1. Monitoring HIV risk behaviors among heterosexual couples: Challenges and lessons learned Amy Lansky, Tricia Martin, Melissa Cribbin Behavioral Surveillance Team Behavioral and Clinical Surveillance Branch Division of HIV/AIDS Prevention, NCHHSTP, CDC Presented at APHA 135 th Annual Meeting November 5, 2007 Washington DC The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

6. The Problem of No Risk Many women do not know their partner’s risk –3347 of 4149 HIV cases among women attributed to heterosexual contact were attributed to “Sex with HIV-infected person, risk factor not specified” –Another 4880 cases among women included those with no risk factor reported or identified

7. Partner Study Objectives Describe the risk behaviors of male sex partners of minority women Assess the extent and nature of the gap between women’s perceptions of their male sex partners’ risky behaviors and the male partner’s reported behaviors

8. Partner Study: Methods (1) Recruitment of women National HIV Behavioral Surveillance System among Heterosexuals At Risk Eligibility for women –Black or Hispanic women –Had >1 sex partner in past 3 months –Had HIV test as part of NHBS-HET Consent-Women –Complete an anonymous survey –Recruit 1 or 2 male sex partners

9. Partner Study: Methods (2) Recruitment of male partners –Women given coupons&training to recruit men –Men brought coupon to study site Eligibility for men –18 years or older –Had sex during past 3 months with female who recruited him Consent: Men –Complete an anonymous survey –Take an HIV test Sample size goal: 100 male partners per city

10. Formative Research Prior to implementation to identify barriers to participation HIV test Incentives Female recruitment of males Male participation Content of survey During implementation to improve response rates

11. NHBS Partner Study, 2006-2007 Atlanta Ft. Lauderdale Miami Dallas Houston San Diego Los Angeles Las Vegas San Francisco Seattle Denver St. Louis Chicago Detroit Boston New Haven New York City Newark Philadelphia Baltimore Norfolk

12. Implementation Early Implementers 8 sites started Sept – Dec 2006 Mid-Implementers 9 sites started Jan – April 2007 Late Implementers 4 sites started June 2007 or later

13. Pre-Implementation Formative Research: Key Recommendations Secure community support for the study Provide women information to use to recruit their partners HIV paradox –Downplay HIV focus of study –Ensure men knew HIV test was required Some concern about violence towards women

14. Expected Operational Challenges (Staff) Low participation rate for women 2-partner limit HIV serodiscordance

15. Actual Operational Challenges Male recruitment rates Women enroll and complete survey, but male partners don’t show up Study was anonymous so cannot follow-up with women or their male partners

16. Recruitment Rates As of September 2007 –Women enrolled: ~ 3000 –Men enrolled: ~1200 –Most women had only 1 partner As of October 2007 –6 of 8 early implementers enrolled 100 men –4 of 9 mid-implementers enrolled 100 men

17. Lessons Learned/Applied Appointments for women to do survey –Asked them to give out coupons before survey –They often returned with their partner

18. Lessons Learned/Applied Stressed in consent that agreeing to do study meant bringing in male partners –Reduced women’s enrollment –Increased female: male ratio

19. Lessons Learned/Applied Extended hours for men –Evening –Weekend Same-day appointments

20. Lessons for Future Studies Using parent study is complex Anonymous study: reduces ability to encourage recruitment/participation of partners Do formative research before and during study to better understand reasons for participation

21. Acknowledgements Participants Partner Study Sites –Ethnographers –Interviewers CDC Team

22. What do people know about the risk behaviors of their sex partners?