What Do We Know?
7.7 Summary and Conclusion
This chapter underscores the importance of couple-based approaches to HIV prevention and care. Compared to individual and group-level HIV interventions, couple-based HIV interventions are in nascent stages of development in the USA and internationally. The advantages of couple-based approaches are evident. They can reduce drug and sexual behaviors that drive transmission of HIV and improve adherence to ART that, in turn, can decrease the risks of transmission. However, there remains a need for more research on couple-based approaches, especially for drug users and MSM, as well as for seroconcordant-positive couples. Effective couple-based HIV prevention strategies are needed for primary prevention for sero-discordant couples, couples who do not know their HIV status, or who are both HIV negative; in other words, all couples in which HIV transmission is possible, espe-cially for those whose behaviors place them at high risk for HIV (El-Bassel et al.
2005 ) . In this chapter, we have presented a number of the advantages that accrue from using a couple-based modality as well as a number of gaps.
The science of couple-based research can be advanced by addressing the gaps and challenges discussed in this chapter, in particular biological outcomes and the impact of couple-based interventions on concurrent sexual relationships. More attention and resources must be given to the dissemination of evidence-based, couple-focused prevention and treatment research into real-world settings. All couple-based studies have been effi cacy trials rather than effectiveness trials. It has yet to be deter-mined whether any of the interventions is capable of widespread effectiveness under realworld conditions. Advancing the science of couplebased research (e.g., effi -cacy, effectiveness, and dissemination) has the potential to reduce HIV acquisition and transmission among vulnerable populations.
Despite their demonstrated value in reducing risk behaviors and improving adherence to HIV medication, couple-based approaches are rarely employed in HIV service settings. Reasons for the limited dissemination and scaling up of couple-based HIV interventions to date may include common ideological preferences of staff and administrators for individual or group services; agencies are not structured to provide couple services, even if partners present and want to be treated together;
and there is a lack of access to evidence-based HIV interventions for couples, and lack of funding and staff training in couple-based modalities.
Expanding the scope of dissemination and scaling up couple-based HIV inter-ventions will require government and donor commitment for funding dissemination and implementation research as well as funding for training providers in couple-based approaches.
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© Springer Science+Business Media, LLC 2012
Abstract This chapter provides an overview of the impact of the HIV/AIDS epidemic on vulnerable children and families in sub-Saharan Africa. There is a discussion of the terms used to describe HIV-affected vulnerable children. As a result of the generalized epidemic and widespread poverty, many children and families are in need of services. This chapter covers the research on the impact of HIV/AIDS on children and their families in four key areas: (1) care arrange-ments, (2) educational opportunities, (3) mental health, and (4) HIV risk behav-iors. This is followed by a review of the emerging literature on services and programs. The chapter concludes with a discussion of the shortcomings of the research and what has been learned from the studies and programs to date.