World AIDS Day, observed on December 1st since 1988, has become a yearly reminder of the staggering statistics associated with a disease that continues to challenge health officials and the public. In 2009, over 1.5 million people in the United States were living with HIV or AIDS, and the Center for Disease Control estimates that approximately 50,000 people are infected with HIV each year.
African Americans constitute 12% of the U.S. population, but account for roughly 45% of those newly infected with HIV, according to the CDC. Furthermore, a large percentage of new infections occur in women as a result of heterosexual sex. In New York City alone, there are over 3,000 new HIV diagnoses a year.
Treatment options have effectively addressed the scourge. So have positive trends in prevention. Dr. Nabila El-Bassel, a professor at the Columbia University School of Social Work, has been involved in HIV studies for 20 years. And she was principal investigator on a recent couple-based prevention approach to lowering HIV vulnerabilities in African American communities.
With funding from the National Institute of Health, and research and analysis from Columbia University, the University of Pennsylvania, Emory University and UCLA, Professor El-Bassel and an investigative team from each school, designed and implemented Project Ebana culturally congruent HIV prevention for serodiscordant (one partner is HIV-positive, the other is not) African American couples. Meaning fence, the term Eban symbolizes safety and security. Indeed, the project was designed to address overall health advancement as well as HIV risk reduction.
An Effective Couple-Based Prevention Approach
In keeping with public health officials recommendation to go beyond individual HIV prevention strategies, Project Eban is relationship-based. Redirecting the focus to address relationship factors that influence sexual decision-making increases the likelihood that risk reduction will be stable over time among couples, says Dr. El-Bassel.
Conducted in New York, Philadelphia, Atlanta and Los Angeles, Eban tracked 535 randomly-selected, pre-screened couples for one year to assess and reduce their HIV/AIDS risk. The couplesall heterosexual, with at least one self-identified as African American or Blackconsisted of one HIV-negative and one HIV-positive partner of either gender. In addition to awareness of each anothers HIV status, the couples, at least 18 years and older, were required to have been together at least 6 months, with intention to remain together at least 12 months. The couples also reported having unprotected intercourse with their partner in the previous 90 days.
HIV risk reduction intervention is designed to raise participants involvement and awareness in the following ways:
Discussion of sexual behaviors and perceived risks; exercises encouraging talking and listening skills; use of video screenings and practice; problem-solving exercises; identifying and defining sexual violence; examination of gender roles; condom use; prostitution discussion; identifying social support systems; discussion of childhood/family history and trauma; alcohol and drug use.
A vital aspect of Project Eban is its specific Afrocentric design. Applying Kwanzaa principles such as self-determination, cooperation and unity, and using Afrocentric videos, songs and literature effectively engaged the study participants. Additionally, the presence of highly qualified, trained African American facilitators helped create an atmosphere of trust, lessening the stigma of HIV during the sharing of crucial information among the participants, paired and individually.
The unique realities of African Americans who are at risk for HIV were addressed because Eban is a culturally congruent HIV prevention study, says Dr. El-Bassel.
The year-long sessions provided an opportunity for both partners to improve their HIV knowledge, disclose and identify risks, and develop mutual goals and joint responsibility for protecting each other from STIs (sexually transmitted infections). The results were encouraging, suggesting that successful couples intervention helps protect the wider community from the spread of infection.
Dr. El-Bassel, also director of the Global Health Research Center of Central Asia, reported the success of the intervention study to the CDC and is looking into opportunities to share the findings with community centers and churches. In the 1-year follow-up period, the proportion of condom-protected sex and the percentage of couples practicing consistent condom use increased, and over 70% of the participating couples remained together, she said. This represents a plus in sexual behavior outcomes, strengthens confidence in intervention efforts, and has helped reduce the impact of HIV/AIDS on African American communities, she adds.