PREVENTION OF HETEROSEXUAL TRANSMISSION OF HUMAN-IMMUNODEFICIENCY-VIRUS THROUGH COUPLE COUNSELING

In the absence of an effective vaccine, behavior change remains the mo st effective means to prevent the spread of HIV. We examined behavior change-over time and rates of HIV seroconversion in a cohort of HIV in dividuals and their heterosexual partners recruited since 1985. Partic ipants were recruited from various HIV counseling and testing sources throughout California and were usually interviewed and tested in their own homes. Couple counseling and risk assessments were conducted at a verage intervals of six months. Data from 144 couples who were discord ant for HIV serostatus are reported. Of the index cases, 78% were men. Most male index cases were bisexuals, and most female index cases wer e infected through heterosexual intercourse with a previous sexual par tner. The mean duration of the relationship for the couple at intake w as 5.6 years. Both condom use and sexual abstinence increased over tim e (p < 0.001 for both), and most behavior change occurred between inta ke and first follow-up visit. We observed no seroconversion after 193 couple-years of follow-up. Couple counseling in combination with socia l support appears to be an effective means to promote and sustain beha vior change among HIV-infected individuals and their heterosexual part ners.