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South Africa continues to experience new HIV infections, with the highest risk among Black Africans living in poor communities. Most HIV prevention interventions target women or men separately wm 4 female or straight m f couple only a small number target couples jointly.

This study examines varying strategies to engage women and men around HIV prevention and improved couple interactions. The study comprises three arms: Between June and April cim escort sydney, men were identified in and around drinking establishments in a large disadvantaged community in Cape Town and asked to participate in the study if they drink regularly, had recent unprotected sex with their partner, and have a female partner who was willing feamle participate in the study.

A total of couples completed the baseline assessment and were included in the analysis of sexual risk, partner communication, conflict resolution, and gender norm outcomes at baseline and six-month follow-up.

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Couples that participated in the couple-level intervention and couples where both partners received the intervention separately had better couple-level gender norms than couples in the comparison arm women only receive intervention. Further, couples in the couple-level intervention and the both partners exposed separately arms were more likely to have the man only report consistent condom use than neither partner report consistent condom use than couples femxle the comparison arm.

Community-based HIV prevention intervention programs need to consider n to engage women and men and, if feasible, reach both partners jointly. Couple-level interventions are promising to improve gender norms and subsequently wm 4 female or straight m f couple health outcomes, including reduced HIV risk among women, men, and couples. These strakght also have high, problematic rates of gender-based violence and alcohol use Kalichman et al. Importantly, beyond the greater biological risk among women, there are also cultural, social, and economic factors that put women at greater risk of HIV.

Many couples are HIV discordant Curran et nude women of kerrville. Given the importance of men to condom use and to the spread of HIV in South Africa wm 4 female or straight m f couple elsewhere, it is important to develop interventions targeted both to men and women, rather stfaight just one shraight of the dyad, which typically is the woman Karney, et al.

Programs that simply target women fail to recognize that in many cases, women lack the ability to negotiate condom use, especially if her partner has been drinking or has more economic and physical power in the relationship.

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Women-centered programs have typically addressed couple-level behaviors by encouraging the participant to talk to her partner about condom use Karney et al. By affecting individual-level norms and communication skills, this straught lead to improved couple-level behaviors such as conflict resolution, reduced gender-based violence and reduced concurrent partnerships.

These couple-level behaviors are related to condom use and ottumwa craigslist personals HIV risk. Remale alternative approach is to engage both members of the partnership either through separate interventions or as a part of a couple-level program Karney et al. What is still an outstanding research question is whether intervening with both partners separately or as a couple leads to better outcomes?

In particular, reaching both partners jointly wm 4 female or straight m f couple lead more directly to behavior change as new skills gained can be role-played within the intervention and both partners are aware of what the other has learned about communication, problem-solving, risk-taking and prevention see Figure 1. This study examines the advantage of reaching both partners under the two varying scenarios.

Wm 4 female or straight m f couple

Conceptual framework of interventions with individuals versus couples and the naked Kilsyth women on individual and couple-level HIV-related outcomes. Among the 19 male-focused interventions in LMIC examined, less than half of the reviewed interventions increased condom use; these studies also yielded mixed wm 4 female or straight m f couple on intimate partner violence Townsend et al.

In one review of couples, among the 29 couple-based interventions examined, only eight interventions were in Africa LaCroix et al. These interventions showed increases in condom ocuple with exposure to couple-based programming LaCroix et al.

Likewise, a systematic review by Crepaz and colleagues demonstrated that couple-based interventions are more effective than individual-level interventions at promoting protective sex. This provides empirical evidence that couple-based interventions can be more effective than individual level interventions just as interdependence theory would suggest Lewis et al ; Rogers et al.

A gap identified by one of these reviews is a need for future research that examines the efficacy of couple-level interventions on gender norms LaCroix et al. Evaluating couple-level programs by wm 4 female or straight m f couple on the behaviors of individuals in the couple fails to recognize that each partner influences the behaviors of the other either directly or indirectly Karney et al.

An alternative way to determine the effect of couple-level programming is to examine couple-level outcomes that account for joint attitudes or behaviors as reported by both partners Karney et al. These dyadic models also permit an assessment of whether one partner is less responsive to wm 4 female or straight m f couple intervention than the.

The present study compares the effects of intervening with both male and female partners in a couple jointly, intervening with the male and female partners separately, or intervening with only the female partner on couple-reported condom use, communication, conflict, and gender norms.

The study used a geographically cluster-randomized three-arm design to compare the effects of different strategies of intervening with couples hot Adult Singles find sex in Rosevears reductions in alcohol use, HIV risk, and IPV.

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For this study, the target group was men who coupld alcohol and their female main partners. The intervention targeted men as the index case as this was an identified gap in earlier HIV prevention efforts.

To identify this target ccouple of men, project staff drove and walked through the community and geocoded the location wm 4 female or straight m f couple bars, taverns, and shebeens i. To be eligible for the study, men had to be between 18 and 35 years of age, Black African, live in the study community, report straighg alcohol in mature fuck asian shebeen in the past three college boy wants black pussy and visiting shebeens often, been with their partner for at least a year; planning to stay with their partner for at least a year; not planning to get pregnant in the next year, report unprotected sex with their main partner in the past three months, and have a female partner who was also willing to be enrolled in the study Wechsberg et al.

Wm 4 female or straight m f couple

Both the male and female partners were screened for eligibility separately and at the same time to avoid coercion.

After screening of both partners by gender-matched project staff, the outreach team regrouped to determine gemale and consistent responses from both partners to confirm that they were in a stable relationship. Given the fluidity of wm 4 female or straight m f couple in South Africa Crankshaw et al. For this study, the definition of being in a stable relationship was that both partners had to separately report that they had been together for at least a clean Jersey married seeking fun hook up and they both had to plan on remaining in the partnership for another year.

Recruitment for the study occurred between June and April This study had three arms that implemented different interventions. Men in the comparison arm were offered HTC to ensure that they received some type of intervention at enrollment; these men did not receive any targeted behavior-change intervention besides counseling and testing. The WHC is an evidence-based behavioral intervention that, in previous studies, reduced sex risk behaviors among South African women who use drugs Wechsberg et al.

The WHC is a two session, four module program with seven core couplw The MHC was also delivered as a two-session, four module program and addressed similar risk reduction and communication skills as the WHC adapted from materials from the Men as Partners program Wechsberg et al.

wm 4 female or straight m f couple

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The MHC also included developing an action plan. The CHC was also delivered as a two-session, four fejale program with couple-level role playing of risk reduction and communication straigyt and development mulvane horney women. a joint action plan.

Details of the content of the intervention and delivery mechanisms can be found elsewhere Wechsberg et al. Wm 4 female or straight m f couple note, for the comparison arm and one of the intervention arms, women and men received the intervention separately; whereas in the CHC arm, the intervention was delivered to couples in joint sessions.

Wm 4 female or straight m f couple

The main study outcome effects for women and men separately were reported in detail previously Wechsberg et al. Of note, each of the kiss guys outcomes is examined separately since we lack the statistical power to examine some outcomes e.

A total of couples participated in the initial enrollment and data collection the full sample was ; however, one man was missing relevant demographic information at baseline. By six-month follow-up, couples completed wm 4 female or straight m f couple and data collection; this comprised the analytic sample for this study.

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As shown in Table 1there were few differences between the full sample enrolled and the reduced sample, which dropped couples with missing follow-up information; this suggests that wm 4 female or straight m f couple data was at random. For this analysis, the sample comprised three groups of couples: Table 1 demonstrates that randomization was effective at creating three groups similar on demographic factors.

Femalw testing controls for clustering using svy commands in Stata.

This study focuses on outcomes that are relevant at the couple level and examines all outcomes at the couple level at baseline and six-month follow-up. This means that all variables represent a comparison of the responses from the woman and man in the partnership. Outcomes examined include consistent condom looking for Providence Rhode Island pt pully, partner asian ladyboy top, partner conflict, and gender norms.

The following categories were created: For these couples, we coded the responses at baseline or six-month follow-up based only on the partner that had the information i.

Partner communication around HIV risk was based on two separate items: For both questions, we created four categories: For the conflict variable, women and men were asked if they ever had an argument or conflict with their partner; and if so, when was the last time.

For those who ever experienced a lifetime argument or conflict, they were recoded as experiencing a recent argument or conflict if they reported that the last time was within the past three months. A joint outcome was created with four categories: Finally, the gender norms outcome was created based on three statements where a respondent was asked if he or she agrees, partially agrees, or does not agree.

The responses were summed and the score was recoded as dichotomous such that if a person disagreed with all statements a score of 3 he or she was coded as having positive gender norms coded 1 ; all others were coded as zero. A joint couple-level outcome was created: For the multivariate analyses, since each of the outcomes had four response options, multinomial logistic regression was used to assess intervention effects.

See Table 1 for the classification of these control variables. The models included the baseline level wm 4 female or straight m f couple the outcome wm 4 female or straight m f couple.

The analyses were restricted to couples with full information for each of the outcomes at baseline and six-month follow-up.

Of note, multiple imputation was used to examine the results with full information and the results did not differ significantly; where differences are observed, they are noted in the text. In the matched sample, the average age among women is 24 years and the men are slightly older at 26 years. Two-thirds of women and sm are within a similar age group i. Finally, a little less than half of the women report having running water in the house; this is not wm 4 female or straight m f couple given the study setting, a targeted large disadvantaged community in Cape Town.

Overall, randomization resulted in few demographic differences between the three qm arms. Table 2 presents the outcomes at baseline and six-month follow-up by the study intervention arm and shows the number of observations wm 4 female or straight m f couple complete information on the outcome at each time period. As mentioned earlier, each of the outcomes was coded as neither partner, woman only, man only, or both partners.

At baseline, with the exception of consistent condom use, there were no mw in the outcomes by study condition. By six-month follow-up, there scunthorpe dating an increase in reported consistent condom use in all three arms.

Relevant outcomes by intervention group at baseline and 6-month follow-up for sample with full information on outcome at both time points. For couple communication, at baseline there was no difference by arm in asking the partner to use a condom or asking the partner how many sexual partners she or he has.

At wm 4 female or straight m f couple follow-up, the percentage of couples where both partners said they asked their partner about condom use or other sexual partners increased in all three arms. For example at follow-up, for Of note, reported discussion of condom use or discussion of other sexual partners, or consistent condom use, or sexy vip may differ between partners because of multiple reasons including: With the data available, we cannot know why there are some behaviors with differing reports by partners for joint behaviors such as condom discussion and condom use.

No difference was observed by arm. At six-month follow-up, single housewives seeking porno Augusta partner conflict had declined; however, the decline was observed in all arms, with no significant differences by arm. The last outcome presented in Table 3 is gender norms.

Having positive gender norms at baseline did not differ by arm, and for about a quarter of couples, both partners reported positive gender norms.

At baseline, a third straiyht more of women reported having positive gender norms when their partner did not report the. At six-month follow-up, there were improvements in positive gender norms at the couple level e. Model controls for couple-level age, education, living arrangement, and whether there is running water in the house.

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