Intervention promotes healthy behavior in black HIV patients

El-Bassel N. Arch Intern Med. 2011;171:728-736.

An intervention to promote healthy behavior resulted in increased fruit and vegetable consumption, physical activity and cancer screening among black HIV-seropositive and HIV-seronegative men and women, according to new findings published in the Archives of Internal Medicine.

“African Americans are at high risk for morbidity and mortality from chronic diseases and are less likely to report engaging in behaviors associated with reduced risk of such diseases and to detect them at an early stage. Moreover, the risk of chronic disease is of particular concern for African Americans living with HIV because HIV and its treatment with [antiretroviral therapy] are associated with increased risk,” according to Nabila El-Bassel, PhD, of the Social Intervention Group of Columbia University School of Social Work, and colleagues.

“Although interventions targeting behaviors tied to reduced risk of chronic diseases and early identification of malignant neoplasms in African Americans, particularly those living with HIV, are needed, little research has focused on such interventions for people living with HIV,” the researchers wrote.

For this reason, El-Bassel and colleagues evaluated the efficacy of a health promotion intervention based on social cognitive theory. The intervention was designed to influence the following behaviors linked to the risk for cardiovascular disease, cerebrovascular disease, diabetes and certain cancers:

Physical activity.
Fruit and vegetable consumption.
Fat consumption.
Breast cancer screening.
Prostate cancer screening.
Alcohol use.

Black HIV–serodiscordant heterosexual couples from Atlanta, Los Angeles, New York and Philadelphia were enrolled in the multisite cluster-randomized controlled trial between Nov. 1, 2003, and June 30, 2007. Couples eligible were heterosexual with only one HIV-positive partner, both aware of each other’s HIV serostatus, and at least one black partner.

Participants were randomly assigned to a health promotion intervention focused on the individual, which addressed multiple health-related behaviors in 260 couples (n=520); or the control HIV/STD risk reduction intervention, which focused on the participants as members of couples rather than individuals, consisting of 275 couples (n=550).

Eight weekly, structured, 2-hour sessions were incorporated in both interventions. The health promotion intervention used experiential exercises, discussions and skill-building activities to increase self-efficacy, outcome expectancy, behavioral skills, and risk reduction knowledge, whereas the HIV/STD risk reduction intervention covered HIV/STD transmission and acquisition prevention.

Their reported health behaviors were assessed; these included adherence to fruit and vegetable consumption and physical activity guidelines, consumption of fatty or fried foods, prostate and breast cancer screening and alcohol use during pre-intervention, immediately post-intervention, and 6 and 12 months postintervention.

Compared with HIV/STD intervention participants, health promotion intervention participants were more likely to consume at least five servings of fruits and vegetables daily (RR=1.38; 95% CI, 1.18-1.62); adhere to physical activity guidelines (RR=1.39; 95%CI, 1.22-1.59); and consume fatty foods less frequently (mean difference: -0.18; 95% CI, -0.30 to -0.07). Additionally, more women received a mammogram (RR=1.26; 95% CI, 1.06-1.50) and more men received prostate cancer screening (RR=1.51; 95% CI, 1.21-1.88) in the health promotion intervention. El-Bassel and colleagues said alcohol use was the same among both intervention groups.

“Although the behavioral goals in the health promotion intervention were geared toward the individual and not the couple, mere participation as a couple may have encouraged the individuals to support each other even without prompting by the facilitators and may have contributed to the intervention’s efficacy,” the researchers said.

The researchers suggest that further generalizability studies are needed.

Disclosure: The researchers report no relevant financial disclosures.

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