HIV This Week

Burton J, Darbes LA, Operario D. Couples-Focused Behavioural Interventions for Prevention of HIV: Systematic Review of the State of Evidence. AIDS Behav. 2008 Oct 9. [Epub ahead of print]

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. Burton and colleagues conducted a systematic review of studies testing whether couples-focused behavioural prevention interventions reduce HIV transmission and risk behaviour. They included studies using randomized controlled trial designs, quasi-randomized controlled trials, and nonrandomized controlled studies. They 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 programmes 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.

Editors’ note: This first ever, systematic review of couples-focused HIV prevention included studies involving heterosexual couples in five countries ( Kenya, Tanzania, Zambia, Trinidad, and the USA). At this stage of the epidemic, the paucity of HIV prevention scientific literature focusing on couples is astonishing. More attention is required to the dynamic interactional forces that influence sexual risk behaviour within couples, such as gender roles, power imbalances, communication styles, childbearing intentions, and quality of relationship issues (commitment, satisfaction, and intimacy).

Among HIV-infected persons, Mackellar and colleagues evaluated use of client partner notification and health-department partner notification strategies to inform sex partners of possible HIV exposure, and prior exposure to partner counselling and referral services. They conducted a cross-sectional, observational study of 590 persons diagnosed with HIV in the prior 6 months at 51 HIV test, medical, and research providers in Chicago and Los Angeles in 2003 and 2004. Logistic regression was used to identify independent correlates of using client partner notification to notify all locatable partners. Participants reported a total of 5091 sex partners in the 6 months preceding HIV diagnosis; 1253 (24.6%) partners were locatable and not known to be HIV-positive. Of 439 participants with >/=1 locatable partners, 332 (75.6%) reported notifying 696 (55.5%) partners by client partner notification (585, 84.1%), health-department partner notification (94, 13.5%), or other means (17, 2.4%); 208 (47.4%) used client partner notification to notify all locatable partners. Independent correlates of client partner notification included having fewer locatable partners and discussing the need to notify partners with an HIV medical-care provider (black and Hispanic participants only). Many participants reported that their HIV test or medical-care provider did not discuss the need to notify partners (48.8%, 33.7%, respectively) and did not offer health-department partner-notification services (60.8%, 52.8%). Many locatable sex partners who might benefit from being notified of potential HIV exposure are not notified. In accordance with national policies, HIV test and medical-care providers should routinely provide partner counselling and referral services to HIV-infected clients so that all locatable partners are notified and provided an opportunity to learn their HIV status.

Editors’ note: Real increases appear to have occurred over the past 20 years in the proportion of newly diagnosed people in the US who notify locatable sexual partners of their risk exposure. Heterosexuals are more likely than men who have sex with men to notify all locatable partners (68% versus 55%), possibly due in part to differences in the numbers of sex partners (median [interquartile range Q1- Q3] of 2 [1-3] versus 3 [2-7]). Other barriers to overcome in both populations include concern for personal safety, having used condoms, and perceiving the partner as healthy.