Couples Motivational Interviewing to reduce drug use and HIV risk in vulnerable male couples

Project Summary The development of effective drug use interventions for sexual minority men (SMM) in relationships is a public health priority. SMM – particularly those under age 35 – continue to represent the majority of new HIV infections in the US and 35-68% of these infections are transmitted between main or primary relationship partners. Drug use is a well-established correlate of sexual HIV transmission risk behavior (TRB) for SMM generally and associations between drug use and HIV TRB are comparable for single and partnered SMM. Despite success with individuals and groups, applications of MI with couples are rare and initially produced mixed results. Developed for use with individuals, MI provided relatively little guidance to counselors when partners were not equally ready to change or one partner argued against a health behavior. Dr. Starks (PI) has devoted more than a decade of research to the development of a novel framework for conducting MI with a couple. Our paradigm views the couple (rather than one partner in the relationship) as the client and offers strategies for managing conflict and promoting the development of shared goals and change plans. Our team, which includes experts in behavioral intervention development and HIV prevention with SMM, now proposes an efficacy trial of the Couples Health Project (CHP). CHP is the first multi-session couples MI drug use and HIV risk reduction intervention intended for use by counselors and other mental health professionals who deliver evidence-based substance use treatment to SMM. The project builds directly on the intervention development work and pilot randomized controlled trial (RCT) results of DA043422 (PI- Starks). Results indicated that CHP was associated with significant reductions in drug use and sexual risk taking among couples who were at the highest risk. We now propose a multi-site trial powered to test the efficacy of CHP and evaluate putative moderators (and mediators) identified in our pilot work. Participants include 180 male couples in which at least one partner is age 18 – 34; HIV negative; and reports recent (past 30 day) drug use and sexual HIV TRB. Biological markers for drug use (urine assay) as well as bacterial sexually transmitted infections corroborate self-reported drug use and HIV TRB data. To increase generalizability and feasibility, couples will be recruited online across the US. Following completion of a remote baseline assessment by both partners, the couple is randomized to either the CHP intervention or a single session of couples HIV testing and counseling (the standard of care for male couples’ sexual health) delivered in a telehealth format via HIPAA complaint ZOOM by interventionists based at geographically diverse medical and research facilities (New York City; Detroit, MI; and Charlottesville, VA). SMM complete follow-up assessments (remotely) 3, 6, and 9-months post-intervention.