New Directions: Multimedia Connect Professor Susan Witte & Debbie Marcus

About Project Connect A Relationship-Based HIV/STI Intervention for Heterosexual Couples  Randomized, controlled clinical trial with 217 couples (n=434)  4-year study funded by the National Institute of Mental Health  Carried out 1997 – 2002

Why Relationship-Based? A relationship-based approach to HIV/STI prevention:  Allows a more realistic appraisal of the couple’s risks for HIV transmission  Addresses the context of gender and power in the relationship, intimacy, love, and closeness and how they are related to HIV risk among couples  Provides a supportive environment that enables intimate partners to feel safe disclosing highly personal information (extra dyadic relationships, STIs, etc.) and to learn together effective couple communication and negotiation of condom use

Theoretical Background for the Relationship-Based Intervention  Cognitive/Behavior Theories  Feminist Theory/Gender Roles  Marital and Family Therapy  Ecological Framework

Intervention Components/Goals  Increase perceived vulnerability for HIV infection  Increase motivation to stay healthy  Shared responsibility for safer sex  Increase safer sex communication  Increase male and female condom use and “outercourse”  Increase joint HIV testing  Promote safer sex among family, friends, and community  Maintain safer sex behavior changes over time

What Do We Actually Do in Sessions?  Scripted, manualized format facilitator follows, dictating language and activities  Review goal from previous session, exploring successes or barriers to success  Review skills from earlier session  Introduce new content for this session  Model and practice skills  Set a couple-oriented safer sex goal for coming week to achieve by next session  Give male and female condoms

Screened eligible women (16%) Couple Sessions Woman-Alone Sessions Education/Control Session 3-Month Follow-Up ♀ and ♂ 3-Month Follow-Up ♀ and ♂ 3-Month Follow-Up ♀ and ♂ Baseline 217 Couples (56%) Randomization 12-Month Follow-Up ♀ only 12-Month Follow-Up ♀ only 12-Month Follow-Up ♀ only Project Connect: Design

Unprotected Sex in Prior 90 days (#) Couple Woman-Alone Education Baseline 3-Month Follow-Up # Unprotected Sex: Baseline & 3-Month Follow-Up

Protected Sex in Prior 90 days (%) Couple Woman-Alone Education % Protected Sex: Baseline & 3-Month Follow-Up Baseline 3-Month Follow-Up

Implications and Next Steps  The relationship-based HIV/STI prevention intervention is effective in reducing HIV/STI risk behaviors  Behavioral change on HIV risk was maintained over time (12 months)  The study provides two alternative effective modalities to reduce HIV risk among women and their main sexual partners  Relationship-based HIV interventions can be delivered to couples together or to women alone if the partner is aware of and willing to be engaged in the intervention through the female partner  We need to adapt and make it more widely disseminable, and disseminate it.

Collaboration

 Effective use of media  New forms of behavioral support Collaboration: Goals Improve Outcomes of the Intervention

 Structure  Standardization  New Training Possibilities Collaboration: Goals Widening the Range of Facilitators

 Internet and CD-ROM  Localized for Culture and Language Collaboration: Goals Internationally Deployable

Collaboration: Discovery  Separate environment for client interaction and facilitator training  Skills modeling originally conducted by facilitator can be done with video models  Didactic information can be made more engaging using animation and interactive “games”  Recording client decisions and interactions can give clients an artifact to remember the sessions and a sense of accomplishment

Collaboration: The Plan  Create Prototype for Funding Opportunities (NIMH)Prototype  Build Components for Use in Teaching at the School of Social WorkComponents