1. Effect of a values-based prevention curriculum on HIV- positive couples from four regions in Ethiopia Presented at XIX IAC 2012 By Misgina Suba, MPH 25 July 2012

2. Background Evidence increasingly reveals that much of the heterosexual HIV transmission in Southern and East Africa takes place within marriage or cohabitation. The Faithful House (TFH) is a culturally sensitive skills-building HIV prevention program designed to strengthen relationships for cohabitating couples.

3. Program Description TFH is a 5-day participatory curriculum developed by CRS and Maternal Life International Groups of 10-15 couples complete sessions together and as couples Facilitators guide discussion by the interest and needs of the group

4. Program Description Drama, role plays and pictures evoke discussion so literacy is not required Modified for couples living with HIV and PMTCT programs CRS has trained facilitators in 12 countries and reached over 79,000 beneficiaries

5. Study Objective Assess the outcomes of TFH for PLHIV on: Couples’ communication, quality of relationship Family strengthening attitudes and behaviors Couples’ health maintenance behaviors, such as adherence to medication, health visit completion and follow-up

6. Methodology Study design: Quantitative and qualitative methods, randomized controlled trial Study period: June 1 to Sept 30, 2011 Sample size : 204 couples living with HIV Data collection : standardized survey by trained enumerator Comparison: intervention and control at 3 month follow-up

7. Results: Demographic 10% of couples were HIV discordant 99% urban population 45% cohabiting; 43% traditional marriage 87% had children; 35% caring for OVC 46% of males; 68% of females did not complete primary education

8. Results: Relationship Satisfaction Indicator (Scale 1-10) Control GroupIntervention Group Baseline3-Mo.Baseline3-Mo. Relationship quality7.38.0**7.38.6** Communication quality7.38.1**7.58.7** Respect received from partner 7.58.3**8.09.0** Sharing personal income and financial assets 7.48.1*7.59.0** Have an open discussion with partner about sex 7.57.27.98.4* * = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)

9. Results: Family Indicators Indicator ControlIntervention Baseline3-Mo.Baseline3-Mo. Both partners responsible for caring for children57%51%60%70%* Joint decision-making power on important family matters55%63%53%71%* Joint decision-making power on when to have sex37%56%*43%71%** Participants writing Will in past 3 months 13%58%** * = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)

10. Results: Health Status Indicators ControlIntervention Baseline3-Mo.Baseline3-Mo. % non-adherent to their regimen^ 18%16%18%10%* % diagnosed with a STI in the last 3 months 8.7%9.3%7.3%4.7% % male partners initiated new care-taking in past 3 months 26%79%* Joint decision-making power on accessing HIV services65%71%67%75% *= statistically significant change (p<0.05) ^ non adherent defined by three or more missed doses in the last month

11. Results: Partner Violence Family Life ControlIntervention Indicator Baseline3-Mo.Baseline3-Mo. % all forms violence or threat 46%39%47%31% % physical violence 14%10%17%6%

12. Qualitative Results The primary findings from our focus group discussions: 1.TFH helped couples reconcile after disclosure and blame related to the positive diagnosis. 2. TFH provided couples with the skills needed for conflict resolution. Participants in TFH workshop going together for VCT

13. 10 – Month Follow-Up Question (Response scale 1-10) InterventionControl Overall quality of communication8.928.11** Discuss financial issues8.968.34* Discuss sexual issues8.467.15** Sexual satisfaction with partner8.457.71** Overall quality of the relationship8.958.02** Partner has knowledge, values and skills to be faithful 8.998.33** * = statistically significant change (p<0.05) ** = statistically significant change (p<0.001)

14. Gender Survey Question, scale 1-10InterventionFemaleMaleP-value Overall quality of communication 8.928.849.010.45 Discuss on financial issues8.968.879.070.38 Discuss on sexual issues8.46 8.470.97 Sexual satisfaction with partner 8.45 8.460.96 Overall quality of relationship 8.958.769.150.09 Partner has knowledge, values and skills to be faithful 8.998.879.130.36

15. Study Limitations Surveys not translated into all the local languages. No objective data to validate self reported responses All couple participants were self-selecting, already enrolled in HIV treatment and care services, and only eligible if both partners could attend Attention bias

16. Conclusion TFH has a positive impact on attitudes and determinants of behaviors that affect relationship and physical health. TFH can be used to encourage male involvement in care of sick children and couple participation in PMTCT and ART programs. TFH is being evaluated to test its potential use in encouraging female participation in decision making around use of household assets.

17. For more information www. crsprogramquality.org Materials in Booth #171 Contact misgina.suba@crs.org