Reducing Risks for Multicultural HIV+/- Women & Partners

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DESCRIPTION (provided by applicant): The aims of the proposed study are to reduce risk of HIV/STD transmission, reinfection and ARV drug resistance among culturally diverse HIV+/- women and their partners (HIV+ sero-concordant and sero- discordant couples) in the developed (Miami, Florida) and developing worlds (Lusaka, Zambia). The proposed study will compare the efficacy of gender-concordant Cognitive Behavioral Risk Reduction Group Counseling (Group Counseling) with traditional Safer Sex Couple Counseling (Couple Counseling) with the goals of 1) increasing partner participation in the use of barriers, 2) identifying interpersonal factors that influence sexual barrier acceptability, 3) developing and testing strategies to improve the acceptability and use of sexual barriers and 4) evaluating the impact of these strategies on long-term barrier maintenance. The current study, funded in 2000, has demonstrated this cognitive behavioral sexual risk reduction intervention to be effective with low SES minority women living with HIV in the US and Zambia. The intervention, tailored to these populations, focused on a) decreasing sexual risk behavior; b) increasing sexual barrier acceptability; and c) identifying factors that influence sexual barrier use. Preliminary data from our pilot work with male partners, however, has confirmed the need to expand our sexual behavior intervention to target both women and their male partners. Two hundred twenty HIV+ sero-concordant and sero-discordant couples at each site will be randomized to the two treatment conditions noted above and followed for one year. In addition to the primary aims related to barrier product acceptability, usage and maintenance, the role of sexual communication and negotiation will be considered as mediator/moderator variables of sexual risk behavior. Finally, intervention-related changes in ARV medication adherence will also be evaluated, as a means of preventing the transmission of drug-resistance strains of HIV among HIV+ and sero-discordant couples. Reducing HIV transmission and anti-retroviral drug resistance are principal goals of this proposed multisite study. A "cognitive-behavioral" sexual risk reduction program promoting monogamy and use of sexual barrier methods (male and female condoms) will be compared to traditional HIV couples counseling for 440 HIV+ or serodiscordant couples in the developed world (Florida) and the developing world (Zambia) to improve primary and secondary prevention of HIV transmission among these vulnerable populations.