Program

Oct 08, 2007

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., 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.

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

KEYWORDS: Adolescence (12-17), Young Adulthood (18-24),
Youth (16+), High-Risk, Community-Based, Clinic-Based, Provider-Based, Black or
African-American, Hispanic or Latino, White or Caucasian, Life Skills Training,
Education, Reproductive Health, Risky Sex, STD/HIV/AIDS, Substance Use, Alcohol
Use, Illicit Drugs

Program information last updated on
10/8/07.

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