Abstract
BackgroundIn South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex.MethodsTo address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women’s HIV prevention intervention (the Western Cape Women’s Health CoOp) to include components of an evidence-based couple’s intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability.ResultsThe new intervention is called the Couples’ Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples’ Health CoOp also includes “voices” from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants’ suggestions made during formative work and pilot testing.ConclusionsThe Couples’ Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa.Trial registration numberNCT01121692.
Highlights
In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex
Substance use is prevalent in Western Cape communities and it has been linked to HIV transmission through its association with unprotected sex and other risk behaviors [7]
The foundation of the new couples’ intervention is the Western Cape Women’s Health CoOp (WCWHC) intervention, as it addresses the intersection of HIV, sex risk behaviors, alcohol and other drug use, and gender-based violence in the context of South Africa; has demonstrated efficacy in addressing these multiple risk behaviors among different populations of women in South Africa, and has cultural congruence for people from poor communities in the Cape Town area
Summary
In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex. The significant role of substance use in social and sexual interactions in some South African townships [8] and its association with impaired judgment and risky decision-making [11,12,13] creates even greater obstacles for women to negotiate the conditions of sex and to reduce their risk for HIV [14,15]. These conditions speak to the urgency of addressing HIV prevention needs within heterosexual couples in South Africa [16,17,18,19]
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