AEGiS-14IAC: Playing the odds: Challenges in reducing risk behaviors among HIV-serodiscordant heterosexual couples.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Playing the odds: Challenges in reducing risk behaviors among HIV-serodiscordant heterosexual couples.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrE1027)

Gomez CA, van der Stratten A, Padian N
Center for AIDS Prevention Studies (CAPS), AIDS Research Institute (ARI), University of California, San Francisco, CA, United States

BACKGROUND: Serodiscordant couples present unique intervention challenges in the face of real risk for HIV transmission. The California Partners Study II was a randomized controlled intervention trial for serodiscordant heterosexual couples reporting unprotected vaginal or anal sex in the previous six months.

METHODS: Sexually active heterosexual HIV-serodiscordant couples were recruited between November 1996 and July 1999 from 17 Northern California counties. Behavioral assessments and laboratory testing for HIV, STD, and pregnancy were conducted at baseline, and at 6-, and 12- months. Couples were randomized to either a one-on-one, 4-session harm-reduction counseling intervention for each person within the couple, or to a condition where only the HIV-positive (HIV+) person received counseling. Intervention focused on risk reduction, gender dynamics, and communication skills.

RESULTS: A total of 101 couples were randomized. Couples in each arm did not differ in gender of index case (51% male). Preliminary findings indicate that all couples reported significant increase in consistent condom use (22% vs. 34%; X2=26.25, p<.001) and reduction in mean number of vaginal sex acts (60 vs. 41; p<.001) and anal sex acts (1.7 vs. 0.5: p<.005) in the past 6 months from baseline to 12-month follow-up. The majority (86%) of HIV-negative partners reported "I've been unsafe before and didn't get infected with HIV" as the main reason for not using condoms at last unprotected sex.

CONCLUSION: HIV-discordant couples are able to reduce risk behaviors, but continue to engage in substantial amounts of unprotected sex even after receiving an intensive counseling intervention. Counseling the HIV-negative partner in addition to the HIV+ partner does not seem to enhance effectiveness of the intervention. Providing couples with broad harm reduction messages may increase the likelihood that they will seek alternative ways to reduce risk of transmission beyond increasing condom use.

Keywords: AEGIS, Heterosexuality, Risk-Taking, HIV Infections, Sex Behavior, HIV Seropositivity, Condoms, Counseling, Play and Playthings, Safe Sex, California, Male, Female, Pregnancy

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