AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #297 - An efficacious HIV prevention program for adolescents in alternative schools
Authors: Presenting Author: Dr. Larry Brown - Rhode Island Hospital
Additional Authors: Dr. Laura Whiteley, Dr. Nicole Nugent, Dr. Celia Lescano, Dr. Larry Brown,
Aim: Objective: To determine the efficacy of a HIV prevention intervention for adolescents in therapeutic and alternative schools. Youth in mental health treatment have higher rates of HIV risk behaviors than their peers due to many factors including impulsivity, cognitive immaturity, unhealthy peer influences and the aftermath of sexual abuse. HIV prevention programs have been implemented for these adolescents but none yet has demonstrated an impact on behavior.
Method / Issue: Methods: A RCT for adolescents from therapeutic and alternative schools in southern New England (Project STAR) enrolled youth in either a group-based, 14 session theory-driven HIV prevention program (STAR) or a general health promotion program (Control) matched for time and attention. The interventions were highly scripted and observed by staff to ensure fidelity to the protocol. STAR provided basic skills pertaining to communication and condom use as well as information about HIV/AIDS, sexuality, and healthy relationships. Also, it was tailored for youth with psychiatric disorders and histories of trauma so that affect management and distress tolerance skills were taught and were directly applied to scenarios involving sexual encounters Youth were also taught to challenge dysfunctional thinking related to sexual behaviors and sexual communication. Assessment of relevant sexual behaviors and attitudes were done at baseline, 3 months, 6 months and 9 months after the intervention.
Results / Comments: Results: 185 adolescents (mean age 15.3, 60% female, 47% non-white, 27% Hispanic, 55% sexually active) were enrolled and randomized. 85% of subjects attended half or more of sessions and 90% of subjects completed at least one follow-up assessment. Tests of both initial intervention effects (baseline to 6 months post intervention) and maintenance of effects (after 9 months) were simultaneously conducted using mixed effects modeling to account for nesting at the group level using HLM software. Relative to control participants, participants in the STAR intervention showed a significant decrease in sexual risk across the 3 and 6 month follow-up assessments (t (27) = -2.60, p < .05). They also showed greater increases in HIV-related knowledge (t (27) = 2.81, p < .05), and greater increases in condom-use self-efficacy (t (27) = 2.28, p < .05). Maintenance of effects observed at six months post-intervention were tested simultaneous with initial treatment effects in mixed models of each outcome. Although the direction of most effects was consistent with waning influence of intervention at six months post intervention none of these trends reached statistical significance.
Discussion: Conclusions: Although adolescents in therapeutic settings are at great risk for HIV, a tailored and theory-driven program can have an efficacious impact on improving safe sexual behavior for up to 6 months after the intervention. The impact appeared to diminish by 9 months and suggests the need for booster sessions.
Go Back