Synergistic interactions between substance use and violence (SAVA syndemic) are strongly associated with heightened risk for HIV acquisition in the African American population. While couple-based interventions have shown efficacy among at-risk and HIV-positive serodiscordant couples, no interventions have specifically targeted SAVA syndemic risk reduction for HIV-negative, high-risk, heterosexual African American couples in the United States. This pilot study tested the feasibility, safety, and preliminary effects of an integrated sexual risk reduction intervention for African American couples. Ten African American couples attended eight cognitive behavioral couple therapy sessions over Zoom. Surveys were completed at baseline and post-intervention, along with a post-intervention interview. The pilot intervention proved feasible with high acceptability among participants, who especially valued the session structure and the racial and gender matching of therapists with clients. Participants reported that the intervention content and exercises were highly useful and helped improve their ability to communicate in non-threatening, affirming ways. Cochran-Armitage test of trend results indicated participants had a significant decrease (p <
.05) in mean frequency of condomless vaginal intercourse, and men had a significant reduction (p <
.05) in frequency of substance use other than alcohol before sex. Participants had a significant increase in proportion of pre-exposure prophylaxis awareness (p <
.05) and men in having HIV testing discussions with their partners (p <
.05) using a Fisher Exact test. Participants reported significant increase in relationship satisfaction. These encouraging preliminary findings suggest the need for a larger clinical trial.