Program

Dec 21, 2011

OVERVIEW

HIV Prevention for Adolescents in Low-Income Housing Developments targets 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
HIV Prevention for Adolescents in Low-Income Housing Developments program found that while there were no short-term
effects on continued abstinence rates, at the long-term follow-up, adolescents
in the HIV Prevention for Adolescents in Low-Income Housing Developments 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  HIV Prevention for Adolescents in Low-Income Housing Developments intervention
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

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