The AIDS epidemic among women in the United States continues disproportionately to affect racial and ethnic minorities: three quarters of women with AIDS are African-Americans and Latinas, and the infection rates among African-American and Latin women are 16 and 7 times greater, respectively, than that of white women. The majority of these HIV-infected heterosexual women have been exposed to HIV through a steady sex partner with a history of drug use. Many studies have shown that although women have reduced their sexual risk behavior with casual or commercial partners, they continue to practice unsafe sex with their regular partners. In this study the researchers will evaluate the effectiveness of a social-cognitive preventive intervention tailored to low-income African American and Latina women and their main sexual partners. A total of 450 women (and their male partners) will be recruited from a primary health care clinic in the South Bronx, a community with a high HIV prevalence. Following a baseline interview, couples will be randomly assigned to one of three study arms: (1) Six conjoint sessions of social-cognitive HIV/AIDS prevention, in which a woman and her main regular partner will participate together in the intervention (a facilitator and the couple). (2) Six individual sessions of social-cognitive HIV/AIDS prevention, in which a woman alone participates in the intervention (a facilitator and the woman). (3) One individual session of HIV/AIDS information, in which a woman alone participates in the intervention (a facilitator and the woman). The researchers will conduct follow-up interviews with women and their main regular partners 3-, 6-, and 12 months after the completion of the intervention. Protocols and outcomes from the proposed study will be of immediate relevance in primary health care settings. In contrast to the STD clinic setting, the primary care setting is non-stigmatized and touches a vulnerable population that may be unaware of HIV infection. Moreover, in such settings, interventions with individuals and couples may be delivered and replicated more feasibly than those with groups. The research will be conducted by members of the Social Intervention Group at Columbia University and conducted collaboratively with St. Barnabas Hospital.
