazakhstan

  24. Central Asia Source: Russia-Ukraine-Travel.com

  25. Project Renaissance RCT to test an integrated overdose and HIV prevention delivered to couples (NIDA funded, underway, to be completed October 2012) Outcomes: Reduction of sexual and drug risk behavior, reduce incidence of overdose, of HIV and other STIs Improve access to harm reduction programs and HIV treatment and care

  26. Project Renaissance Screened 966 Individuals Baseline 732 Individuals (367 Couples) Randomization 300 Couples (600) Couple HIV Risk Reduction and Overdose 5 Sessions (151 Couples) Couple Wellness Promotion and Overdose 5 Sessions (141 Couples) • Immediately Post-Treatment (IPT) • 6-Month Follow-Up • 12-Month Follow-Up • Immediately Post-Treatment (IPT) • 6-Month Follow-Up • 12-Month Follow-Up

  27. Sociodemographics, Criminal Justice and HIV (N=600)

  28. Partner Abuse

  29. Multiple Regression Models for Sexual Risk Reduction * p<0.05; ** p<0.01

  30. Overdose Rates in Past 6 Months **p<0.05

  31. Conclusions Although the number of couple-based HIV behavioral studies is small, evidence for their effectiveness is strong in: Increasing access to HIV testing and ART Reducing sexual and drug risk transmission, and increasing condom use Improving communication skills and promoting a healthy relationship Reducing sexual and physical IPV among couples

  32. Conclusions Scaling up couple-based HIV behavioral interventions is important Even though the FDA has approved over-the-counter HT, CHTC is still needed. Couples may need to address negative reactions to disclosure of HIV and risk reduction strategies Behavioral HIV couple-based interventions should be integrated with biomedical interventions such as ART, PREP

  33. Acknowledgments Louisa Gilbert (PhD) Columbia University AsselTerlikbayeva (MD, MSW) Global Health Research Center Susan Witte (PhD) Columbia University Elwin Wu (PhD) Columbia University Mingway Chang (PhD) Columbia University Robert Remien (PhD) Columbia University Sholpan Primbetova (MD, MSW) Global Health Research Center Chris Beyer (MD, MPH) John Hopkins University National Institute on Drug Abuse (NIDA)

  34. Team in Kazakhstan

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