Abstract
“Eban” Program Helps HIV Serodiscordant Black Couples
A new program is producing safer sexual behaviors in heterosexual African‐American couples in which only one partner is HIV positive. The culture‐specific intervention program is designed to reduce the risk of HIV and other sexually transmitted diseases.
It is based on “Eban,” an African concept that symbolizes safety, security, and love within one's family and relationship space. The program was designed not only to reduce risky sexual behaviors but also to increase couples' ability to communicate with each other, to make safer behaviors more appealing, to stay in healthy relationships, and to respect their communities.
Researchers from UCLA's Center for Culture, Trauma, and Mental Health Disparities, as well as the University's AIDS Institute, have the program in four cities with high HIV infection rates: Atlanta, Philadelphia, Los Angeles, and New York. Their multisite study tested the efficacy of a couples‐based randomized controlled trial comparing the HIV/sexually transmitted infection (STI) risk‐reduction program with an intervention focused on general health promotion.
Of the 535 couples enrolled, 260 were randomly assigned to receive the HIV/STI risk‐reduction intervention, and 275 received the comparison intervention. The researchers assessed participants' STI status and collected self‐reports of sexual behavior at the start of the study, immediately after the 8‐week intervention, and at 6 and 12 months after the end of the intervention.
The comparison intervention provided information about healthy lifestyle habits, such as eating more fruits and vegetables, and risk behaviors linked to heart disease, hypertension, stroke, and certain cancers. Unlike the risk‐reduction intervention, the comparison intervention did not focus on sexual risk behaviors and addressed participants as individuals rather than as couples. The structure and activities of both interventions were designed to appeal to the cultural values and real‐world experiences of urban, heterosexual African Americans. Attendance at the sessions of both interventions was high. Couples in the Eban intervention attended 91.4% of the sessions, and those in the comparison group attended 84.1%.
Compared with couples in the comparison intervention program, those who received the Eban‐based risk‐reduction intervention reported more‐frequent and more‐consistent condom use after the intervention, including at the 6‐ and 12‐month follow‐ups. According to the researchers, 63% of the couples used condoms consistently, versus 48% in the comparison group. They also had fewer acts of unprotected sex (an average of 1.5 fewer). These effects were maintained over all follow‐up assessments.
The cumulative incidence of STIs did not differ between the two groups over the 12‐month follow‐up. Of the partners who began the study HIV negative, two in the intervention group and three in the comparison group became HIV positive during the study, an overall rate that translates to 935 per 100,000. This conversion rate was significantly higher than the overall incidence estimate for African Americans (83.8 per 100,000). As a result, HIV‐negative African Americans in serodiscordant relationships are at high risk for acquiring HIV, even if their relationships are stable.
The researchers noted that couples who are not aware of their differing HIV status, couples in which both partners are HIV positive, and couples at risk for HIV may benefit from other types of interventions. Future studies should also explore methods for reducing risk behaviors in so‐called concurrent relationships—those that involve individuals other than a person's regular sexual partner—among couples in which one partner is HIV positive. The findings from the study suggest that culture‐specific interventions may be the key to bringing about beneficial changes in sexual behavior.
More details about the study can be found in the July 12 online print edition of the Archives of Internal Medicine.
Center for AIDS Research Planned for Washington, DC
Researchers from institutions across Washington, DC, have been awarded nearly $3 million over a 5‐year period from the National Institutes of Health (NIH) to establish the District of Columbia Developmental Center for AIDS Research (DC D‐CFAR). Led by Alan E. Greenberg, M.D., M.P.H., of The George Washington University School of Public Health and Health Services, the Center's mission will be to provide scientific leadership and institutional infrastructure to promote HIV/AIDS research. It will also have as a major goal the development of the next generation of HIV/AIDS investigators in Washington, DC.
The researchers are AIDS experts from The George Washington University, Children's National Medical Center, Georgetown University Medical Center, Howard University, and the DC Veterans Affairs Medical Center, with the support of investigators from numerous community‐based clinics throughout Washington DC. The institutions have established administrative, developmental, scientific, and educational functions that will serve as a foundation upon which the DC D‐CFAR will be built.
Funding will enable the consortium of institutions in Washington to support new HIV/AIDS research through pilot grants, access to core research services and facilities, and mentorship by senior scientists to enhance the ability of junior and minority researchers to establish themselves as independent NIH‐funded investigators. The overall goal is to establish a full CFAR after the initial 5‐year funding period.
Currently, 20 CFARs are located at academic and research institutions throughout the United States. Seventeen of these are standard CFARs, and three are developmental CFARs. The CFAR program emphasizes the importance of interdisciplinary collaboration, especially between basic and clinical investigators, and an emphasis on inclusion of minorities, prevention, and behavioral‐change research. The CFAR program is jointly funded by the National Institute of Allergy and Infectious Diseases (NIAID) and six other NIH institutes.
Depression in HCV Infection Overlooked
Researchers from the NORDynamIC project group, representing Denmark, Sweden, Norway, and Finland, have found that depressive symptoms in patients with hepatitis C virus (HCV) infection are commonly overlooked in routine clinical interviews. In addition, treatment‐induced depression can compromise the outcome of HCV therapy.
The researchers estimated the value of routine medical interviews in diagnosing depression in chronic HCV patients receiving PEG‐interferon/ribavirin therapy by using the Major Depression Inventory (MDI). This is a self‐rating depression scale with a dual functionality in diagnosing major depression and in the measurement of depression severity. Of the 325 HCV patients enrolled in the study, 6% were observed with major depression at baseline. Among the remaining 306 patients, 37% (n = 114) developed depression while receiving HCV combination therapy. Based on the MDI criteria, 32% of the 114 patients with major depression were correctly diagnosed during routine medical interviews.
In addition, the emergence of major depression frequently led to premature discontinuation of the PEG‐interferon/ribavirin therapy. Those patients with higher MDI scores (30 and higher) were more likely to have a diminished treatment outcome. According to the researchers, using the MDI in the clinical setting may help identify those patients at risk for depression and subsequent therapy‐adherence issues.
The study was published in the August issue of Hepatology 2010;52(2):430–435.
Brief Intervention Reduces HIV Risk in Female Sex Workers
A short behavioral intervention program averaging 35 minutes can measurably reduce the incidence of HIV and sexually transmitted infections (STIs) among female sex workers in the United States–Mexico border region. According to researchers from the University of California San Diego, Universidad Autonoma de Baja California, and the University of Xochiacalco in Tijuana, Mexico, the program is not only effective but also cheap to provide.
By using a sophisticated modeling system, researchers studied how a hypothetical group of 1,000 female sex workers in the United States–Mexico border region would respond to a previously tested behavioral intervention program called Mujer Segura or Healthy Woman. Approximately 35 minutes in length, Mujer Segura uses motivational techniques to encourage female sex workers to use safer sex practices, and teaches better condom‐negotiation skills with clients who request unprotected sex. Researchers modeled the effect of receiving Mujer Segura intervention training once, annually, and not at all.
Among sex workers who received once‐only interventions, an estimated 33 HIV cases were prevented, and 5.7 months of quality‐adjusted life expectancy (QALE) added, compared with sex workers who received no intervention. For sex workers who received annual interventions, 29 additional HIV cases were prevented, and 4.5 more months of QALE were achieved. Each intervention costs less than $200.
According to the researchers, the Mujer Segura intervention program could be adapted for use in other cultures and regions throughout the world. Additional funding has been received to expand the program in Mexico.
The study was published in the June 30 issue of the online journal PLoS One.
ED Drug Users Have Higher STI Rates
A new study has found that men who use erectile dysfunction (ED) drugs are more likely to have sexually transmitted infections (STIs) compared with men who do not use these medications. According to researchers from Massachusetts General Hospital, doctors prescribing these drugs should include a discussion of safer sex practices with their patients.
In this study, researchers examined health insurance claims records covering 1997 though 2006 from 44 large U.S. employers. For more than 1.4 million male beneficiaries older than 40 years who used ED drugs, the researchers collected data covering 1 year before and 1 year after the first prescription was filled. Each ED drug user was matched with five nonusers randomly selected from the database for whom claims data covering the same 2‐year periods was collected.
The final study group included about 40,000 men who used ED drugs and nearly 1.37 million who did not. In both the year before and the year after the first ED drug prescription, users had significantly higher rates of STIs than did nonusers in matching time periods. Specifically, the rate of STIs in older men is 1 per 1,000. However, the researchers found that older male ED users had rates that were 2 to 3 times higher. This was the case both before and after they filled their first prescriptions.
According to the researchers, HIV/AIDS was the most frequently reported STI in both groups. This was followed by chlamydia. Because the prevalence of STIs did not markedly change after ED drug therapy began, the authors note that the difference between groups probably reflects higher‐risk sexual practices among users of the drugs.
More details on the study can be found in the July 6 issue of Annals of Internal Medicine 2010;153(1):1–7.
Gays and Lesbians Lack Specialized Substance‐Abuse Treatment Facilities
Findings from a study by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that only 777 of 13,688 substance‐abuse treatment facilities surveyed across the nation offer special programs for gay and lesbian clients. This amounts to just 6% of all facilities. In addition, the availability of these special programs varies according to whether they are private or public and according to their primary focus of treatment.
Those facilities that are privately run, especially “for‐profit” ones, are more likely to offer special gay and lesbian programs than are federal government run facilities. For example, privately run for‐profit treatment programs are more than twice as likely as federal facilities to offer these programs (7.0% versus 2.6%). Among state government–run facilities, 5.5% offered specialized services for gays and lesbians, whereas 5.8% of private nonprofit‐run facilities offered these kinds of services.
Similarly, substance‐abuse treatment facilities whose primary focus is treating a mix of substance‐abuse and mental health issues are more likely than other types of treatment facilities to provide special programs for gay and lesbian clients. Those facilities with a mixed substance‐abuse and mental health focus were more than twice as likely to offer programs for gays and lesbians than were facilities with a primary focus of general health care (7% versus 2.3%).
The study, “Substance Abuse Treatment Programs for Gays and Lesbians,” is based on the 2008 National Survey of Substance Abuse Treatment Services that surveys substance‐abuse treatment facilities across the United States. A copy of the study can be obtained by visiting the SAMHSA website at
HPV Vaccination Recommended for 9‐ to 26‐Year‐Old Male Patients
On May 28, 2010, the Advisory Committee on Immunization Practices (ACIP) published its guidance for use of the quadrivalent human papillomavirus (HPV) vaccine in male patients. The statement noted that the vaccine was approved by the FDA for use in male patients ages 9 through 26 to reduce their likelihood of acquiring genital warts. However, it did not recommend routine HPV vaccination of male subjects. As a result, the Society for Adolescent Health and Medicine (SAHM) recommends strongly that 9‐ to 26‐year‐olds receive the HPV vaccine, regardless of gender.
In June 2006, the FDA approved a quadrivalent HPV vaccine for 9‐ to 26‐year‐old female patients to prevent HPV infections that cause genital warts and cervical cancer. In October 2009, the FDA approved a bivalent HPV vaccine for 9‐ to 26‐year‐old female patients, and at the same time approved the use of the quadrivalent HPV vaccine for 9‐ to 26‐year‐old male patients for the prevention of genital warts. Both the FDA and the ACIP also acknowledge that HPV infection is associated with penile, anal, and oropharyngeal cancers among men, even though the data for this have not been reviewed for licensure at this time.
Despite not recommending the vaccine for routine use in male patients, the ACIP has designated that vaccination of male patients should be covered under the Vaccines For Children (VFC) Program, providing the vaccine free of cost through the age of 18 years for those who are uninsured, have Medicaid, or are underinsured and attend a federally qualified health center or a rural health center.
Even though the vaccine is provided by these government programs, it does not guarantee that private insurers will allow the vaccine to be provided to their subscribers. This sets up the possibility that youth who have private health insurance may be denied coverage for the HPV vaccine, based on the lack of a more definite recommendation for the routine use of the vaccine in male patients. In addition, the lack of a recommendation for routine vaccination of male patients may discourage clinicians from using the vaccine for their male patients.
Society officials acknowledge that the vaccination of male patients is not as cost‐effective as is vaccination of female patients as a means of preventing HPV‐related cancer. However, mathematical modeling demonstrates that the vaccination of male patients is more cost‐effective when the rate of immunization in female patients is less than 80%. At this time, coverage rates among female patients are low (less than 25% for all three of the HPV vaccinations), making HPV vaccination an important alternative strategy for preventing cancer‐causing infections in female patients.
Routine use of the HPV vaccine in male patients provides direct benefits to men and may benefit their sexual partners. It also increases overall immunization rates among both male and female patients. The vaccine may also be cost‐effective. For these reasons, the Society strongly recommends the routine use of HPV vaccination in male patients as well as in female patients. The Society is urging all clinicians and insurance organizations to consider the benefit of routine vaccination for all age‐appropriate patients, regardless of gender, in an effort to support the primary prevention of disease among adolescents and adults.
More information about SAHM and their position statement can be found on their website at