Couples programme illustrates benefits in effecting change in drinking and HIV risk behaviours among men

The male factor: outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township.

Wechsberg WM, Zule WA, El-Bassel N, Doherty IA, Minnis AM, Novak SD, Myers B, Carney T. Drug Alcohol Depend. 2016 Apr 1;161:307-15. doi: 10.1016/j.drugalcdep.2016.02.017. Epub 2016 Feb 18.

Background: This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence.

Methods: Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners.

Results: At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm.

Conclusions: A couples-based intervention focusing on intersecting risks for HIV can improve bio-behavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.

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Editor’s notes: This study describes the benefits of a novel couples-based programme that addresses key drivers of HIV incidence in South Africa. It focuses on the intersection of alcohol use, relationship contexts, and gender norms. Heavy drinking among men in South Africa is associated with HIV risks including multiple concurrent sexual partnerships and low rates of condom use. In addition, heavy drinking alongside gender norms that disempower women can lead to increased HIV risk for female partners. For example, women may seek sexual partners outside of their main relationship for money, due to male regular partners spending household income on alcohol instead. The study extends the Women’s Health CoOp (an evidence-based programme to reduce substance use, violence, and sexual risks among vulnerable women) to include both partners. The hypothesis is that a programme addressing both partners together (the Couples Health CoOp [CHC] arm) would be more effective than the original female-focused programme at reducing alcohol use and risk behaviors. They found that men reported reduced heavy drinking in all three arms including the control arm after six months (compared to baseline) and the reduction in heavy drinking was greatest in the CHC arm. This highlights the role of couples-based programmes for HIV prevention in women. The high HIV incidence in this setting (16 per 100 person-years in women; 4 per 100 person-years in men) is a reminder that innovative activities are necessary. Future work should continue to include exploration of the effectiveness of adapting of single-gender programmes to be couple-based. 

South Africa
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