Promoting safe sex in African-American couples
Intervention works and is popular with couples
Despite the HIV epidemic's impact on poor, urban African Americans nationwide, there have been few prevention interventions targeting this population specifically.
Now there is one new evidence-based program that has demonstrated an increase in safer sexual behaviors among heterosexual African American couples. A new study of sero-discordant couples has found that the Eban program works.
"We developed the intervention because there are very few, if any, interventions developed for couples who are heterosexual, and we wanted to devote our attention to the African American couples because this population is overburdened with HIV/AIDS," says Gail E. Wyatt, PhD, professor of psychiatry and biobehavioral sciences, University of California Los Angeles (UCLA).
"We felt this was important to address because it was possible that couples where one person was HIV positive and the disease could be transmitted simply didn't know how to negotiate safer sex practices," Wyatt says. "We thought they might not know how to preserve the love, romance, and commitment to each other in a relationship where there is a disease that can kill you."
Researchers devised an eight-week intervention that had couples involved in individual sessions, lasting two hours once a week, with a male and female facilitator, who modeled how to communicate, how to negotiate safer sex techniques and practices, and how to retain love and commitment within the relationship, she explains.
The couples had been together for an average of seven years. Most were unmarried and had children with each other.
The facilitators would demonstrate how to talk within a relationship without yelling, as part of the exercises.
"Many couples remarked they had never seen two people talk without yelling and screaming," Wyatt notes.
The interventions also included discussions of sex and bodies and were broadened to be relationship-focused.
"We don't often talk about love in HIV interventions, but in these interventions we talked about love and how to be romantic," Wyatt says. "They could have a night out or just make dinner for each other."
All of these issues were placed in the context of HIV prevention, she adds.
There was a second intervention that involved health promotion. It focused on how to stay healthy through diet, exercise, and making regular doctor's appointments.
"Half of the group got the health promotion only, and the other half had the risk reduction only," Wyatt says. "We compared how couples changed risk reduction behavior after the intervention at intervals of six months and 12 months."
Investigators found that couples in the risk reduction intervention were significantly more likely to use condoms 100% of the time and less likely to have unprotected sex with their partners than were the couples in the health promotion group, Wyatt says.
"The results were highly significant and very powerful," she says.
Interventions culturally congruent
Both interventions featured games and handouts, and the interventions were culturally congruent, Wyatt says.
"We had music, poetry, Afrocentric pieces of information to steep couples in a celebration of who they were," she adds. "People liked being in an intervention that wasn't just condom-focused."
The risk reduction intervention also had time for discussing HIV stigma and the difficulty couples have in dealing with various aspects of life when one person is HIV positive. They discussed sexual function and childhood abuse. The study found that 71% of the couples had a history of childhood sexual abuse.
"These were two people with vulnerable abuse histories, and they were less likely to use condoms," Wyatt says.
Couples with a history of physical violence within the past year of the relationship were excluded from the study. Also, couples who were planning to have a child within the next year were excluded.
"The couples were referred for counseling and had to be comfortable saying what was on their mind," Wyatt says.
The discussions often centered around the discrimination couples experienced from their parents.
"They wouldn't let the HIV-positive person eat at the table, use the bathroom," Wyatt says. "They experienced stigma, and many parents were not supportive."
Both the couples and their families could benefit from increased HIV prevention education, as well as information about how HIV is transmitted, Wyatt says.
"HIV is now seen as a chronic disease, and in a lot of people's minds it is not seen that way," she says.
So family members of HIV-infected people need more information about the virus so they can be supportive of the couples.
"These relationships are endangered with high divorce rates or too many baby fathers and too many relationships without formation or context," Wyatt explains.
"Our goal was to help them enhance that commitment and stay together, but to also be safe," she adds.
"Our focus was on getting couples to use condoms consistently so no one could risk the chance of getting infected," she says. "We had demonstrations with dildos and asked them to practice with facilitators to see if they had the skills of placing on a condom."
The intervention included the female condom, but most couples said they were not interested in using it, she adds.
The next step is to disseminate the Ebon intervention to community-based organizations.
"You need a trained facilitator and some resources," Wyatt says. "It's a new approach, and we have to be ready to adapt it for the community."
Despite the HIV epidemic's impact on poor, urban African Americans nationwide, there have been few prevention interventions targeting this population specifically.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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