November 22, 2010
Noting that rates of new HIV infections are seven times higher for African Americans than for white persons, the researchers undertook to determine whether couple-level efforts may be a promising intervention strategy.
A cluster randomized controlled trial (Eban) was conducted in four US cities -- New York, Atlanta, Philadelphia, and Los Angeles -- to determine if a behavioral intervention can reduce HIV/STD risk behaviors among HIV serodiscordant African-American couples. Eligibility requirements included both partners being at least 18 years old, being aware of each other's serostatus, and having had unprotected intercourse in the previous 90 days. In all, 1,070 participants were enrolled. Their mean age was 43; 40 percent of the males were HIV-positive.
The couples were randomized into one of two interventions: the couple-focused Eban HIV/STD risk reduction intervention, or attention-matched individual-focused health promotion comparison. The study's primary outcomes were the promotion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea or trichomonas). Data were collected before and after the intervention, and at six and 12 months.
Data were analyzed for 260 couples in the intervention group and 275 in the comparison group. At 12-month follow-up, 81.9 percent were retained. Generalized estimating equation analyses found the proportion of condom-protected intercourse acts was greater among intervention group couples (0.77) than among the comparison group (0.47; risk ratio, 1.24; 95 percent confidence interval 1.09 to 1.41, P=.006) after adjustment for baseline criterion measure.
The adjusted percentage of couples consistently using condoms was higher in the intervention group (63 percent) than in the comparison group (48 percent, RR, 1.45; 95 percent CI, 1.24 to 1.70, P<.001 the adjusted mean number of unprotected intercourse acts was lower in intervention group than comparison difference percent ci to p>
"The overall HIV seroconversion at the 12-month follow-up was five (two in the intervention group, three in the comparison group) of 535 individuals, which translates to 935 per 100,000 population," the authors noted.
"The findings draw attention to an effective intervention strategy that may be scaled up to curb the magnitude and continued spread of HIV and other STDs," the authors concluded. "Future studies must explore the generalizability of the findings to couples irrespective of serostatus and in settings where individuals and couples are not aware of their risks for HIV transmission but whose relationships can be supported as they learn to minimize the risks for themselves and each other. Moreover, the approach of engaging couples should be tested elsewhere in the United States and in other parts of the world, including sub-Saharan Africa, where sex-based power imbalances make it especially difficult for women in couples to reduce their risk of heterosexual exposure to HIV and other STDs."