New Directions: Multimedia Connect

Professor Susan Witte & Debbie Marcus

http://www.columbia.edu/cu/ssw/sig/

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 theRelationship-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 2416388 eligible women (16%)

Couple Sessions Woman-Alone Sessions

Education/ControlSession

3-Month Follow-Up♀ and ♂

3-Month Follow-Up♀ and ♂

3-Month Follow-Up♀ and ♂

Baseline217 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 (#)

0 10 20 30 40

Couple

Woman-Alone

Education

Baseline

3-Month Follow-Up

# Unprotected Sex: Baseline & 3-Month Follow-Up

Protected Sex in Prior 90 days (%)

0 15 30 45 60

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)

Build Components for Use in Teaching at the School of Social Work