Monitoring HIV risk behaviors among heterosexual couples: Challenges and lessons learned

Issue: We conducted a study of Black and Hispanic women and their male sex partners to assess risk behaviors and knowledge of partner risks. Implementing this anonymous survey in multiple cities posed many challenges. Methods: Black and Hispanic women in 21 cities were asked to recruit up to 2 men they had sex with in the past 3 months. Both partners completed an anonymous survey about their sexual behaviors and were tested for HIV. The sample size goal per city was to recruit 100 male partners. Formative research was conducted prior to survey implementation to identify barriers to participation. Results: Recommendations resulting from formative research were to secure community support for the study, provide women information to use when recruiting partners, and, paradoxically, downplaying the HIV focus yet ensuring men knew they would get an HIV test during the study. These recommendations were addressed differently across the 21 cities. Expected operational challenges focused on women: low participation rates and having a 2-partner recruitment limit. Based on early implementation in half the cities, women's participation rates were >90%; most had only 1 partner but the partner return rate was 30% (range:10%-50%). Ongoing formative research suggested methods to improve response rates, such as extending appointment hours for men to late evenings and weekends. Lessons Learned: Conducting anonymous surveys of sex partners presents challenges for achieving high response rates. Ongoing formative research is useful to identify and address barriers to participation.