Group‐based HIV risk reduction intervention for adolescent girls: Evidence of feasibility and efficacy

Abstract

The purposes of this pilot study were (a) to assess the feasibility of a community-based, small group HIV risk reduction intervention with adolescent girls, and (b) to obtain preliminary evidence of the efficacy of this theoretically-guided intervention using a controlled design. The feasibility of the intervention was demonstrated by successfully implementing it with 33 sexually-active, single girls. Preliminary evidence of the efficacy of the intervention was obtained using a randomized trial with 62 sexually-active, single girls. Data obtained at a 3-month follow-up assessment showed that girls who received the HIV-related intervention improved their HIV-related knowledge and enhanced their motivation for risk reduction compared to girls who received a control (health promotion) intervention. Effect sizes suggest that the HIV intervention also reduced several risk behaviors (e.g., vaginal sex without a condom, giving oral sex, and alcohol and drug use before sex). Challenges to implementation and suggestions for intervention enhancement are discussed. KeywordsHIV prevention; adolescent girls; risk reduction; randomized controlled trial; pilot Adolescent girls are increasingly at risk for acquiring HIV and AIDS. Recent data confirm that the overall male to female ratio of reported AIDS cases is approximately 8:1, but in adolescents the ratio is less than 3:1 (Centers for Disease Control, 2000). The majority (89%) of all heterosexually-acquired HIV infections in adolescents now occur in girls (Centers for Disease Control, 2004). Adolescent girls also have higher rates of gonorrhea and chlamydia than similarly aged males or older persons of either sex (Padian, Shiboski, Glass, & Vittinghoff, 1997). These statistics are especially relevant because sexually transmitted infections (STIs) are known to facilitate the transmission of HIV. The purpose of this study was to pilot test an HIV risk reduction intervention for this at-risk group.In an integrative review of the adolescent HIV prevention intervention literature, 23 randomized controlled trials (RCTs) assessing behavioral outcomes were critiqued, and the summary of findings provides evidence for the efficacy of these interventions (Pedlow & Carey, 2003). These studies took place in a variety of settings including schools, health care Despite the obvious threat that HIV poses to adolescent girls, only five randomized controlled trials assessing behavioral outcomes have been conducted to evaluate HIV risk reduction interventions developed specifically for adolescent girls (Mansfield, Conroy, Emans, & Woods, 1993;Orr, Langefeld, Katz, & Caine, 1996;Workman, Robinson, Cotler, & Harper, 1996;Shrier et al., 2001;Koniak-Griffin et al., 2003). Three of these studies are interventions provided to individuals. Mansfield et al. used a small, predominantly female sample (n=90 youth; 83 [90%] females) and found no differences 2 months after the intervention on condom use, abstinence, number of partners, or new STIs between an individual HIV education and counseling ...

Interventions to Reduce Sexual Risk for Human Immunodeficiency Virus in Adolescents

“…Such effects were larger to the extent that interventions included greater amounts of condom skills-training and included more motivational training. Contrary to other reviewers’ conclusions that intervention dosage does not matter, 108 the current results found that maximal efficacy results from interventions sessions that provide condom skills and motivational training per session (e.g., 1 hour 17, 73–74 ). These patterns did not hinge on the number of sessions interventions had.…”

“…Use of these criteria resulted in 67 independent studies including 9 studies containing supplemental information (e.g., intervention details, outcomes from follow-up assessments), which included 98 separate interventions and sampled 51,240 participants. 17, 19–93 Each intervention was treated as an individual study (see supplemental figure). …”

“…14 Risk-reduction strategies vary from broad and diffused dispersion of factual information about HIV, to frank discussions of condom use for reducing HIV risk, to small group interventions allowing interaction and role-playing to enhance motivation and relevant skills. Theory 14 as well as primary level research 15–17 suggests that interventions that include motivational and skills-based strategies are the most likely to promote risk reduction.…”

Avoiding Early Study Attrition in Adolescent Girls: Impact of Recruitment Contextual Factors

“…The participants who consented and attended the intervention or control sessions (n = 62) were compared with the participants who consented but did not attend any intervention or control sessions (n = 67) on all demographic, risk behavior, and antecedent variables. These analyses revealed no differences between groups for the following variables: demographics (age, race, hours worked per week, risk behavior, pregnancy history, and STI history), HIV-related knowledge, motivation (risk perception, readiness to change, behavioral intentions, pros and cons of condom use), behavioral skills (confidence in condom use), and sexual risk behaviors (Morrison-Beedy et al, 2005).…”

How Much Does Gender Explain in Sexual Attitudes and Behaviors? A Survey of Canadian Adults

“…Laumann et al (1994) found that older respondents and those with less education were less likely to have experienced oral sex. In Canadian studies, oral sex has been mainly studied among youth ( Barrett, 2004;McKay, 2004;Morrison-Beedy, Corey, Kowalski, & Tu, 2005). The COMPAS survey was the first to ask a random sample of Canadian adults about their experience with oral sex.…”