Prevention of heterosexual transmission of human immunodeficiency virus through couple counseling.

In the absence of an effective vaccine, behavior change remains the most effective means to prevent the spread of HIV. We examined behavior change over time and rates of HIV seroconversion in a cohort of HIV individuals and their heterosexual partners recruited since 1985. Participants 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 average intervals of six months. Data from 144 couples who were discordant for HIV serostatus are reported. Of the index cases, 78% were men. Most male index cases were bisexuals, and most female index cases were infected through heterosexual intercourse with a previous sexual partner. The mean duration of the relationship for the couple at intake was 5.6 years. Both condom use and sexual abstinence increased over time (p < 0.001 for both), and most behavior change occurred between intake and first follow-up visit. We observed no seroconversion after 193 couple-years of follow-up. Couple counseling in combination with social support appears to be an effective means to promote and sustain behavior change among HIV-infected individuals and their heterosexual partners.