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March 27, 2003


Emory Study Will Examine HIV Serodiscordant Couples, In Hopes of Encouraging Greater Condom Use

Emory University School of Medicine researchers will begin a study this fall to examine African-American serodiscordant couples in relationships, in which one partner is HIV positive and the other is HIV negative. The aim of the study is to educate and encourage couples to use condoms, in hopes of reducing their risk of acquiring a sexually transmitted infection. The study, scheduled to start in September, is the first intervention of its kind focusing on serodiscordant couples.

The Eban study, as it is known, comes from the South African word meaning "fence." The term means to keep all of the good, positive, and vibrant energy inside and to push distractive energy away. Overall, the word focuses on a sense of well-being and positive energy. The study is funded by a five-year, $5 million National Institutes of Mental Health grant.

Gina M. Wingood, ScD, MPH, associate professor of public health and co-director of Behavioral and Social Science Core at the Rollins School of Public Health, is the principal investigator. She is also working with Jeffrey Lennox, MD, associate professor in the Division of Infectious Diseases at the Emory University School of Medicine and medical director of the Ponce de Leon Center; Ralph DiClemente, PhD, professor of behavioral sciences and health education at the Rollins School of Public Health; Richard Rothenberg, MD, professor in the Department of Family and Preventive Medicine at Emory; and Angela Caliendo, MD, PhD, associate professor and medical director of the Emory Medical Lab.

Dr. Wingood said the study is significant for several reasons.

"Number one, most people who work in the area of HIV usually only focus on the individual," Dr. Wingood explained. "A female has to go to her partner and ask him to use a condom, which can be a difficult negotiation. Itís better to work with a dyad, or couple, because itís a more efficient way of reducing everyoneís risk of HIV."

In Atlanta, couples will be recruited at the Ponce de Leon Center, the Atlanta Veterans Affairs Medical center, and AIDS social service organizations. The study also will be conducted at the University of California at Los Angeles, Columbia University in New York, and at the University of Pennsylvania in Philadelphia. Each site will recruit 200 couples.

"We want to educate couples to reduce their risk of acquiring a sexually transmitted infection and passing it on either to their partner or to someone else," Dr. Wingood explained. "Additional STDs may accelerate the progression of HIV and also make it easier to transmit HIV to a negative partner."

The study, which will enroll participants ages 18 to 44, requires that couples be together at least six months. Although not all are monogamous, the hope is to reduce couples from having multiple sexual partners. Couples will attend sessions with their primary partner.

"The major concern here is transmission of not only STDs, but also of HIV," Dr. Wingood said. "In addressing the HIV/AIDS epidemic, most people focus on primary prevention. The aim of our study is: to increase condom use in this population and reduce STDs and HIV transmission from the positive partner to the negative partner. We also want to prevent the negative partner from acquiring a STD and transmitting it to the positive partner."

In this randomized, controlled study, couples will be interviewed via computer and asked questions regarding their current sexual behaviors, their attitudes toward condom use, negotiation of condom use, and couple norms regarding condom use. Couples will also be tested for STDs.

"Our primary objectives are to reduce high risk social behavior, increase attitudes that are in favor of using condoms, increase ability to negotiate condom use, and reduce STDs," said Dr. Wingood.

Couples are randomized to one of two interventions. One arm of the study will focus on safer sex; the other arm will focus on general health, such as nutrition, exercise and medication adherence. Each group will consist of five couples for two-hour sessions for a period of two months, until a total of 100 couples have gone through both of the sessions. It will take approximately two years to recruit all couples.

All eight educational sessions will be conducted and supervised by African-American health educators and will include education to promote self-esteem and social support for those living with HIV.

Six months after the intervention, couples will be tested again for STDs to determine if those who were randomized were more likely to use condoms, develop favorable attitudes toward using condoms, and possess skills and norms to facilitate condom use. Researchers will also examine STD rates.

"Our interest is not just in educating these couples for the short period of time, but in teaching them to maintain these same behaviors over a longer period," Dr. Wingood said. "We want to prevent relapse among these couples for high risk sexual behavior."

The study also aims to increase relationship satisfaction, such as what partners like about one another and the challenges they both face, all with emphasis on positive relationships. Dr. Wingood notes that couples in healthy, satisfying relationships are more likely to use condoms, whereas those who are less satisfied may seek attention, support or gratification elsewhere.

Overall, the intervention is designed to discourage couples from having sex with multiple partners. Couples will be taught to use condoms and encouraged to talk about what triggers them to engage in unsafe sex and how to cope with those triggers.

"Itís a really exciting study," Dr. Wingood said. "As couples talk about their social-sexual lives, it opens up the communication process, and thatís very healthy. As researchers, we can intervene and make communication a smoother process."

For more information, or to enroll in the Eban study, please contact Tamu Daniel, project director, at (404) 727-9729, or at

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