摘要：Objectives. This study examined the efficacy of a relationship-based HIV/sexually transmitted disease prevention program for heterosexual couples and whether it is more effective when delivered to the couple or to the woman alone. Methods. Couples (n = 217) were recruited and randomized to (1) 6 sessions provided to couples together (n = 81), (2) the same intervention provided to the woman alone (n = 73), or (3) a 1-session control condition provided to the woman alone (n = 63). Results. The intervention was effective in reducing the proportion of unprotected and increasing the proportion of protected sexual acts. No significant differences in effects were observed between couples receiving the intervention together and those in which the woman received it alone. Conclusions. This study demonstrates the efficacy of a relationship-based prevention program for couples at risk for HIV infection. Sustained rates of heterosexually acquired HIV infection in the United States, particularly among African American and Latina women, 1 have mobilized efforts to develop alternative prevention strategies, including couple-oriented prevention models. 2– 5 Individual or group intervention efforts often fail to demonstrate increased barrier method use, particularly among women in long-term intimate relationships. 6– 11 New methods that recognize the context of relationship dynamics and focus on couple communication patterns may enable women to initiate and sustain condom use with long-term intimate partners. 10, 12 Couple counseling has been found to be efficacious in promoting HIV counseling and testing, as well as condom use. 13– 18 However, most of the studies that reached this finding were conducted outside the United States. Relationship-based risk reduction interventions encourage collaboration to address mutual needs, and these may be more effective for intimate partners than non–relationship-based interventions. Couple-based therapy literature suggests that relationship-based interventions can be provided either to 1 partner alone or to the couple together. 19, 20 Relationship-based interventions delivered to the couple together may be more effective for several reasons. First, research suggests that individuals acting unilaterally to introduce safer sexual practices may be confronted with negative reactions, including isolation, threats to terminate the relationship, or physical violence. 21– 23 Second, the expectation that individuals can convey new knowledge and skills to their partners assumes that they have the requisite relationship-specific communication skills. Third, the supportive environment of couple counseling may enable intimate partners to feel safer disclosing highly personal information (e.g., extradyadic relationships, sexually transmitted disease [STD] histories) to their partners that will enable them to gain a more realistic appraisal of their risks for HIV/STD transmission as a couple. 24 Project Connect was a randomized clinical trial designed to examine 2 aims. The primary aim was to test whether a 6-session HIV/STD relationship-based intervention would be equally, more, or less efficacious in increasing condom use, decreasing STD transmission, and reducing the number of sexual partners among heterosexual couples in comparison with a control condition consisting of a single session of HIV/STD education. The secondary aim was to examine whether the intervention would be more efficacious when the woman and her partner received the relationship-based intervention together or when the woman received it alone.
