An integrated substance use, violence, and HIV/AIDS syndemic risk-reduction intervention for African American Couples

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PROJECT SUMMARY/ABSTRACT Synergistic interactions between substance use, violence and HIV/AIDS (SAVA syndemic) are closely linked with HIV acquisition in the African American (AA) population. However, no interventions have been developed to address SAVA syndemic risk-reduction for currently HIV-negative but high-risk heterosexual AA couples in the United States (US). This application is focused on adapting and pretesting the feasibility and acceptability of a couple-based SAVA syndemic informed risk-reduction intervention for HIV-negative, AA heterosexual couples who report high-risk sexual behaviors, intimate partner violence (IPV, perpetration and/or victimization), and substance (drug) use. The proposed work builds on the results from a previous K01 award that developed an integrated IPV-HIV risk-reduction intervention among low-income urban abused women. Specifically, findings showed promising impact of the intervention, but also indicated the importance of expanding its scope to incorporate substance use and involve women’s steady partners in the intervention. The proposed research includes two specific aims focused on adapting a SAVA informed intervention for high-risk AA heterosexual couples (aim 1) and pilot testing the resulting HIV risk-reduction intervention (aim 2). The adaptation of the intervention will be guided by Cognitive-Behavioral Theory (CBT) with specific intervention elements drawn from Cognitive Behavioral Couple Therapy (CBCT) and Behavioral Activation (BA). Year 1 of the project will be focused on conducting key informant interviews with 30 AA couples who report high-risk sexual behaviors, IPV, and substance use and adapting the SAVA syndemic informed HIV risk-reduction intervention for AA couples. A portion of year 1 and year 2 of the project will involve a randomized clinical trial (RCT) with 40 AA couples randomized to the SAVA informed risk-reduction intervention (20) or treatment as usual (20) using a random allocation sequence of group assignments within blocks of 10 that will be created using SAS. Participants will complete pre- and 3-month post-intervention behavioral assessments to measure changes in condom use, IPV, and substance use and biological testing for STIs. Percentage of couples who consent to participate, intervention attendance, intervention satisfaction, revictimization due to study participation, and percentage of couples who return for 3-month follow-ups will be tracked to determine feasibility and acceptability of the adapted intervention. Given the disproportionate impact of HIV on AAs in the US, this study addresses a key gap in literature by adapting and testing the first SAVA informed risk-reduction intervention for high-risk, HIV-negative, heterosexual AA couples. It is expected that the proposed intervention will help in addressing a NIH and Office of AIDS Research (OAR) high priority research area, “to reduce health disparities in the incidence of new HIV infections” with its focus on a highly vulnerable and marginalized group in the US and co-occurring HIV-related risk factors among couples.