Adapting an evidence-based HIV behavioral intervention for South African couples

Wendee M Wechsberg, Nabila El-Bassel, Tara Carney, Felicia A Browne, Bronwyn Myers, William A Zule, Wendee M Wechsberg, Nabila El-Bassel, Tara Carney, Felicia A Browne, Bronwyn Myers, William A Zule

Abstract

Background: 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.

Methods: To 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.

Results: The 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.

Conclusions: The 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 number: NCT01121692 .

Figures

Figure 1
Figure 1
Examples of the voices from focus group participants.

References

    1. Abdool Karim SS, et al. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009;374(9693):921–933. doi: 10.1016/S0140-6736(09)60916-8.
    1. Cleland J, Ali MM. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Lancet. 2006;368(9549):1788–1793. doi: 10.1016/S0140-6736(06)69738-9.
    1. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press; 2014.
    1. Wechsberg WM, Doherty IA, Myers B, Morgan-Lopez AA, Emanuel A, Carney T, et al. Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community. Int J Drug Policy. 2014;25(3):583–90. doi: 10.1016/j.drugpo.2013.10.016.
    1. Browne FA, Wechsberg WM. The intersecting risks of substance use and HIV risk among substance-using South African men and women. Curr Opin Psychiatry. 2010;23:205–209. doi: 10.1097/YCO.0b013e32833864eb.
    1. Eyawo O, de Walque D, Ford N, Gakii G, Lester RT, Mills EJ. HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(11):770–777. doi: 10.1016/S1473-3099(10)70189-4.
    1. Parry C, Pithey A. Risk behaviour and HIV among drug-using populations in South Africa. African Journal of Drug and Alcohol Studies. 2006;5(2):139–156.
    1. Parry CDH, Plüddemann A, Myers B, Wechsberg WM, Flisher AJ. Methamphetamine use and sexual risk behaviour in Cape Town, South Africa: A review of data from 8 studies conducted between 2004 and 2007. Afr J Psychiatry. 2011;14(5):372–376. doi: 10.4314/ajpsy.v14i5.4.
    1. Wechsberg WM, Luseno WK, Karg RS, Young S, Rodman N, Myers B, et al. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: A small randomized trial in the Western Cape. International Journal of Drug Policy. 2008;19(2):130–139. doi: 10.1016/j.drugpo.2007.11.018.
    1. Wechsberg WM, Myers B, Reed E, Carney T, Emanuel AN, Browne FA. Substance use, gender inequity, violence and sexual risk among couples in Cape Town. Cult Health Sex. 2013;15(10):1221–1236. doi: 10.1080/13691058.2013.815366.
    1. George S, Rogers RD, Duka T. The acute effect of alcohol on decision making in social drinkers. Psychopharmacology (Berl) 2005;182:160–169. doi: 10.1007/s00213-005-0057-9.
    1. Gilman JM, Smith AR, Ramchandani VA, Momenan R, Hommer DW. The effect of intravenous alcohol on the neural correlates of risky decision making in healthy social drinkers. Addict Biol. 2012;17(2):465–478. doi: 10.1111/j.1369-1600.2011.00383.x.
    1. Zule WA, Costenbader EC, Meyer JWJ, Wechsberg WM. Methamphetamine use and risky sexual behaviors during heterosexual encounters. Sex Transm Dis. 2007;34(9):689–694. doi: 10.1097/01.olq.0000260949.35304.22.
    1. Pitpitan EV, Kalichman SC, Cain D, Eaton LA, Carey KB, Carey MP, et al. Condom Negotiation, HIV Testing, and HIV Risks among Women from Alcohol Serving Venues in Cape Town. South Africa PLoS ONE. 2012;7(10):1–6.
    1. Wechsberg WM, Luseno WK, Kline TL, Browne FA, Zule WA. Preliminary findings of an adapted evidence-based woman-focused HIV intervention on condom use and negotiation among at-risk women in Pretoria, South Africa. J Prev Interv Community. 2010;38(2):132–146. doi: 10.1080/10852351003640799.
    1. Maharaj PP, Neema S, Shah I. Condom use within marriage: An assessment of changes in South Africa and Uganda. AIDS Care. 2012;24(4):444–450.
    1. Minnis AM, Doherty I, Kline T, Zule WA, Myers B, Carney T, et al. Relationship power, communication, and violence among couples: results of a cluster-randomized HIV prevention study in a South African township. Int J Womens Health. in press
    1. Desgrées-du-Loû A, Orne-Gliemann J. Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters. 2008;16(32):151–161. doi: 10.1016/S0968-8080(08)32407-0.
    1. El-Bassel N, Wechsberg WM. Couple-based behavioral HIV interventions: Placing HIV risk-reduction responsibility and agency on the female and male dyad. Couple and Family Psychology: Research and Practice. 2012;1(2):94–105. doi: 10.1037/a0028890.
    1. Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376(9734):41–48. doi: 10.1016/S0140-6736(10)60548-X.
    1. Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. The relationship between intimate partner violence, rape and HIV amongst South African men: a cross-sectional study. PLoS One. 2011;6(9):e24256. doi: 10.1371/journal.pone.0024256.
    1. Department of Health . National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa, 2010. Pretoria: Department of Health; 2011.
    1. Wechsberg WM, Luseno W, Riehman K, Karg R, Browne F, Parry C. Substance use and sexual risk within the context of gender inequality in South Africa. Subst Use Misuse. 2008;43:1186–1201. doi: 10.1080/10826080801918247.
    1. Sawyer KM, Wechsberg WM, Myers BM. Cultural similarities and differences between a sample of Black/African and colored women in South Africa: convergence of risk related to substance use, sexual behavior, and violence. Women Health. 2006;43(2):73–92. doi: 10.1300/J013v43n02_05.
    1. Wechsberg WM, Wu LT, Zule WA, Parry CD, Browne FA, Luseno WK, et al. Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa. Subst Abuse Treat Prev Policy. 2009;4:11. doi: 10.1186/1747-597X-4-11.
    1. Wechsberg WM, Zule WA, Luseno WK, Kline TL, Browne FA, Novak SP, et al. Effectiveness of an adapted evidence-based woman-focused intervention for sex workers and non-sex workers: The Women’s Health CoOp in South Africa. J Drug Issues. 2011;41(2):233–252. doi: 10.1177/002204261104100205.
    1. Sawyer-Kurian KL, Wechsberg WM, Luseno WK. Exploring the differences and similarities between Black/African and Coloured men regarding violence against women, substance abuse, and HIV risks in Cape Town, South Africa. Psychol Men Masculinity. 2009;10(1):13–29. doi: 10.1037/a0013267.
    1. Kalichman SC, Pitpitan E, Eaton L, Cain D, Carey KB, Carey MP, et al. Bringing it home: community survey of HIV risks to primary sex partners of men and women in alcohol-serving establishments in Cape Town, South Africa. Sex Transm Infect. 2013;89(3):231–236. doi: 10.1136/sextrans-2012-050569.
    1. van Loggerenberg F, Dieter AA, Sobieszczyk ME, Werner L, Grobler A, Mlisana K. HIV prevention in high-risk women in South Africa: condom use and the need for change. PLoS One. 2012;7(2):e30669. doi: 10.1371/journal.pone.0030669.
    1. Hendriksen ES, Pettifor A, Lee S, Coates TJ, Rees HV. Predictors of condom use among young adults in South Africa: The Reproductive Health and HIV Research Unit National Youth Survey. Am J Public Health. 2007;97(7):1241–1248. doi: 10.2105/AJPH.2006.086009.
    1. Pettifor A, MacPhail C, Nguyen N, Rosenberg M, Parker L, Sibeko J. Feasibility and acceptability of Project Connect: a couples-based HIV-risk reduction intervention among young couples in Johannesburg, South Africa. AIDS Care. 2014;26(4):476–82. doi: 10.1080/09540121.2013.841827.
    1. Ehrhardt AA, Sawires S, McGovern T, Peacock D, Weston M. Gender, empowerment, and health: What is it? How does it work? J Acquir Immune Defic Syndr. 2009;51(Suppl 3):S96–S105. doi: 10.1097/QAI.0b013e3181aafd54.
    1. Kalichman SC, Simbayi LC, Cloete A, Clayford M, Arnolds W, Mxoli M, et al. Integrated gender-based violence and HIV Risk reduction intervention for South African men: results of a quasi-experimental field trial. Prevention science : the official journal of the Society for Prevention Research. 2009;10(3):260–269. doi: 10.1007/s11121-009-0129-x.
    1. LaCroix JM, Pellowski JA, Lennon CA, Johnson BT. Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis. Sex Transm Infect. 2013;89(8):620–627. doi: 10.1136/sextrans-2013-051135.
    1. El-Bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93(6):963–969. doi: 10.2105/AJPH.93.6.963.
    1. Villar-Loubet OM, Cook R, Chakhtoura N, Peltzer K, Weiss SM, Shikwane ME, et al. HIV knowledge and sexual risk behavior among pregnant couples in South Africa: the PartnerPlus project. AIDS Behavior. 2013;17(2):479–487. doi: 10.1007/s10461-012-0360-5.
    1. Peacock D, Levack A. The Men as Partners Program in South Africa: Reaching men to end gender-based violence and promote sexual and reproductive health. Int J Men’s Health. 2004;3(3):173–188. doi: 10.3149/jmh.0303.173.
    1. Wechsberg W. Effectiveness of HIV risk reduction initiatives among out-of- treatment non-injection drug users. J Psychoactive Drugs. 1998;30(3):279–290. doi: 10.1080/02791072.1998.10399704.
    1. Lyles CM, Kay LS, Crepaz N, Herbst JH, Passin WF, Kim AS, et al. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. Am J Public Health. 2007;97(1):133–143. doi: 10.2105/AJPH.2005.076182.
    1. Wechsberg WM, Browne FA, Ellerson RM, Zule WA. Adapting the evidence-based Women's CoOp intervention to prevent human immunodeficiency virus infection in North Carolina and international settings. N C Med J. 2010;71(5):477–481.
    1. Sawyer-Kurian KM, Wechsberg WM. Adapting an evidence-based HIV intervention for at-risk African American college women at Historically Black Colleges and Universities who use alcohol and drugs. Sage Open. 2012;2(4):1–13. doi: 10.1177/2158244012464977.
    1. Jones HE, Myers B, O’Grady KE, Gebhardt S, Theron GB, Wechsberg WM. Initial feasibility and acceptability of a comprehensive intervention for methamphetamine-using pregnant women in South Africa. Psychiatry J. 2014. doi:10.1155/2014/929767.
    1. Wechsberg WM, Luseno WK, Lam WK, Parry CD, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav. 2006;10(2):131–137. doi: 10.1007/s10461-005-9036-8.
    1. Wechsberg WM. A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: A randomised trial of the Women’s Health CoOp. BMJ Open. 2013;3:e002622. doi: 10.1136/bmjopen-2013-002622.
    1. Wechsberg WM, Krupitsky E, Romanova T, Zvartau E, Kline TL, Browne FA, et al. Double jeopardy-drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial. Subst Abuse Treat Prev Policy. 2012;7:1–9. doi: 10.1186/1747-597X-7-1.
    1. El-Bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, et al. Longterm effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS Behav. 2005;9(1):1–13. doi: 10.1007/s10461-005-1677-0.
    1. Wu E, El-Bassel N, Donald McVinney L, Fontaine YM, Hess L. Adaptation of a Couple-Based HIV Intervention for Methamphetamine-Involved African American Men who have Sex with Men. The open AIDS journal. 2010;4:123–131. doi: 10.2174/1874120701004010123.
    1. El-Bassel N, Gilbert L, Wu E, Witte SS, Chang M, Hill J, et al. Couple-based HIV prevention for low-income drug users from New York City: a randomized controlled trial to reduce dual risks. J Acquir Immune Defic Syndr. 2011;58(2):198–206. doi: 10.1097/QAI.0b013e318229eab1.
    1. El-Bassel N, Gilbert L, Terlikbayeva A, Wu E, Beyrer C, Shaw S, et al. HIV Among injection drug users and their intimate partners in Almaty. Kazakhstan AIDS and behavior. 2013;17:2490–2500. doi: 10.1007/s10461-013-0484-2.
    1. EngenderHealth. Planned Parenthood Association of South Africa . Men as Partners: A Program for Supplementing the Training of Life Skills Educators. New York, USA: EngenderHealth; 2001.
    1. McKleroy VS, Galbraith JS, Cummings B, Jones P, Harshbarger C, Collins C, et al. Adapting evidence–based behavioral interventions for new settings and target populations. AIDS Educ Prev. 2006;18(Supplement A):59–73. doi: 10.1521/aeap.2006.18.supp.59.
    1. Williams RJ, Tregear SJ, Dusablon T, Caceda-Castro LE, Miller KJ, Hill G, et al. Increasing adoption of comparative effectiveness research in community behavioral health: Methodology. J Behav Health Serv Res. 2014;41:258–75. doi: 10.1007/s11414-013-9367-6.
    1. Castro FG, Barrera M, Holleran Steiker LK. Issues and challenges in the design of culturally adapted evidence-based interventions. Annu Rev Clin Psychol. 2010;6:213–239. doi: 10.1146/annurev-clinpsy-033109-132032.
    1. Blase K, Fixsen D. Core Intervention Components: Identifying and Operationalizing What Makes Programs Work. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation and Office of Human Services Policy, US Department of Health and Human Services; 2013.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel