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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Connect (Couple or Woman-alone)

BEST-EVIDENCE

Intervention Description

Target Population
Minority, inner-city heterosexual couples

Goals of Intervention

  • Increase safer sex practices among couples (i.e., increasing condom use, decreasing STD transmission, and reducing number of sex partners
  • Increase relationship communication

Brief Description

Connect can be delivered to the couple or the woman alone. The Couples intervention consists of an orientation session and 5 relationship-based sessions delivered to each couple. An initial orientation session is delivered one-on-one to each woman and her partner. The orientation session increases participants’ motivation for attendance, heightens risk awareness, and prepares participants for the intervention. The 5 relationship-based sessions are delivered to intact intimate couples (i.e., a woman and her regular male sex partner). These sessions emphasize the importance of relationship communication, safer sex negotiation and problem solving skills. The sessions also highlight how relationship dynamics are affected by gender roles and how social supports can help maintain safer sex behavior. The intervention delivered to each woman alone is identical in content and session format as the Couples intervention.

Theoretic Basis

  • AIDS Risk Reduction Model
  • Bronfenbrenner’s Ecological Perspective

Intervention Duration
Six 2-hour sessions delivered over 6 weeks

Intervention Setting
Hospital outpatient clinic

Deliverer
Female facilitators who were either a Masters in Social Work (MSW) or social work graduate student.

Delivery Methods
  • Counseling
  • Demonstrations
  • Discussions
  • Exercises
  • Goal setting
  • Practice
  • Risk reduction supplies (male and female condoms)
  • Video

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Intervention Package Information

An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. Information about the intervention package can be found at: http://wwwcdc.gov/hiv/prevention/research/rep/packages/connect.html

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Evaluation Study and Results

The original evaluation study was conducted in Bronx, New York between 1997 and 2001. Of the 217 couples who participated in the study, 52% had completed high school or obtained their GED.

Study Sample

  • 55% AA; 39% Hisp; 6% Other
  • 47% AA couples; 30% Latino couples; 23% mixed ethnic couples
  • 50% Female and 50% Male
  • Mean age of 38 years

Recruitment Settings
Hospital-based outpatient clinics

Key Intervention Effects

  • Couple intervention increased protected vaginal sex acts.
  • Woman-Alone intervention reduced unprotected vaginal sex acts and increased protected vaginal sex acts.

Eligibility Criteria
Women were considered eligible if they were between 18 and 55 years of age, had a regular male sex partner, involved in a long-term relationship with this partner, had at least 1 episode of unprotected vaginal/anal sex with this partner within the past 30 days, no report of life-threatening abuse by this partner with the past 6 months, and a patient of the outpatient clinic. In addition, women had to know or suspect their partner of having 1 of the following HIV/STD risk criteria during the past 90 days: sexual relations with other men or women, diagnosis or symptoms of an STD, drug injection, or HIV-seropositive.

Assignment Method
Couples (or the women) were randomly assigned to 1 of 3 groups: Couple intervention (n=81 couples), Woman-alone intervention (n=73 women), or an Education control (n=63 women).

Comparison Group
The Education control group involved only the woman taking part in 1 HIV/STD information session that consisted of a video followed by a brief question-and-answer period.

Relevant Outcomes Measured and Follow-up Time

  • Sexual risk behaviors during the previous 90 days (including number of unprotected vaginal sex acts with study partner, percent protected vaginal sex acts with study partner, and number of sex partners) were measured at 3 months post-intervention.
  • Self-reported number of STD symptoms measured at 3 months post-intervention.

Participant Retention

  • Couples Intervention:
    86% retained at 3 months
  • Woman-alone Intervention:
    84% retained at 3 months
  • Education Control:
    79% retained at 3 months

Significant Findings
The Couples and Woman-alone interventions each significantly increased the proportion of protected vaginal sex acts compared to the Education control (p < .05 for each comparison). The Woman-alone intervention significantly reduced the number of unprotected vaginal sex acts when compared to the education control (p < .05).

Considerations
No significant differences were reported between couples receiving the intervention together or women receiving the intervention alone.

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References and Contact Information

  • El-Bassel, N., Witte, S. S., Gilbert, L., et al. (2003). The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. American Journal of Public Health, 93, 963–969.
  • El-Bassel, N., Witte, S. S., Gilbert, L., et al. (2001). HIV prevention for intimate couples: A relationship-based model. Families, Systems & Health, 19, 379–395.

Researcher: Dr. Nabila El-Bassel
Social Intervention Group, Columbia University School of Social Work
622 West 113th Street, Box 713
New York, NY 10025
e-mail: ne5@columbia.edu

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