Men who have sex with men (MSM) continue to be the most heavily-impacted risk group in the US HIV epidemic. Studies suggest that the majority of incident HIV infections among MSM are attributable to sex with a main male sex partner;however, HIV prevention interventions that target male-male couples are lacking. Because of this, Couples HIV Voluntary Counseling and Testing (CVCT), an intervention that has been repeatedly shown to reduce HIV transmission within heterosexual couples, has been adapted to US MSM couples. CVCT for MSM couples is now available in 11 US cities. The FDA recently approved home-based HIV testing: however, critics have pointed to the lack of counseling involved, particularly for those who receive a positive HIV test. The proposed activities include an innovative combination of home-based HIV testing and CVCT. The activities investigate the utility of home-based HIV testing combined with a video-Skype operated CVCT session, operated by a remotely located CVCT counselor. Through the screening of 1300 online recruited MSM couples from across the US and the enrollment of 600 in a RCT, the study aims to examine the impact of home-based HIV testing PLUS a video-Skype operated CVCT session (experimental condition) versus home- based HIV testing alone (control) on reductions in sexual risk-taking, formation of and adherence to agreements around sex, relationship functioning for the management of HIV risk in relationships among MSM couples. The proposed activities examine the impact of the intervention on self-reported sero-concordant negative couples (n=300) and self-reported sero-discordant couples (n=300). As a secondary aim, the activities propose to investigate the impact of home-based HIV testing plus a video-Skype operated CVCT session on timely linkage to care for those receiving a preliminary positive HIV result. Couples will complete baseline, 3 month and 6-month follow-up questionnaires, detailing recent sexual risks, scales to measure dyadic communication and coping around HIV risk management, and agreements around sex outside of the relationship. The researchers hypothesize that adding a Skype-operated couples-focused counseling session to home-based testing will act to increase coping mechanisms and communication for the effective management of HIV risks in relationships and will lead to reductions in sexual risk taking both within and outside of the relationship and for those receiving a HIV positive test result will increase timely linkage to care. CVCT provision through Skype offers an inexpensive opportunity for a couples-focused intervention to be taken to a wider audience and to provide a mechanism for those under-taking home-based HIV testing to receive counseling.
From a sample of 1300 online recruited MSM couples (2600 individuals) from across the United States, 600 MSM (1200 individuals, comprised of 300 HIV sero-discordant couples and 300 HIV concordant negative couples) will be randomized to either home-based HIV testing alone or home-based HIV testing with a video Skype operated couples HIV testing and counseling session. The research examines the impact of adding online counseling to home testing on sexual risk taking, formation and adherence to sexual agreements and linkage to care.