Ralph J. DiClemente, PhD and Gina Wingood, ScD, MPH and a multi-university team of colleagues conducted a randomized, controlled clinical trial of 522 sexually experienced adolescent African-American girls aged 14 to 18 years, between September 1995 and August 2002. Participants were randomly assigned to either an HIV intervention group or a general health promotion group. At the beginning of the study all participants completed a self-administered questionnaire and an interview, demonstrated condom application skills, and provided specimens for STD testing. The HIV intervention consisted of four, 4-hour group sessions, emphasizing ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The control group participated in a structurally identical program of four, 4-hour group sessions that emphasized exercise and nutrition.
The primary measurable outcome of the study was consistent condom use, defined as condom use during every instance of vaginal sexual intercourse. This measure was selected given its strong association with a significantly reduced risk of acquiring an HIV infection. Other outcome measures included self-reported sexual behaviors, including numbers of protected and unprotected instances of sexual intercourse, condom application skills, new vaginal sex partners, STD infections, self-reported pregnancy, and attitudes and beliefs that are related to sexual behavior. These included HIV prevention knowledge, perceived partner barriers to condom use, attitudes toward condom use, and frequency of sexual communication.
Outcomes of the intervention were assessed at 6 and 12 months following completion of the HIV or general health promotion interventions. Participants in the HIV intervention group reported using condoms 75.3% of the time during the 30 days preceding the 6-month follow-up vs. 58.2 % for the control group. HIV group participants also reported consistent condom use of 73.3% in the 30 days preceding the 12-month follow-up vs. 56.5% for the control group. In the 6 months preceding the 6-month and 12-month follow-ups, HIV group participants reported using condoms more consistently than control group participants (61.3% vs. 42.6% and 58.1% vs. 45.3%). Overall, the girls in the HIV intervention group were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, have better condom application skills, report a higher percentage of instances of condom-protected intercourse, and report fewer instances of unprotected intercourse. They also had fewer chlamydia infections and fewer new pregnancies.
"African-American girls are disproportionately affected by the HIV epidemic, and we considered it a high priority to address this health disparity by designing and implementing a prevention intervention specifically tailored to this population," Dr. DiClemente said.
Although other studies have shown a reduction in sexual risk behaviors in adolescents, this study was the first HIV intervention to show a substantial reduction in sexual risk behaviors, including acquiring new male sex partners, and marked enhancement of mediators and skills associated with HIV prevention behaviors among high-risk African American girls. It also demonstrated promising effects for self-reported pregnancy and chlamydia. According to Dr. DiClemente, "STDs, which are prevalent among adolescents, also are known to facilitate HIV transmission. Any reduction in STDs could have an important impact on HIV transmission."
"The effectiveness of our intervention may be attributed to its gender-tailored messages related to relationships, sexual interactions, and emotional commitment," Dr. DiClemente said. "By discussing HIV prevention in the broader context of healthy relationships, we were able to offer new options for changing behavior. We also promoted solidarity and ethnic pride through our theme of 'Stay Safe for Yourself and Your Community,' which inspired participants to modify risky behaviors for altruistic motives. As Dr. DiClemente noted, "ultimately, to be optimally effective, HIV among adolescents must emerge from being a hidden epidemic. He noted that "We, as a society, must marshal our collective resources to confront this health threat with all the resolve and determination needed to protect a future generation of young people. To do anything less makes today's adolescents a generation in jeopardy."
Other study authors include: Kathy F. Harrington, MPH, MAEd; Delia Lang, PhD, MPH; Susan L. Davies, PhD, MEd; Edward W. Hook, III, MD; M. Kim Oh, MD; Richard A. Crosby, PhD; Vicki Stover Hertzberg, PhD; Angelita B. Gordon, MS; James W. Hardin, PhD; Shan Parker, PhD, MPH; and Alyssa Robillard, PhD, MSPH.
Journal
JAMA