A Review of HIV Prevention Interventions for Juvenile Offenders

Abstract

Several HIV prevention programs with juvenile offenders have led to sexual risk reduction, although effect sizes are modest. Most existing programs have neglected to address the impact of family, mental health, and substance use on HIV risk. More work is needed to develop evidence-based interventions that include HIV prevention strategies relevant and appropriate for the juvenile justice setting.

Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders

“…Nevertheless, youth behavioral change in the family-based intervention might represent a regression to the mean effect for risky sex acts and marijuana use and as such, a larger trial is needed for replication of these findings. Despite significant group differences on key primary behavioral outcomes, effect sizes were small, but not too distant from prior HIV prevention trial findings with juvenile offenders (Tolou-Shams et al, 2010). Structural or systems-level interventions may be more effective in achieving greater behavioral change for youth on a broader scale.…”

“…These data provide a compelling case to specifically target substance use within HIV prevention interventions for juvenile offenders. Underlying constructs contributing to and/or exacerbating psychiatric distress, substance use and sexual risk behavior among these youth, such as extensive trauma exposure (Evans-Chase, 2014), greater emotion dysregulation (Lescano, Brown, Miller, & Puster, 2007) and family dysfunction are also important to consider when developing and testing HIV prevention interventions for substance using offenders (Tolou-Shams, Stewart, Fasciano, & Brown, 2010). We briefly review the evidence for these associations and the rationale for targeting these areas in a comprehensive family-based HIV prevention program for juvenile offenders.…”

“…Such data might explain why juvenile offenders are particularly at risk for HIV because of their substantially higher rates of risk behaviors, especially using substances during sex (Donenberg, Emerson, Mackesy-Amiti, & Udell, 2015; Tolou-Shams, Hadley, Conrad, & Brown, 2011). Compared to their peers, juvenile offenders begin begin sexual activity earlier, have more partners, use condoms less often, and have high rates of sexually transmitted diseases/infections (STIs;) and pregnancy (Dembo, Childs, Belenko, Schmeidler, & Wareham, 2009; Donenberg et al, 2015; Tolou-Shams et al, 2010). Juvenile offenders are at increased risk for HIV infection secondary to their alcohol and drug use,, which supports the relevance of integrated substance use and HIV prevention interventions for this youth population.…”

“…A recent small-scale adolescent-only HIV prevention intervention targeting affect regulation with youth on probation resulted in decreased substance use over time and moderate change in sexual risk behavior (Donenberg et al, 2015). Overall, outcomes of HIV prevention interventions for these youth have been mixed; juvenile offenders may improve condom use (or other harm reduction skills) and experience changes in attitudes and beliefs in the short-term, but data supporting long-term sexual risk reduction is limited (Tolou-Shams et al, 2010). Despite that these youth commonly use substances (including before and during sexual activity) very few interventions target both substance use and HIV risk.…”

Methamphetamine Use and High-Risk Sexual Behaviors among Incarcerated Female Adolescents with a Diagnosed STD

“…A meta-analysis of HIV prevention programs for juvenile offenders showed that most existing programs have not addressed the critical impact of family, mental health, and substance use on HIV risk. 54 In summary, the identification of incarcerated girls' health and mental health needs, including the relationship between their drug use and sexual behaviors, illustrates the urgent need for tailored interventions and pre-release coordination of services for young female offenders. These activities are imperative in order to disrupt the cycle to high-risk behaviors and recidivism among incarcerated female adolescents in the United States.…”