The HIV/AIDS epidemic continues to be a major public health concern that has hit African Americans particularly hard. Individual-level prevention approaches, although effective, are too narrowly focused and ignore the role relationships play in HIV/STD transmission. Couple-level interventions, especially with serodiscordant couples, redirect the focus to changing the relationship factors that influence sexual decision-making and increase the likelihood that sexual risk reduction will be stable over time. This U10 competing continuation application seeks four additional years of support to meet the original plan to enroll 800 African American HIV serodiscordant couples into Project Eban, the NIMH Multisite HIV/STD Prevention Trial for African American Couples, that is being conducted in four clinical sites-Atlanta, Los Angeles, New York, and Philadelphia-in collaboration with the NIMH and a Data Coordinating Center. Although attendance rates at intervention sessions and retention rates at follow-up assessments have been excellent, recruitment challenges have caused slower couple enrollment than was originally planned. Additional time is needed to implement new recruitment activities that are anticipated to recruit these hard-to-reach couples. As in the original trial, we will randomize couples to (1) an 8-session couples-focused HIV/STD Risk Reduction Intervention or (2) an 8-session individual-focused Health Promotion Intervention (the comparison condition) that addresses health issues unrelated to sexual behavior. Both interventions involve couple and group sessions led by trained male and female co-facilitators. The approach draws upon the social cognitive theory, an ecological framework, an Afro centric paradigm and the applicant teams'previous work with African American populations. The primary behavioral outcome is self-reported proportion of condom- protected sexual intercourse;the primary biological outcome is the incidence of STDs (i.e., chlamydia, gonorrhea, and trichomonas) assessed by DNA amplification tests on urine and vaginal specimens. Secondary outcomes include theoretically relevant variables hypothesized to mediate and moderate 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. Generalized estimating equations (GEE) and mixed-effects modeling (MEM) will be used to test (1) the effects of the intervention on STD incidence and condom use as well as on mediator variables of these outcomes and (2) whether the effects of the intervention differ depending on key moderator variables (e.g., gender of the seropositive partner, length of relationship, psychological distress, sexual abuse history, and substance abuse history. The findings will contribute significantly to an understanding of HIV/STD risk reduction among African American serodiscordant couples, a population at high risk of transmission.
