A randomized trial was conducted to test the effectiveness of couple-based HIV counseling and testing (CB-HIV-CT) and women-only relationship-focused HIV counseling and testing (WRF-HIV-CT) in reducing HIV risk compared to the National Institute on Drug Abuse HIV-CT standard intervention. Substance using HIV-negative women and their primary heterosexual partner ( couples) were randomized to 1 of the 3 interventions. Follow-up assessments measuring HIV risk behaviors and other relevant variables were conducted at 3- and 9-months postintervention. Repeated measures generalized linear mixed model analysis was used to assess treatment effects. A significant reduction in HIV risk was observed over the 9-month assessment in the CB-HIV-CT group compared to that of the control group ( ) and compared to that of the WRF-HIV-CT group ( ), but no significant difference was observed between WRF-HIV-CT and controls ( ). A brief couple-based HIV counseling and testing intervention designed to address both drug-related and sexual risk behaviors among substance using women and their primary male partners was shown to be more effective at reducing overall HIV risk compared to a standard HIV-CT intervention in an urban setting. 1. Introduction Over the past two decades women have increasingly shouldered the burden of the HIV/AIDS pandemic. From 1997 to 2007 the female proportion of people living with HIV/AIDS globally rose from 41% to 50% [1, 2]. In the United States, the proportion of women representing new AIDS cases has more than tripled since 1985, from 8% to 27% [3]. This trend is most evident among African American and Latina women, who make up 24% of the female population in the USA but account for 82% of women living with HIV/AIDS [3]. AIDS remains the leading cause of death for African American women aged 25 to 34, and it is the second and third leading cause of death, respectively, for African American and Latina women between 35 to 44 years of age. About 80% of all incident HIV infections among minority women are sexually acquired, primarily from minority men [3]. In many low-income urban and rural communities across the USA the HIV/AIDS epidemic among African American and Latina women has reached alarming levels eliciting warnings of a “state of emergency” [4] and “an insidious epidemic… that demands immediate attention” [5]. Recent evidence has further shown that most women who become HIV infected acquire the virus from a husband or other primary male partner [1, 6–17]. In our work with drug-using minority women in East Harlem, New York City, the relative
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