Abstract
HIV is frequently transmitted in the context of partners in a committed relationship, thus couples-focused HIV prevention interventions are a potentially promising modality for reducing infection. We conducted a systematic review of studies testing whether couples-focused behavioral prevention interventions reduce HIV transmission and risk behavior. We included studies using randomized controlled trial designs, quasi-randomized controlled trials, and nonrandomized controlled studies. We searched five electronic databases and screened 7,628 records. Six studies enrolling 1,084 index couples met inclusion criteria and were included in this review. Results across studies consistently indicated that couples-focused programs reduced unprotected sexual intercourse and increased condom use compared with control groups. However, studies were heterogeneous in population, type of intervention, comparison groups, and outcomes measures, and so meta-analysis to calculate pooled effects was inappropriate. Although couples-focused approaches to HIV prevention appear initially promising, additional research is necessary to build a stronger theoretical and methodological basis for couples-focused HIV prevention, and future interventions must pay closer attention to same-sex couples, adolescents, and young people in relationships.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adimora, A. A., Schoenbach, V. J., Martinson, F. E., Donaldson, K. H., Stancil, T. R., & Fulliove, R. E. (2003). Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection. Journal of Acquired Immune Deficiency Syndrome, 34, 423–429. doi:10.1097/00126334-200312010-00010.
Ajzen, I., Albarracin, D., & Hornik, R. (Eds.). (2007). Prediction and change of health behavior: Applying the reasoned action approach. Mahwah, NJ: Lawrence Erlbaum Associates.
Albarracin, D., Gillette, J. C., Moon-Ho, H., Early, A. N., Glasman, L. R., & Durantini, M. R. (2005). A test of major assumptions about behaviour change: A comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychological Bulletin, 131, 865–897. doi:10.1037/0033-2909.131.6.856.
Allen, S., Meinzen-Derr, J., Kautzman, M., Zulu, I., Trask, S., Fideli, U., et al. (2003). Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS (London, England), 17, 733–740. doi:10.1097/00002030-200303280-00012.
Allen, S., Tice, J., Van de Perre, P., Serufilira, A., Hudes, E., Nsengumuremyi, F., et al. (1992). Effect of serotesting with counseling on condom use and seroconversion among HIV discordant couples in Africa. BMJ (Clinical Research Ed.), 304, 1605–1609.
Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2, 324–473.
Catania, J. A., Kegeles, S. M., & Coates, T. J. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Education & Behavior, 17, 53–72. doi:10.1177/109019819001700107.
Coates, T. J., Grinstead, O. A., Gregorich, S. E., Sweat, M. D., Kamenga, M. C., Sangiwa, G., et al. (2000). Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: A randomised trial. Lancet, 356, 103–112. doi:10.1016/S0140-6736(05)74446-9.
El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., et al. (2003). The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. American Journal of Public Health, 93, 963–969.
El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., et al. (2005). Long-Term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS and Behavior, 9, 1–13. doi:10.1007/s10461-005-1677-0.
Farquhar, C., Kiarie, J. N., Richardson, B. A., Kabura, M. N., John, F. N., Nduati, R. W., et al. (2004). Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. Journal of Acquired Immune Deficiency Syndromes, 37, 1620–1626. doi:10.1097/00126334-200412150-00016.
Fisher, J. D., & Fisher, W. A. (2002). The Information-Motivation-Behavioral Skills Model. In R. DiClemente, R. Crosby & M. Kegler (Eds.), Emerging theories in health promotion practice and research (pp. 40–70). San Francisco, CA: Jossey Bass Publishers.
Foss, A. M., Hossain, M., Vickerman, P. T., & Watts, C. H. (2007). A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sexually Transmitted Infections, 83, 510–516. doi:10.1136/sti.2007.027144.
Gorbach, P. M., & Holmes, K. K. (2003). Transmission of STIs/HIV at the partnership level: Beyond individual-level analyses. Journal of Urban Health, 80(suppl 3), 15–25. doi:10.1093/jurban/jtg079.
Grinstead, O. A., Gregorich, S. E., Choi, K. H., & Coates, T. (2001). Positive and negative life events and counselling and testing: The voluntary HIV-1 counselling and testing efficacy study. AIDS, 15, 1045–1052.
Halperin, D. T., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. Lancet, 364, 4–6. doi:10.1016/S0140-6736(04)16606-3.
Harmann, J. J., & Amico, K. R. (2008). The relationship-oriented information information-motivation-behavioral skills model: A multilevel structural equation model among dyads. AIDS and Behavior (Epub ahead of print).
Harvey, S. M., Henderson, J. T., Thorburn, S., Beckman, L. J., Casillas, A., Mendez, L., et al. (2004). A randomized study of a pregnancy and disease prevention intervention for Hispanic couples. Perspectives on Sexual and Reproductive Health, 36, 162–169. doi:10.1363/3616204.
Higgins, D. L., Galavotti, C., O’Reilly, K. R., Schnell, D. J., Moore, M., Rugg, D., et al. (1991). Evidence for the effects of HIV antibody counseling and testing on risk behaviors. Journal of the American Medical Association, 266, 2419–2429. doi:10.1001/jama.266.17.2419.
House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241, 540–545. doi:10.1126/science.3399889.
Jones, D. L., Ross, D., Weiss, S. M., Bhat, G., & Chitalu, N. (2005). Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. Journal of Urban Health, 82(suppl 4), 92–100.
Kalichman, S. C., Ntseane, D., Nthomang, K., Segwabe, M., Phorano, O., & Simbayi, L. C. (2007). Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sexually Transmitted Infections, 83, 371–375. doi:10.1136/sti.2006.023630.
Kelly, J. A., & Kalichman, S. C. (2002). Behavioral research in HIV/AIDS primary and secondary prevention: Recent advances and future directions. Journal of Consulting and Clinical Psychology, 70, 626–639. doi:10.1037/0022-006X.70.3.626.
Kenny, D. A., Kashy, D. A., Cook, W. L., & Simpson, J. A. (2006). Dyadic data analysis. New York, NY: Guilford Press.
Kissinger, P. J., Niccolai, L. M., Magnus, M., Farley, T. A., Maher, J. E., Richardson-Alston, G., et al. (2003). Partner notification for HIV and syphilis: Effects on sexual behaviors and relationship stability. Sexually Transmitted Diseases, 30, 75–82. doi:10.1097/00007435-200301000-00015.
Koniak-Griffin, D., Lesser, J., Henneman, T., Huang, R., Huang, X., Tello, J., et al. (2008) HIV prevention for latino adolescent mothers and their partners. Western Journal of Nursing Research, 30, 724–742.
Lescano, C. M., Vazquez, E. A., Brown, L. K., Litvin, E. B., Pugatch, D., & Project SHIELD Study Group. (2006). Condom use with “casual” and “main” partners: What’s in a name? The Journal of Adolescent Health, 39, 443. doi:10.1016/j.jadohealth.2006.01.003.
Lewis, M. A., McBride, C. M., Pollak, K. I., Puleo, E., Butterfield, R. M., & Emmons, K. M. (2006). Understanding health behavior change among couples: An interdependence and communal coping approach. Social Science & Medicine, 62, 1369–1380. doi:10.1016/j.socscimed.2005.08.006.
Padian, N. S., O’Brien, T. R., Chang, Y., Glass, S., & Francis, D. (1993). Prevention of heterosexual transmission of human immunodeficiency virus through couple counseling. Journal of Acquired Immune Deficiency Syndromes, 6, 1043–1048.
Painter, T. M. (2001). Voluntary counseling and testing for couples: A high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa. Social Science & Medicine, 53, 1397–1411. doi:10.1016/S0277-9536(00)00427-5.
Parsons, J. T., Huszti, H. C., Crudder, S. O., Rich, L., & Mendoza, J. (2000). Maintenance of safer sexual behaviours: Evaluation of a theory-based intervention for HIV seropositive men with haemophilia and their female partners. Haemophilia, 6, 181–190. doi:10.1046/j.1365-2516.2000.00404.x.
Prestage, G., Mao, L., McGuigan, D., Crawford, J., Kippax, S., Kaldor, J., et al. (2006). HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care, 18, 166–172. doi:10.1080/09540120500358951.
Vidanapathirana, J., Abramson, M. J., Forbes, A., & Fairley, C. (2006). Mass media interventions for promoting HIV testing: Cochrane systematic review. International Journal of Epidemiology, 35, 233–234.
Acknowledgments
We would like to thank Kristen Underhill for assistance in conducting the literature review, and all researchers and primary authors who responded to our requests for additional information. This research was supported by NIDA grant R01DA018621 to Don Operario, and NIMH grant K08MH072380 to Lynae Darbes.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burton, J., Darbes, L.A. & Operario, D. Couples-Focused Behavioral Interventions for Prevention of HIV: Systematic Review of the State of Evidence. AIDS Behav 14, 1–10 (2010). https://doi.org/10.1007/s10461-008-9471-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-008-9471-4