Varying the Timing of an HIV-Prevention Intervention

Guide to Effective Programs
for Children and Youth

VARYING THE TIMING OF AN HIV-PREVENTION INTERVENTION

OVERVIEW

An HIV-prevention intervention, based upon the principles of cognitive-behavioral theory and social learning theory, was developed for use with at-risk adolescents. The intervention was designed to be implemented either in seven 1.5-hour sessions or three 3.5-hour sessions.

In an experimental study, subjects were randomly assigned to take part in a seven-session implementation of the intervention, a three-session implementation of the intervention, or not to receive the intervention. During the three months after the intervention period, subjects who had been assigned to the seven-session intervention had significantly fewer sexual partners than did subjects assigned to the three-session intervention. Seven-session subjects also engaged in fewer acts of unprotected vaginal and anal sex than did three-session or control subjects during this time period (though this latter difference only approached statistical significance). Researchers concluded that the seven-session implementation had a greater impact on sexual behavior than did the three-session implementation.

A second experimental study compared subjects assigned to receive the three-session implementation of the intervention with subjects assigned to a control group. A sizable proportion of the subjects in this study were non-heterosexual. During the three-month follow-up period, three-session intervention subjects’ sexual behavior did not differ significantly from the sexual behavior of control subjects. Three-session intervention subjects had as many partners as did control subjects and took part in as many unprotected sex acts as did control subjects.

DESCRIPTION OF PROGRAM

Target population: at-risk adolescents

An HIV-prevention intervention, based upon the principles of cognitive-behavioral theory and social learning theory, was developed for use with at-risk adolescents. The 10.5-hour intervention sought to convey information about HIV and teach negotiation skills, condom use, and goal setting. The intervention also sought to impact social-cognitive factors, including outcome expectancies, perceived risk of acquiring HIV, and self-efficacy.

The intervention was designed to be implemented either in seven 1.5-hour sessions or three 3.5-hour sessions. Regardless of implementation strategy, each session reviewed participants’ completion of HIV-related goals since the previous session, taught participants new skills, gave participants opportunities to practice those skills, and had participants set goals to implement prior to the next session. Each session included a focused review of personal successes for each participant and ended with participants complimenting one another.

EVALUATION(S) OF PROGRAM

Rotheram-Borus, M. J., Gwadz, M., Fernandez, M. I., & Srinivasan, S. (1998). Timing of HIV Interventions on Reductions in Sexual Risk Among Adolescents. American Journal of Community Psychology, 26(1), 73-96.

Evaluated population: 151 individuals between the ages of 13 and 24 served as the study sample for this investigation. Subjects were recruited from The Door, a comprehensive social service agency in New York City. 53% of subjects were African American, 39% were Hispanic, and 8% classified themselves as members of other ethnic groups. 93% of subjects self-identified as heterosexual.

Approach: Subjects were randomly assigned to one of three conditions: a seven-session intervention condition, a three session intervention condition, or a no-intervention condition. Subjects assigned to the seven-session intervention condition and the three-session intervention condition received identical curricula delivered by the same leaders; however, each session from the seven-session intervention was 1.5 hours long and each session from the three-session intervention was 3.5 hours long. Each session was led by two co-facilitators who received a week of training and ongoing supervision. Each pair of co-facilitators included at least one facilitator who was African American or Latino and, in most cases, one male and one female.

All subjects were interviewed about their sexual behaviors at baseline. 84% of subjects were interviewed again three months after the end of the intervention period.

Results: During the three months after the intervention period, subjects who had been assigned to the seven-session intervention had significantly fewer sexual partners than did subjects assigned to the three-session intervention. Seven-session subjects also engaged in fewer acts of unprotected vaginal and anal sex than did three-session or control subjects during this time period (though this difference only approached statistical significance). There was no significant difference between intervention conditions on substance use during the follow-up period, however; and impacts on psychosocial mediators were concentrated in varied subgroups with no clear pattern.

The authors concluded that, when it comes to reducing sexual risk acts among adolescents, multiple short sessions spaced out over a longer period of time are superior to a few longer sessions spaced out over a shorter period of time.

Rotheram-Borus, M. J., Murphy, D. A., Fernandez, M. I., & Srinivasan, S. (1998). A Brief HIV Intervention for Adolescents and Young Adults. American Journal of Orthopsychiatry, 68(4), 553-564.

Evaluated population: 139 individuals between the ages of 13 and 24 served as the study sample for this investigation. Subjects were recruited from the Los Angeles Gay and Lesbian Community Services Center, a social-service agency in West Hollywood, California. Subjects were predominantly male (82%). 40% of subjects were white, 26% were African American, 25% were Hispanic, and 9% classified themselves as members of other ethnic groups. 33% of subjects self-identified as homosexual, 25% identified as bisexual, and 42% identified as heterosexual. All subjects had been sexually active at some point in their lives.

Approach: Subjects were randomly assigned to either the intervention group or the control group. Subjects assigned to the intervention group received the curriculum in three 3.5-hour sessions over the course of 1.5 weeks. Each session was led by two co-facilitators who received a week of training and ongoing supervision. Session leaders were trained to make the intervention relevant for both homosexual and heterosexual subjects. Subjects assigned to the control group received a single, brief educational session that covered HIV-prevention strategies.

All subjects were interviewed about their sexual behaviors at baseline. Subjects also had their condom use skills and negotiation skills assessed via demonstration and role play. Subjects were assessed again three months later.

Results: During the three-month follow-up period, intervention subjects’ sexual behavior did not differ significantly from the sexual behavior of control subjects. Intervention subjects had as many partners as did control subjects and took part in as many unprotected sex acts as did control subjects. Further, intervention subjects’ knowledge, beliefs, skills, and attitudes did not differ significantly from those of control subjects at follow-up. Intervention subjects and control subjects had comparable condom use skills, self efficacy in condom use, and assertiveness. Intervention subjects did have more refusal strategies at their disposal than did control subjects, however.

SOURCES FOR MORE INFORMATION

Curriculum materials available from the author:

Mary Jane Rotheram-Borus – mrotheram@mednet.ucla.edu

References:

Rotheram-Borus, M. J., Murphy, D. A., Fernandez, M. I., & Srinivasan, S. (1998). A Brief HIV Intervention for Adolescents and Young Adults. American Journal of Orthopsychiatry, 68(4), 553-564.

Program categorized in this guide according to the following:

Evaluated participant ages: 13-24

Program age ranges in the guide: Adolescence, Youth, Young Adults

Program components: Clinic/Provider-Based

Measured outcomes: Reproductive Health

Program information last updated on 10/8/07.