HIV Sexual Risk-Reduction Interventions for Youth: A Review and Methodological Critique of Randomized Controlled Trials

Abstract

The authors review and provide a methodological critique of randomized controlled studies of HIV risk reduction interventions that measured sexual risk behavior outcomes with adolescents. Studies conducted in school, community, and health care settings were reviewed. Overall, 13 of 23 interventions (57%) were effective in reducing sexual risk behavior. Methodological strengths of extant studies included an emphasis on a theoretical framework, evaluation of both individualized and group-intervention formats, use of multiple assessments of risk behavior (including biological outcomes), and inclusion of efficacy and effectiveness trials. Methodological limitations included limited evaluation of theoretical mediators of risk reduction, failure to report effect sizes, and lack of sustained findings. Inconsistencies were found in data analytic procedures and reporting, including how nested designs, skewed data, and attrition were addressed. Recommendations for designing methodologically rigorous interventions are provided.

Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention

“…Disparities exist not only in the occurrence of these health problems, but also in research to prevent HIV in this highly vulnerable population. Several interventions show efficacy in reducing HIV risk among adult MSM (57) and ethnically diverse heterosexual youth (58), but insufficient attention has been paid to the HIV prevention needs of YMSM. The only way to combat the growing HIV epidemic among YMSM is to develop, implement, test, and disseminate interventions tailored to this group.…”

Developmentally appropriate sexual risk reduction interventions for adolescents: Rationale, review of interventions, and recommendations for research and practice

“…The extant evidence indicates that interventions including skills-training are effective for adolescents (5)(6)(7)9). However, implementing behavioral self-management or interpersonal skills in the absence of life experience can be challenging.…”

“…Although recent reviews and meta-analyses of the literature suggest that interventions can be efficacious (5)(6)(7)(8)(9), few of the extant interventions have been replicated. Moreover, some interventions appear ineffective, and much of the variance in reducing sexual risk remains unaccounted for, suggesting that additional factors or theoretical frameworks are needed to guide future intervention studies (10).…”

Impact of an educational intervention program on the sexual behaviors of higher education students

“…Uma alternativa às intervenções prolongadas é o uso de sessões de reforço após o termo da intervenção formal, no sentido de evitar uma recaída no comportamento de risco. As intervenções com sessões múltiplas ou de doses (cargas horárias) longas não têm demonstrado ter melhores resultados do que as intervenções de doses mais curtas (Pedlow & Carey, 2003 …”