Community-Level HIV Prevention

OVERVIEW

Community-level HIV prevention programs are interventions targeted at the normative social and peer environments of at-risk adolescents.  By focusing on developing skills and beliefs in adolescents to reduce risk behavior, as well as affecting change in the environment of inner city housing developments, these interventions aim to change communities so that they become more supportive in terms of maintaining avoidance of HIV risk behaviors.  An experimental evaluation of one community-level HIV prevention program found that while there were no short-term effects on continued abstinence rates, at the long-term follow-up, adolescents in the community-level intervention were significantly more likely to have remained abstinent than those in the control condition.  At both the short- and long-term follow-ups, participants in the control condition had significantly lower condom use rates than those in both the workshop and community-level intervention conditions.  There were no significant differences between the workshop and community-level intervention conditions at either follow-up.

DESCRIPTION OF PROGRAM

Target Population: At-risk adolescents

The intervention program consists of both skills-training workshops and a multi-component community-level intervention.  For the workshop portion of the intervention, adolescents attend two, three-hour sessions, held one week apart.  Both sessions are led by two, trained facilitators, and separate sessions are held for males and females, with divisions also occurring by ages 12-14 and 15-17 years.  Adolescents receive $20 at each session for attending.  Workshops emphasize three facets of avoiding risk: delaying the initiation of sexual activity, refraining from unwanted sex for those who are sexually active, and consistently utilizing condoms for those who are sexually active.  Material covered during the workshops to emphasize these aspects of avoiding risk includes sexual negotiation skills, HIV/STD education, condom use skills, skills training to avoid/resist unwanted sexual activity, and risk behavior self-management, tied with themes of developing personal pride and self-respect. 

Following the workshops, adolescents complete the community-level portion of the intervention.  First, participants attend two follow-up sessions along with peers from their social networks within the housing developments.  The first session acts as a transitional meeting to connect the workshops to the community activities, while the second involves the participation of opinion leaders sponsored by a Teen Health Project Leadership Council (THPLC).  Opinion leaders consist of up to three adolescents nominated by their peers, based on how trustworthy and well liked they are, within each community development workshop group.  Additionally, three adolescents are nominated by session facilitators, who make selections based on communication, leadership, motivational skills, and HIV knowledge.  Through a combination of these nominations, the groups of opinion leaders are selected, which then make up the individual THLPCs. 

Once the THLPCs have been formed, each group of opinion leaders meets weekly with research staff to develop activity plans that address the following goals: 1) encourage attendance at follow-up sessions, 2) plan HIV prevention activities that maintain risk reduction, 3) establish norms that support condom use and abstinence, 4) use small media to reinforce condom use and abstinence, and 5) gain adult support to reinforce and promote the THPLC activities.  For attending these meetings, each opinion leader receives $15.  Over the course of six months, the THPLCs develop and implement four program activities for participating adolescents, in addition to two community-wide events.  Examples include using prevention themes in newsletters and on t-shirts and videotaping testimonials by adolescents to reduce HIV risk, which are then showcased at a community-level event.  Festivals, musical performances, talent shows, and social events may all be included in the community-wide activity. 

Lastly, parents of participating adolescents are offered a 90-minute workshop on HIV/AIDS information.  Strategies for discussing issues pertaining to abstinence and condom use with adolescents are also emphasized to empower parents to engage in communication with their children about HIV/AIDS.

EVALUATION(S) OF PROGRAM

Evaluated population: A total of 1172 adolescents (ages 12 to 17) were recruited for this study.  Participants came from 15 low-income housing developments located in Roanoke, Virginia; Seattle and Tacoma, Washington; and Racine and Milwaukee, Wisconsin.  Five sets of three housing developments were selected based on similarities in size, ethnicity of residents, age and gender of adolescents, and high-risk factors that included: high rates of sexually transmitted diseases, poverty, and drug use.  There were equal numbers of males and females in the sample, which was primarily composed of adolescents from ethnic minority backgrounds (51 percent African American, 20 percent Asian, 10 percent East African, 5 percent white, 3 percent Hispanic, 3 percent Ukranian, 2 percent Russian, 1 percent Native American, and 5 percent other). 

Approach:  Five housing developments each were randomly assigned to either the full community intervention (N = 392 adolescents), the workshop intervention (N = 428 adolescents), or the control intervention (N = 352).  There were no significant differences between conditions on demographics or sexual behavior at baseline.  Participants in the workshop condition received only the workshop component of the community-level intervention (described above).  Participants in the control condition were invited to attend a standard community AIDS education session held within the housing development.  During the session, participants would view and discuss a videotape called “Time-Out.”  Following study completion, control adolescents were invited to participate in the workshop intervention.  All three conditions also received educational brochures and free condoms.

To measure the effectiveness of the intervention, data were collected on partner status and sexual behavior, and condom use rates.  Data were collected at baseline, at 3-month follow-ups (following the educational session for the controls, and workshop sessions for the workshop and community-level intervention conditions), and at a long-term follow-up 2 months after completion of the community intervention events portion of the community-level intervention (approximately 12 months after the workshop sessions and 18 months after baseline for all participants).

Results: At the 3 month follow-up, there were no differences between conditions on continued abstinence rates.  At the long-term follow-up, adolescents in the community-level intervention were significantly more likely to have remained abstinent than those in the control condition.  There were no significant differences between the control and workshop conditions, and no significant differences between the workshop and community-level intervention conditions. 

For condom use rates, at the 3 month follow-up, adolescents in the control condition had significantly lower use rates than those in the workshop conditions (both the workshop-only intervention and the community-level intervention).  There were no significant differences between the workshop and community-level conditions.  At the long-term follow-up, condom use rates were again significantly lower for those in the control condition than both the workshop and community-level intervention conditions.  There were no significant differences between the workshop and community-level intervention conditions.

SOURCES FOR MORE INFORMATION

References

Sikkema, K.J., Anderson, E.S., Kelly, J.A., Winett, R.A., Gore-Felton, C., Roffman, R.A., Heckman, T.G., Graves, K., Hoffmann, R.G., & Brondino, M.J. (2005). Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments. AIDS, 19(14), 1509-1516.

KEYWORDS: Adolescents, Youth, Males and Females (Co-ed), High-Risk, Urban, Community-based, Parent or Family Component, Community or Media Campaign, Skills Training, STD/HIV/AIDS, Sexual Activity, Condom Use and Contraception

Program information last updated 12/21/11

© Child Trends 2003