Unique program boosts safe-sex habits among high-risk African American couples
A new study has found that heterosexual African American couples in which only one partner is HIV-positive practiced safer sexual behaviors after participating in a culturally specific intervention program designed to reduce the risk of HIV and other sexually transmitted diseases.
The program, based on Eban, an African concept which symbolizes "safety, security and love within one's family and relationship space," was designed not only to reduce risky sexual behaviors but to increase couples' ability to communicate with each other, make safer behaviors more appealing, stay in healthy relationships and respect their communities, according to researchers.
Compared with couples in a comparison intervention program, those who received the Eban-based HIV/STD risk-reduction intervention reported more frequent and consistent condom use and fewer acts of unprotected sex. These effects were maintained over all follow-up assessments.
The findings from the study, published July 12 in the online edition of the Archives of Internal Medicine, suggest that culturally specific interventions may be the key to bringing about beneficial changes in sexual behavior. This study is the first to report a significant reduction in risky behavior among heterosexual African American couples.
"As our nation strives toward more personalized medicine, the conscientious development of treatments that address the needs of a specific population are an important step," said study co-author Gail Wyatt, director of UCLA's Center for Culture, Trauma and Mental Health Disparities and associate director of the UCLA AIDS Institute. "Sexually transmitted diseases, including HIV, are disproportionately affecting African Americans, who comprise 13 percent of the U.S. population but 49 percent of all new HIV infections."
Research has shown that heterosexual African American couples are at greater risk of HIV transmission than their white counterparts, suggesting the need for culturally specific interventions. In addition, although the majority of African American women are infected through heterosexual contact with a regular sexual partner, there has been a relative lack of research on heterosexual African American couples in which only one partner is HIV-positive.
To address this issue, study investigators in four cities with high HIV infection rates — Atlanta, Philadelphia, Los Angeles and New York — conducted a multi-site study with Dr. Willo Pequegnat, scientific adviser at the National Institute of Mental Health. They tested the efficacy of a couples-based randomized controlled trial comparing the HIV/STD risk-reduction program with an intervention focused on general health promotion.
The comparison intervention provided information about healthy lifestyle habits, such as eating more fruits and vegetables, and risk behaviors linked to heart disease, hypertension, stroke and certain cancers. Unlike the risk-reduction intervention, the comparison intervention did not focus on sexual risk behaviors and addressed participants as individuals rather than as couples.
The structure and activities of both interventions were designed to appeal to the cultural values and real-world experiences of urban, heterosexual African Americans. Comparing such similar interventions helped to counter the Hawthorne effect — a phenomenon in which participants in a study will show improvement simply because they are being studied and may be receiving greater medical attention than usual — thus allowing researchers to assess the effectiveness of the HIV/STD risk-reduction component more accurately.
Of the 535 couples enrolled, 260 were randomly assigned to receive the HIV/STD risk-reduction intervention, and 275 received the comparison intervention. The researchers assessed participants' STD status and collected self-reports of sexual behavior at the start of the study, immediately following the eight-week intervention, and at six and 12 months after the end of the intervention.
The researchers noted that couples who are not aware of their differing HIV status, couples in which both partners are HIV-positive, and couples at risk for HIV may benefit from other types of interventions. Future studies should also explore methods for reducing risk behaviors in so-called concurrent relationships — those that involve individuals other than a person's regular sexual partner — among couples in which one partner is HIV-positive.
In addition to Wyatt and Pequegnat, other principal investigators on the study were Nabila El-Bassel, of Columbia University; John B. Jemmott III, J. Richard Landis and Scarlett L. Bellamy, of the University of Pennsylvania; and Gina M. Wingood, of Emory University.
The National Institute of Mental Health funded this study, and numerous community-based organizations supported the study by referring couples and ensuring that those who participated received appropriate health care.
The UCLA Center for Culture, Trauma and Mental Health Disparities is a unique new interdisciplinary center funded by the NIMH that promotes research into the behavioral, biological, psychological and social factors associated with trauma among ethnic minorities. Center faculty aim to understand how depression, post-traumatic stress disorder and other mental health outcomes affect men and women who may not seek or receive effective care. This understanding would help health care professionals create new strategies to reduce mental health disparities among these groups.
The UCLA AIDS Institute, established in 1992, is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social sciences, public health, nursing and disease prevention. Their findings have led to advances in treating HIV, as well as other diseases, such as hepatitis B and C, influenza and cancer.