Couple-Focused Program Reduces Risky Sex for Men Under Community Supervision

By Anne Harding

April 08, 2019

NEW YORK (Reuters Health) - A couple-based intervention for prevention of HIV and sexually transmitted infection (STI) reduces risky sexual behavior among men in community-supervision programs (CSPs), a new randomized clinical trial shows.

Men were less likely to report having intercourse without condoms or under the influence of alcohol or drugs after participating in the PACT (Protect and Connect) HIV and STI intervention, Dr. Nabila El-Bassel of Columbia University School of Social Work in New York City and her colleagues found.

"There is a need to focus on relationship context and couple context" in interventions targeting HIV and STIs, Dr. El-Bassel told Reuters Health by phone. PACT addresses communication skills, reproductive issues, sexual coercion, social support and other factors.

Nearly two-thirds of the roughly 7 million people involved in the U.S. criminal justice system are in CSPs, which include probation, parole, community court or alternative-to-incarceration programs, Dr. El-Bassel and her team write in JAMA Network Open, online March 29.

The authors recruited 230 men from CSPs across New York City and their main sexual partners, randomizing each couple to the five-session PACT program or a single session of HIV counseling, testing and referral (CTR).

At 12 months, men in the PACT group had significantly fewer acts of anal or vaginal intercourse without a condom with their main partner (incidence rate ratio, 0.67), with other partners (IRR 0.30), and with all partners (IRR, 0.60) compared with the control group.

They were also 45% less likely to have been under the influence of drugs or alcohol the last time they had intercourse with their main partner, and had 26% fewer partners in the previous 90 days. The incidence of HIV and STIs at 12 months was similar in both groups.

"These results suggest that wider implementation of couple-level corrections-based behavioral interventions has the potential to reduce HIV and STI among people of color involved in the criminal justice system," Dr. Tim W. Menza of the Oregon Health Authority in Portland and Dr. Kenneth H. Mayer of Fenway Health write in an accompanying comment.

"The PACT intervention also addressed biomedical HIV prevention, substance use treatment, and overdose prevention. In the United States, access to these important prevention modalities is limited among women as well as black and Latino people, with low pre-exposure prophylaxis (PrEP) uptake among individuals who use drugs," they add. "Thus, relationship-based programs to increase knowledge and use of PrEP and medication-assisted treatment will further strengthen their value to HIV in the correctional setting and will promote parity in access to these interventions."


JAMA Netw Open 2019.