Prevalence of Serodiscordance, Seropositivity and Exclusionary Factors in US Male Couples Presenting for Couples HIV Voluntary Counseling and Testing P Sullivan, R Stephenson, L Salazar, M Mann, J Barnes, L Scales, S Allen Emory University Rollins School of Public Health, Atlanta, Georgia, USA

Background  Major barriers to HIV prevention in US MSM include high prevalence, low awareness of HIV serostatus, and modest rates of disclosure  CVCT is considered a “high leverage” intervention in Africa  Southern African generalized heterosexual epidemics are similar to the US MSM epidemic:  High prevalence  Most new HIV infections estimated to arise from main sex partners

Intervention  We adapted the African CVCT intervention for use with US MSM  Involved academics, prevention providers  Major revisions included shifting focus of family planning issues, addressing agreements  We theater tested the adapted intervention with MSM and HIV prevention counselors in 3 US cities

Feasibility Study Male couples recruited through outreach, advertisements, internet Eligible: Main partners Relationship of at least 3 months duration Neither known HIV+ Ineligible Enrolled: Screen for Coercion History of IPV iVCT Assign iVCT CVCT Present Randomize None 3 month followup

Feasibility Study Male couples recruited through outreach, advertisements, internet Eligible: Main partners Relationship of at least 3 months duration Neither known HIV+ Ineligible Enrolled: Screen for Coercion History of IPV iVCT Assign iVCT CVCT Present Randomize None 3 month followup

Results (1) Eligible: 109 Couples 106 Enrolled: Screen for Coercion History of IPV 41 iVCT 28 (26%) couples assigned iVCT: 10 (9%) Coercion Only 13 (12%) IPV Only 5 (5%) Both Coercion and IPV 37 CVCT Present Randomize None 3 month followup 2 Couples Followup 1 couple had known HIV+ at baseline

Results (2): Participant Characteristics

Results (3): Seroconcordance

Results (4): Seropositivity

Limitations  Because of the population served by AID Atlanta, our participants over-represent blacks and underrepresent Hispanic MSM communities in Atlanta  Data on partnership status, prior HIV testing and other data are self-reported, and subject to misclassification  Results do not generalize beyond participants in the current study

Conclusions  Couples counseling and testing reached a population of MSM with much higher undiagnosed HIV prevalence than traditional iVCT  1 in 5 male couples presenting for CVCT were serodiscordant  CVCT is an important strategy in Atlanta to identify HIV-positive men who may be untested, and HIV-serodiscordant couples for treatment and prevention services  Although self-reported IPV was high, couples reporting IPV had similar rates of serodiscordance, and thus similar need for CVCT

Next Steps  Analysis of 3-month outcomes (Fall 2011)  CVCT rollout in Atlanta and Chicago – starting in September 2011  Evaluation of incident IPV in 400 couples between September 2011-August 2012  Integration of CVCT with prevention packages based on couple serostatus

Acknowledgements  This work was supported by a grant from NIH/NIMH (R34MH086331)  This work was supported, in part, by the Emory Center for AIDS Research (P30 AI050409).  AID Atlanta  Ron Stall, Colleen Hoff, Beau Gratzer, Jeanne Montgomery, Andre’Nita Toson, Elizabeth Stallcup  The couples