Feasibility and Potential Promise of Couple-Based Sexual Risk Reduction Intervention for Black Men Who Have Sex with Men at Risk for HIV/STI Transmission

BACKGROUND & PURPOSE: Despite advances in the prevention programs, HIV incidence has steadily increased among men who have sex with men (MSM) in the U.S. since the 1990s. Innovative approaches are needed to address both MSM populations have longer-standing disproportionate representation among HIV cases, such as Blacks/African Americans, as well as more recently emerging risk dynamics that might be driving a resurgence of infections, such as methamphetamine use. Prior research has supported the efficacy of a preventive intervention for couples, but those earlier risk reduction intervention studies have been conducted exclusively with mixed-gender ("heterosexual") couples. This study examined the feasibility and potential promise of couple-based behavioral intervention for Black MSM couples at elevated risk for HIV/STI transmission.

METHODS: We pilot-tested a manualized, 7-session, couple-based intervention—adapted from an efficacious intervention for heterosexual couples—using a pre-/post-test design with 34 methamphetamine-using, Black MSM couples engaging in sexual risk, i.e., at least one partner had unprotected anal intercourse (AI) with an extradyadic male partner. Data were collected from participants prior to receipt of the intervention ("baseline"), followed by delivery/receipt of the intervention, and then concluded with another assessment 2 months after conclusion of intervention delivery ("follow-up"). Data were collected via audio computer-assisted self interview (ACASI). The study's primary outcome measures focused on sexual risk behaviors; secondary outcomes focused on illicit drug use. Inferential hypothesis testing involved estimation of changes in outcome measures from baseline to follow-up. Parameter estimation and significance tests relied on generalized linear mixed models (GLMM) to account for correlations that arise from repeated measures as well as shared variance in measures that involve behaviors between two partners constituting a couple; GLMM also included covariance adjustment for sociodemographic variables (e.g., age, education, income, etc.).

RESULTS: At baseline, participant reported on average 4.5 (SD=0.6) male sexual partners, 13.3 (SD=1.9) episodes of unprotected AI with their primary male partners, and using condoms during 18.0% (SD=3.1%) of the episodes of AI with their primary male partner. Compared to baseline reports, at 2 months post-intervention, participants reported significantly fewer sexual partners (p<.001) and episodes of unprotected AI with a main partner (p<.001), and a significantly higher proportion of condom-protected AI episodes with a main partner (p<.001). Participants reported a significant reduction in the frequency of using methamphetamine (p<.001) and any illicit drug (p<.01), as well as the number of illicit drugs used (p<.05).

CONCLUSIONS & IMPLICATIONS: To our knowledge, this is the first research study to provide empirical findings regarding a couple-based approach to sexual risk reduction for MSM. Findings indicate that couple-based intervention is feasible and shows promise in reducing both sexual risk behavior and illicit drug use among Black MSM at elevated risk for HIV transmission. These findings provide an impetus for a larger randomized clinical trial with longer follow-up to more rigorously test the efficacy of the intervention as well as duration of behavior changes, altogether extending the horizon of social work research to include an innovative, evidence-based intervention to reduce HIV transmission among Black MSM.