Author: Mark Mascolini
30 July 2010
A behavioral intervention improved condom use in HIV-discordant African-American couples in a cluster-randomized trial. But the intervention did not lower rates of sexually transmitted diseases (STDs), including new HIV infection.
The study involved 1070 African-Americans in HIV-discordant couples (one partner with HIV and one without HIV). The couples lived in Atlanta, Los Angeles, New York, and Philadelphia. Everyone was at least 18 years old, reported unprotected intercourse in the previous 90 days, and knew their partner’s HIV status. Study participants averaged 43 years in age, and 40% of men had HIV infection. The investigators randomized pairs to a couple-focused Eban HIV/STD risk-reduction intervention or to an attention-matched individual-focused health promotion comparison.
The analysis involved 260 people in the Eban intervention group and 275 in the control group. After 12 months, 82% of couples remained in follow-up. A generalized estimating equation analysis at that point determined that the proportion of condom-protected intercourse acts was greater in the intervention group than in the control group (0.77 versus 0.47, risk ratio 1.24, 95% confidence interval (CI) 1.09 to 1.41, P = 0.006).
Adjusted percentages of couples using condoms were 63% in the intervention group versus 48% in the control group. That meant the intervention group had a 45% higher condom use rate in an analysis adjusted for other factors that influence condom use (risk ratio 1.45, 95% CI 1.24 to 1.70, P < 0.001). Adjusted average number of unprotected intercourse acts was significantly lower in the intervention group than in the comparison group (-1.52, 95% CI -2.07 to -0.98, P < 0.001).
Despite better reported condom use in the intervention group, the number of new STDs over 12 months did not differ between the two study groups. There were 2 new HIV infections in the intervention group and 3 in the control group. Those numbers translated into an HIV incidence of 935 per 100,000 people.
The authors believe their study is “the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples.” But higher reported condom use in the intervention group did not appear to protect them from new STDs, including HIV infection.
Source: Nabila El-Bassel, John B. Jemmott, J. Richard Landis, Willo Pequegnat, Gina M. Wingood, Gail E. Wyatt, Scarlett L. Bellamy, for the NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. National Institute of Mental Health Multisite Eban HIV/STD prevention intervention for African American HIV serodiscordant couples: a cluster randomized trial. Archives of Internal Medicine. Published online 12 July 2010. DOI 10.1001/archinternmed.2010.261.
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