Developing a Dyadic Intervention for Sexually Transmitted Infection (STI)/HIV Prevention in Youth

While public health programs have demonstrated modest success in reducing the adolescent and
young adult (AYA) risk for STI/HIV, significant health disparities remain. The risk of
STI/HIV is not uniform among AYA. AYA residing in segregated urban communities with high STI
prevalence and complicated sexual networks face even greater risk for disease and associated
complications. Additional supports designed to increase engagement in care and reduce STI
acquisition and transmissions are urgently needed to meet the sexual health and reproductive
health goals for the nation. Overwhelmingly, AYA STI prevention interventions have targeted
individuals and individual-level factors. While effective, these interventions do not
adequately address other important influences affecting AYA risk for STI/HIV, such as partner
or relationship influences on sexual decision-making and behavior. Partner notification and
treatment is a key strategy for disease control and has previously been tested among adults
for STI/HIV prevention work but has yet to be evaluated for AYA. Our prior research
demonstrates that AYAs with complicated STIs are likely to notify their partners to seek
treatment (88-92%); however, AYAs receiving brief behavioral interventions, relative to those
receiving standard of care were 3 times more likely to be successful in arranging for their
partner's treatment. Thus, partner interventions may hold promise for harnessing the power of
relationship dynamics to enhance sexual decision-making, communication, and subsequent health
behaviors. The investigators propose to pilot test an intervention designed to change sexual
health outcomes by understanding partners and the learning environment related to sex
[COUPLES] by simultaneously delivering two evidence-based STI/HIV prevention interventions
Sister-to-Sister Teen and Focus on the Future. The simultaneous delivery of effective
interventions will be augmented with a joint partner health education counseling session
focused on enhancing communication and negotiation of safe sexual practices within the
relationship. If successful, this pilot will support the development of a larger trial
designed to evaluate the effectiveness of this approach in the busy primary care setting by
providing evidence that AYA can and will safely engage their partners in a supportive primary
care setting that integrates high quality treatment with evidence-based STI/HIV prevention
interventions delivered by health educator teams.

Inclusion Criteria:

The index patient must be

- 16-25 years

- Engage in male-female [heterosexual] intercourse

- Have ever had a positive STI diagnosis or have received presumptive treatment for an
STI

- Permanently reside in the Greater Baltimore Metropolitan Area (GBMA)

- Willing to recruit their main sexual partner for the study

- Willing to participate in a single individual session with a health educator followed
by a joint debriefing session together

- Willing to be contacted in 6 weeks for a telephone interview.

- The partner must be 16-30 years

- Engage in male-female [heterosexual] intercourse with the index patient

- Have a partner with a positive STI diagnosis or received presumptive treatment for an
STI ever

- Permanently reside in the greater Baltimore Metropolitan Area

- Willing to participate in a single individual session with a health educator followed
by a joint debriefing session and to be contacted in 6-8 weeks for a telephone
interview.

Exclusion Criteria:

- Index participants and partners who are unable to communicate with staff or
participate in study procedures due to cognitive, mental, or language difficulties
will not be eligible for recruitment into the study.

- Dyads will also be excluded if in same-sex main partnership or a member of the couple
is currently enrolled in another sexual behavior study, one or both partners has a
known concurrent HIV infection, one or more partners has a pending incarceration,
there is more than five years age difference between the two partners and one partner
is <16 years of age, or there is evidence of intimate partner violence (IPV) in the
relationship.

- Individuals who screen positive for IPV will be referred to local resources for
assistance.