University of North Carolina, Chapel Hill, NC, USA.
RTI International, Research Triangle Park, NC, USA.
Soc Sci Med. 2018 Jul;209:95-103. doi: 10.1016/j.socscimed.2018.05.024. Epub 2018 May 18.
South Africa continues to experience new HIV infections, with the highest risk among Black Africans living in poor communities. Most HIV prevention interventions target women or men separately and only a small number target couples jointly.
This study examines varying strategies to engage women and men around HIV prevention and improved couple interactions.
The study comprises three arms: (1) a couple-based intervention delivered to women and men jointly; (2) women and men both offered a gender-focused intervention that is delivered to them separately; and (3) an intervention offered to women only and their male partners receive standard HIV testing and counseling (comparison arm). Between June 2010 and April 2012, men were identified in and around drinking establishments in a large disadvantaged community in Cape Town and asked to participate in the study if they drink regularly, had recent unprotected sex with their partner, and have a female partner who was willing to participate in the study.
A total of 299 couples completed the baseline assessment and 276 were included in the analysis of sexual risk, partner communication, conflict resolution, and gender norm outcomes at baseline and six-month follow-up. Couples that participated in the couple-level intervention and couples where both partners received the intervention separately had better couple-level gender norms than couples in the comparison arm (women only receive intervention). Further, couples in the couple-level intervention and the both partners exposed separately arms were more likely to have the man only report consistent condom use than neither partner report consistent condom use than couples in the comparison arm.
Community-based HIV prevention intervention programs need to consider strategies to engage women and men and, if feasible, reach both partners jointly. Couple-level interventions are promising to improve gender norms and subsequently improve health outcomes, including reduced HIV risk among women, men, and couples.
南非不断出现新的 HIV 感染病例，风险最高的是生活在贫困社区的黑人。大多数 HIV 预防干预措施分别针对女性或男性，只有少数针对夫妻双方。
本研究旨在探讨不同策略，以促使女性和男性参与 HIV 预防，并改善夫妻互动。
研究包括三个部分：（1）对夫妻双方同时进行基于夫妻的干预；（2）为女性和男性提供分别针对他们的性别焦点干预；（3）仅为女性提供干预，而其男性伴侣接受标准的 HIV 检测和咨询（对照臂）。2010 年 6 月至 2012 年 4 月，在开普敦一个大型贫困社区的饮酒场所内识别男性，并邀请他们参加研究，如果他们有规律地饮酒、最近与伴侣发生过无保护性行为，且其伴侣愿意参加研究。
共有 299 对夫妻完成了基线评估，其中 276 对夫妻纳入了性风险、伴侣沟通、冲突解决和性别规范结果的基线和 6 个月随访分析。参与夫妻层面干预和双方分别接受干预的夫妻比对照组（仅女性接受干预）的夫妻在夫妻层面的性别规范更好。此外，夫妻层面干预组和双方分别暴露于干预组的夫妻中，只有男性报告坚持使用安全套的可能性高于对照组中没有伴侣报告坚持使用安全套的情况。
基于社区的 HIV 预防干预项目需要考虑与女性和男性合作的策略，如果可行，还需要同时接触双方。夫妻层面的干预措施有望改善性别规范，从而改善健康结果，包括降低女性、男性和夫妻双方的 HIV 风险。
