Changing sex risk behaviors, gender norms, and relationship dynamics among couples in Cape Town, South Africa: Efficacy of an intervention on the dyad

• Published in: Social science & medicine (1982) 2018-07, Vol.209, p.95-103
• Main Authors: Speizer, Ilene S., Zule, William A., Carney, Tara, Browne, Felicia A., Ndirangu, Jacqueline, Wechsberg, Wendee M.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Behavior modification; Black people; Communication; Conflict resolution; Counseling; Couple; Couple conflict; Couples; Disadvantaged; Disease prevention; Efficacy; Gender differences; Gender norms; Gender relations; Gender roles; Health problems; Health status; HIV; HIV prevention; Human immunodeficiency virus; Intervention; Low income areas; Norms; Partner communication; Prevention programs; Preventive medicine; Risk assessment; Risk behavior; Safe sexual practices; Sexual behavior; Sexual risk behavior; Sexuality; South Africa; Strategies; Tests
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.05.024

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. •An evidence-based behavior change intervention was adapted for men and couples.•Interventions were delivered in a community setting by local peer educators.•Women and men received communication and prevention skills separately or jointly.•Reaching both partners (jointly or separately) led to better gender outcomes.•Exposing both partners led to more reported consistent condom use by men.