ias2011

1. Prevalence of Serodiscordance, Seropositivity and Exclusionary Factors in US Male Couples Presenting for Couples HIV Voluntary Counseling and Testing P Sullivan, R Stephenson, L Salazar, M Mann, J Barnes, L Scales, S Allen Emory University Rollins School of Public Health, Atlanta, Georgia, USA www.ias2011.org

2. Background • Major barriers to HIV prevention in US MSM include high prevalence, low awareness of HIV serostatus, and modest rates of disclosure • CVCT is considered a “high leverage” intervention in Africa • Southern African generalized heterosexual epidemics are similar to the US MSM epidemic: • High prevalence • Most new HIV infections estimated to arise from main sex partners www.ias2011.org

3. Intervention • We adapted the African CVCT intervention for use with US MSM • Involved academics, prevention providers • Major revisions included shifting focus of family planning issues, addressing agreements • We theater tested the adapted intervention with MSM and HIV prevention counselors in 3 US cities www.ias2011.org

4. Feasibility Study Male couples recruited through outreach, advertisements, internet • Eligible: • Main partners • Relationship of at least 3 months duration • Neither known HIV+ Ineligible Assign iVCT Present 3 month followup CVCT • Enrolled: Screen for • Coercion • History of IPV None Randomize iVCT www.ias2011.org

5. Feasibility Study Male couples recruited through outreach, advertisements, internet • Eligible: • Main partners • Relationship of at least 3 months duration • Neither known HIV+ Ineligible Assign iVCT Present 3 month followup CVCT • Enrolled: Screen for • Coercion • History of IPV None Randomize iVCT www.ias2011.org

6. Results (1) Eligible: 109 Couples 28 (26%) couples assigned iVCT: 10 (9%) Coercion Only 13 (12%) IPV Only 5 (5%) Both Coercion and IPV 2 Couples Inauthentic @ Followup 1 couple had known HIV+ at baseline Present 3 month followup 37 CVCT • 106 Enrolled: Screen for • Coercion • History of IPV None Randomize 41 iVCT www.ias2011.org

7. Results (2): Participant Characteristics www.ias2011.org

8. Results (3): Seroconcordance www.ias2011.org

9. Results (4): Seropositivity www.ias2011.org

10. Limitations • Because of the population served by AID Atlanta, our participants over-represent blacks and underrepresent Hispanic MSM communities in Atlanta • Data on partnership status, prior HIV testing and other data are self-reported, and subject to misclassification • Results do not generalize beyond participants in the current study www.ias2011.org

11. Conclusions • Couples counseling and testing reached a population of MSM with much higher undiagnosed HIV prevalence than traditional iVCT • 1 in 5 male couples presenting for CVCT were serodiscordant • CVCT is an important strategy in Atlanta to identify HIV-positive men who may be untested, and HIV-serodiscordant couples for treatment and prevention services • Although self-reported IPV was high, couples reporting IPV had similar rates of serodiscordance, and thus similar need for CVCT www.ias2011.org

12. Next Steps • Analysis of 3-month outcomes (Fall 2011) • CVCT rollout in Atlanta and Chicago – starting in September 2011 • Evaluation of incident IPV in 400 couples between September 2011-August 2012 • Integration of CVCT with prevention packages based on couple serostatus www.ias2011.org

13. Acknowledgements • This work was supported by a grant from NIH/NIMH (R34MH086331) • This work was supported, in part, by the Emory Center for AIDS Research (P30 AI050409). • AID Atlanta • Ron Stall, Colleen Hoff, Beau Gratzer, Jeanne Montgomery, Andre’Nita Toson, Elizabeth Stallcup • The couples www.ias2011.org