The broad objective of this Interactive proposal is to test the efficacy of a contextually appropriate intervention to reduce the risk of sexually transmitted diseases among African American HIV serodiscordant heterosexual couples. This is a collaborative effort by four PIs (El-Bassel in New York, Jemmott in Philadelphia, Wingood in Atlanta, and Wyatt in Los Angeles) to use a common protocol to implement a randomized controlled trial. While most HIV/STD risk-reduction interventions are conducted at the individual level, a couple-based approach may be more efficacious and consistent with cultural values. The participants will be 800 African American HIV serodiscordant couples (200 per site) recruited from community-based organizations (CBOs), health departments, and HIV clinics. The couplers will be randomized to one or two interventions: an 8-session HIV/STD sexual risk-reduction intervention (the Eban Program) or an 8-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. Both interventions will involve couple and group sessions led by specially trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, and the applicants' previous HIV/STD risk-reduction research with inner-city African American populations. The primary biological outcome is sexually transmitted diseases (chlamydia, gonorrhea and trichomoniasis) based on DNA amplification tests on urine and vaginal specimens. The primary behavioral outcome is the self-reported rate on condom-protected sexual intercourse. Secondary outcome measures include theoretically relevant variables hypothesized to mediate intervention effects. Audio computer-assisted self- interviewing (ACASI) will be used to collect data at baseline, immediately post-intervention, and at 6- and 12-month follow-up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). For instance, the analyses will test (a) the effects of the intervention on STD incidence, sexual behavior, and mediators of sexual behavior; and (b) whether the intervention's effects are different depending on key moderator variables, including gender of seropositive partner, length of relationship, psychological distress, sexual abuse history, ethnic identity, relationship satisfaction and substance abuse history. The findings will contribute significantly to the field of HIV/STD risk reduction by developing and testing an intervention with African American couples that can be offered to HIV clinics and CBOs.
