Project Eban: A Giant Step Forward

Abstract

Substantial progress has been made in the United States since the 1980s in the prevention and treatment of HIV/AIDS, but socially disadvantaged racial/ethnic populations are increasingly bearing a disproportionate share of the burden of this disease. The black or African American population, in particular, is losing ground in the battle against the HIV/AIDS pandemic. Blacks currently have the highest HIV/AIDS infection rate —a rate 8.5 times higher than that of whites. The problem is particularly salient among African American women among whom AIDS is one of the leading causes of death and where the majority have acquired their infection through heterosexual contact. Among persons diagnosed with AIDS, blacks have poorer survival than whites, Hispanics, or Asian Pacific Islanders. Although African Americans are only 13% of the US population, they are 51% of newly diagnosed cases, 65% of infants perinatally infected, 68% of children under 13 with an AIDS diagnosis, and 66% of all 13–19 year olds with AIDS. African Americans are similarly overrepresented in infections rates from other sexually transmitted infections (STIs) where they have the highest rates of Chlamydia, gonorrhea, and syphilis, and in 2008, nearly one half of all African American teenage girls aged 14–19 years were infected by an STI. More research is needed to fully elucidate the determinants of excess risk among African Americans. Although it is clear that the patterns of HIV risk among African Americans are distinctive, much is yet to be understood regarding the ways in which the economic context of the black population combines with psychological, cultural, historical, and social factors to affect patterns of HIV transmission and risk. However, even more urgently, we need a new generation of HIV prevention interventions that are designed to reduce HIV/AIDS risks for African Americans. The prevention and intervention approaches that have led to reducing the spread of HIV among white homosexual males have been less successful among African Americans and Hispanics. There is thus an urgent need for HIV prevention interventions that are grounded in our current knowledge base and seek, in a more comprehensive and innovative fashion than most prior efforts, to effectively address HIV/AIDS prevention in the black community. This is exactly what Project Eban has attempted to do. There are several aspects of this study that are noteworthy and relevant for the design of future interventions with socially stigmatized and disadvantaged populations across multiple racial/ethnic populations and health conditions. First, the Eban project was successfully implemented in a hard-to-reach population group that is difficult to follow over time. In general, serodiscordant couples’ studies are difficult to conduct, and given issues related to social marginalization, generally low income and education, and limited connections to health care and employment, conducting such a study among African Americans (the first of its kind) was particularly challenging. This population tends to be characterized by high levels of comorbidity of other illnesses and/or substance abuse and elevated exposure to a broad range of social stressors including being in and out of jail or prison. This is the type of target population that some researchers fail to study precisely because the task seems too difficult. The challenge of identifying and tracking participants despite their fragile living circumstances and social adversity is a difficult one, which taxed the organizational and financial resources of the study team. Nonetheless, the successful implementation of the intervention demonstrates that it is not an impossible task when both funders and researchers are committed and allocate the needed resources.