Outcomes of a Behavioral Intervention to Increase Condom Use and Reduce HIV Risk Among Urban African American Young Adults

Abstract

African Americans comprise nearly half of people in the United States living with the human immunodeficiency virus (HIV) but compose one tenth of the population. Infection rate among young African American adults is 11 times that of Whites. The Color It Real Program was a seven-session, weekly administered, age-specific, and culturally tailored intervention designed to provide HIV education and address behavioral motivations (risk awareness, decisional balance exercises, partner negotiation, and attitudes) associated with HIV risk among African Americans ages 18 to 24 years in Atlanta, Georgia. Effectiveness was assessed through a quasi-experimental study design that consisted of intervention (n = 88) and control (n = 52) groups completing a 45-item survey. When controlling for gender and education, repeated measures analysis of variance revealed that the intervention group had significant increases in HIV transmission knowledge (F = 4.84, p = .0305), condom use, and intentions to use condoms (F = 4.38, p = .0385). Risky sexual behavior means did not significantly differ between groups (F = 1.44, p = .2331). Results indicate the value of culturally tailored educational strategies toward improved HIV knowledge and adoption of risk reduction strategies. Future studies investigating the differential impact of programs by gender and sexual orientation are also critical. Continued innovation and tailoring of risk reduction strategies for minority young adults will contribute to reducing HIV incidence and prevalence over the life course.

HIV/AIDS and Substance Use Prevention for African American Young Adults: Field Evaluation of “Color it Real”

“…At a surface level, these results were conceptually similar to findings from the original CIR validation study. Zellner et al (2016) and Akintobi et al (2016) measured knowledge of HIV transmission, condom use/intentions to use a condom, risky sexual behavior, and behavioral intentions about substance use, finding significant, positive differences for all scales but risky sexual behavior. Our evaluation focused on similar behaviors (substance use, condom use, and risky sexual behavior) but collected data for constructs that are hypothesized to mediate and moderate behavioral intentions, such as perceived norms and self-efficacy.…”

“…All CIR facilitators received a 15-hr "training-of-trainers" (TOT) with the CIR program developers. The 15-hr TOT was shorter than the 28-hr TOT originally provided by the developers (Akintobi et al, 2016) but is the current standard offering by WSCI, and displayed high training quality in our evaluation of content delivery (Agley et al, 2019).…”

“…Similarly, CIR was included in the now-discontinued National Registry of Evidence-based Programs and Practices (NREPP) by the Substance Abuse and Mental Health Services Administration (SAMHSA) but is not presently listed on the CDC's Effective Interventions list. This is likely because the current published evidence, though promising, is based on a single quasi-experimental study as featured in Zellner et al (2016) and Akintobi et al (2016). These changes appear to have left a gap in available evidence-based programming for African Americans.…”

“…CIR was originally developed by the Wholistic Stress Control Institute (WSCI) in Atlanta, GA, based on content from the Street Smart curriculum (Akintobi et al, 2016). The program activities were reconstructed using the Self-efficacy, Stages of Change, and Health Belief models (Zellner et al, 2016), with the primary goals of increasing prophylactic use and reducing substance misuse and other risky sexual behaviors (Akintobi et al, 2016; Zellner et al, 2016). Proposed mechanisms of action included, but were not limited to, the following:…”

Assessment of a Culturally-Tailored Sexual Health Education Program for African American Youth

“…Though community-based participatory research approaches are being used broadly in research focused on prevention of a variety of health issues, its use in the development of sexual health interventions targeting African American youth is less understood. Community academic partnerships to both implement and evaluate promising interventions, can play a central role in developing central foci and determining contexts central to their effectiveness through position prioritizing communities, in this case, youth, as senior partners in intervention planning, implementation, and evaluation toward increased ownership and sustainability due to cultural and contextual relevance and responsiveness [ 26 , 27 , 28 , 29 , 30 , 31 ].…”