A 5-session couple-based intervention for men in community supervision programs and their female sexual partners significantly reduced reported risky sexual behaviors including the number of partners, condomless intercourse, and being under the influence of alcohol or drugs during the most recent sexual encounter, according to a study published in JAMA Network Open.
HIV infections and sexually transmitted infections (STIs) are more prevalent among individuals in community supervision programs compared with the general population in the United States. This randomized clinical trial of drug-involved men in community supervision programs and their female sexual partners was designed to assess the effectiveness of a 5-session couple-based HIV and STI prevention intervention vs a control group of a 1-session counseling, testing, and referral prevention program.
Researchers identified 460 participants who met inclusion criteria for the study, the mean age of whom was 35.0 years (standard deviation 12.8 years), and 74.1% of whom were black. Men were shown to be willing to invite their partners to participate, and couple retention and participation in the program was high in both groups.
Participants were divided in a 1:1 ratio into the Protect and Connect (PACT) HIV and STI intervention testing arm or the control arm, with 115 couples/230 individuals in each arm. An intent-to-treat approach was used to analyze behavioral outcomes, which were assessed at all time points using self-reported data on the past 90-day sexual behaviors. Biomarkers were collected at baseline and at 12 months, and behavioral outcomes were collected at baseline, 3 months, 6 months, and 12 months.
Of the 18 new STI cases identified at the 12-month study assessment, 10 came from the PACT group, and 8 from the control group. Over the follow-up period, PACT participants had 33% fewer instances of condomless vaginal and/or anal intercourse with their main partner compared with control participants (incidence rate ratio [IRR] 0.67; 95% CI, 0.45-0.99; P =.04), 70% fewer sexual encounters with other partners (IRR 0.30; 95% CI, 0.12-0.74; P =.009), and 40% fewer sexual encounters with all partners (IRR 0.60; 95% CI, 0.42-0.85; P =.005). Further, participants in the PACT group were less likely to be under the influence of alcohol or drugs during their last reported instance of vaginal or anal intercourse with their main partners (odds ratio 0.55; 95% CI, 0.31-0.96; P =.04), and had 26% fewer past 90-day sexual partners (IRR 0.74; 95% CI, 0.61-0.88; P =.001). At 12 months, the incidence of HIV/STIs did not significantly differ between the 2 study groups.
Researchers noted that because information was obtained from self-reports from participants, there may be limitations to the study as a result of biases from these reports. In addition, the researchers noted that some men were interesting in participating in the study, but were excluded because their female sexual partners did not want to participate because of lack of commitment to the relationship and/or time constraints. This may have resulted in the inclusion of exclusively couples who were committed to staying together and therefore more interested in learning ways to enhance their relationship and decrease any risks related to HIV and STI transmission, or drugs.
Although the PACT intervention did not significantly reduce the HIV/STI incidence within a 12-month period compared with the control group, it did appear to significantly reduce self-reported risky sexual behaviors, which led study investigators to conclude, “These findings underscore that the PACT intervention can be scaled up to curb the burgeoning HIV epidemic in [community supervision programs] and similar criminal justice settings.”
El-Bassel N, Gilbert L, Goddard-Eckrich D, et al. Effectiveness of a couple-based HIV and sexually transmitted infection prevention intervention for men in community supervision programs and their female sexual partners: a randomized clinical trial. JAMA Netw Open. 2019;2(3):e191139.