HIV incidence among men who have sex with men (MSM) continues to rise in the United States, and over 50% of new US HIV infections in 2006 were among MSM. A recent CDC analysis suggests that over half of HIV transmissions among MSM are from main partners. Therefore, the development of new HIV preventions that target MSM in main partnerships should be a priority. Couples HIV Voluntary Counseling and Testing (CVCT) is described by CDC as a """"""""high leverage HIV prevention intervention"""""""", has been shown to reduce HIV infections in African women when compared with individual HIV counseling and testing, and has been provided to African couples for decades. We propose to adapt the African CVCT intervention for use with US MSM, and conduct a small feasibility trial to demonstrate feasibility to enroll participants in a trial of this intervention, to demonstrate the safety of the intervention for US MSM, and to derive estimates of key parameters that will be required for design of future trials if indicated. Focus group data will be collected and analyzed to develop study measures and to understand acceptability of the adapted intervention to both potential clients and to HIV prevention counselors, who would eventually deliver the intervention. The adaptation of the intervention and the evaluation of the adapted intervention will be guided by the theoretical framework of the couple's interdependence;to fully evaluate the intervention in this theoretical context, we will also develop and validate new scales to measure several constructs of the theory (preferences for outcomes, couple efficacy, outcome efficacy, and perception of social support). Expected outcomes of the research are a culturally appropriate adapted HIV prevention intervention for couples, preliminary data to support feasibility and design of future efficacy trials, and validated scales for use in future trials and other research on couples'interventions.
MSM are the most heavily impacted risk group in the US HIV epidemic, with HIV rates nearly 100 times the rates in the general population. Yet, only 10% of available best evidence HIV prevention interventions have been tested with MSM. Because new data suggest that most new HIV infections among MSM arise from main sex partners, new interventions that target MSM who have main partners are urgently needed.
