CoupleConnect: A Gender-Transformative Approach to HIV Prevention for Tanzanian Couples

"Couple connectedness is defined as the quality of the emotional bond between partners that is both mutual and sustained over time. For couple connectedness to exist, it must be experienced by both partners in the relationship who are committed to practicing these behaviors..."

This was the core principle underlying CoupleConnect, a gender-transformative curriculum developed by the CHAMPION Project in Tanzania to help couples communicate more effectively about relationship challenges as a way to foster improved sexual and reproductive health and prevent HIV. Created in 2011, the CoupleConnect curriculum was used to guide group education workshops designed to provide couples with insights, information, and skills needed to increase their "connectedness," considered an important determinant of healthy sexual and reproductive health (SRH) behaviour.

The brief explains that "couple connectedness is operationalized by nine determinants of sexual behavior focused on mutual trust and support, communication, financial planning and management, shared goals, love and affection, joint decision making, achievement and maintenance of RH, and conflict resolution." The 15-session CoupleConnect curriculum was designed specifically for Tanzania through a process that included stakeholder meetings and key informant interviews, followed by a pilot project in nine districts. Couples participated in sessions using interactive teaching methodologies, such as large-group and knee-to-knee couple discussions, fishbowls, and other adult learning games. Workshop results were assessed through a comparison of questionnaires to assess attitudes, beliefs, and knowledge related to "couple connectedness."

A number of key findings from the pilot are outlined. Overall, participants' views about the CoupleConnect workshop were overwhelmingly positive, with 85% believing that the programme positively effected them as individuals and couples. Couples demonstrated "a positive change in overall knowledge, attitudes, and beliefs around couple connectedness, HIV, and RH issues." For example, participants were more likely to agree that married couples should get tested regularly for HIV together after the intervention (94%) than before (84%),and more than 8 in 10 participants (86%) correctly identified withdrawal as an ineffective method of FP following the intervention, an increase of percentage points from before. However, there is still significant work to be done. While it was found that Òthe number of participants who believed that it is okay for a wife to say "no" to sex with her husband increased overall (from 36% to 58%), two-fifths of participants did not believe this is okay or were unsure after the intervention." As well, women were still "more likely than men to say that it is shameful to talk about their sexual desires with their partner, both at pre-intervention (43% vs. 33%) and at post intervention (24% vs. 16%)."

The brief offers a number of recommendations:

• Tailor Interventions to Meet CouplesÕ Needs: Workshops should consider education and literacy and group similar sets of couples. The implementation should also respond to identified needs. For example, during the pilot the intervention was adapted from a two-month intervention to an intensive three-day course, which improved attendance and participation by both partners.
• Involve Community Leaders in Implementation: Implementation and recruitments should happen at ward level, as participants then have greater connection to the facilitators who come from the community. Likewise, obtaining intervention buy-in from local authorities and leaders (e.g., community, religious) is critical.
• Ensure Strong Facilitator Capacity and Equitable Interaction: CoupleConnect is facilitated by married co-facilitators. "The manner in which married co-facilitators communicate, negotiate, resolve conflict, and support each other is critical to the success of interactive, mixed-sex, gender-transformative programs like CoupleConnect. Cofacilitators must mirror the positive and gender-equitable communication skills that the curriculum promotes."
• Collect More In-Depth Data: In order to better understand how post-workshop dialogues among couples is nurtured and practiced, more in-depth and rigorous evaluation is required, to help strengthen conclusions about the sustainability of the programme's impact on knowledge and attitudes in the longer term.