STD Quarterly

Community groups can perform HIV intervention

Researchers originally developed program

An approach designed to reduce HIV and sexually transmitted diseases (STDs) in adolescents previously used exclusively by academic researchers now has been shown to be successfully implemented by community-based organizations (CBOs).1

Adolescents are at heightened risk for STDs. The Centers for Disease Control and Prevention estimates that about 19 million new infections occur each year in the United States, with almost half of them among young people ages 15-24.2

The program, "Be Proud! Be Responsible!" originally was developed by researchers at the University of Pennsylvania. The current study was designed to evaluate the program outside the research setting, says program co-developer John Jemmott III, PhD, professor of communication in psychiatry and of communication at the University of Pennsylvania's School of Medicine and Annenberg School for Communication.

The "Be Proud! Be Responsible!" curriculum consists of six culturally appropriate, hour-long modules that address facts, attitudes, and beliefs surrounding HIV and AIDS. Condom use skills and negotiation-refusal techniques are included in the curriculum. The intervention is designed to be informative and entertaining and includes group discussion, games, mini-lectures, videos, condom demonstrations, role-plays, and other interactive activities.

To perform the current study, interventions were led by 86 community-based organizations with a total of 1,707 adolescent participants divided into a control group and an HIV/STD risk-reduction group. The intervention was designed to give adolescents the knowledge, motivation, and skills necessary to reduce their risk of STDs, including HIV. The teens reported in at three, six, and 12 months following the intervention. The study's primary outcome was consistent condom use in the three months prior to each follow-up assessment, averaged over the follow-up assessments.

Results indicate that HIV/STD-intervention participants were more likely to report consistent condom use [odds ratio (OR) = 1.39; 95% confidence interval (CI) = 1.06, 1.84] than were control-intervention participants.1The HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group.

The study also looked at the impact of extended training and found that CBO facilitators who received more training were no more effective than those who received a basic intervention packet alone. Results suggest that the training of CBO facilitators does not need to be "extraordinarily extensive or expensive" to achieve desired results, according to researchers.1

"We were pleased to find that effective interventions can retain their beneficial effects when implemented by CBOs outside of tightly controlled research settings," says program co-developer Loretta Jemmott, PhD, RN, professor of nursing at the University of Pennsylvania School of Nursing. "This has important implications for ways that future interventions can be rolled out."

Two extended versions of the "Be Proud! Be Responsible!" curriculum exist. "Making Proud Choices!" is the safer-sex-based extension, while "Making a Difference!" is the abstinence-based extension. The Jemmott research team continues to research abstinence interventions. Results from their theory-based, abstinence-only intervention appear to be associated with a lower rate of sexual involvement among African American sixth- and seventh-graders.3

The "Be Proud! Be Responsible!" program is one of several "best-evidence" HIV behavioral interventions evaluated by the Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Project. Interventions that are listed in the project's Compendium of HIV Prevention Interventions with Evidence of Effectiveness have been rigorously evaluated and have shown significant effects in eliminating or reducing sex- or drug-related risk behaviors, reducing the rate of new HIV/STD infections, or increasing HIV-protective behaviors. Interventions in the compendium meet the efficacy criteria for best evidence and are considered to provide the strongest scientific evidence of efficacy.4 More than 60 evidence-based individual-level, group-level, and community-level HIV behavioral interventions are now listed in the resource. (To see a list of the programs, go to cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm.)

References

  1. Jemmott JB 3rd, Jemmott LS, Fong GT, et al. Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial. Am J Public Health 2010; 100:720-726.
  2. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.
  3. Jemmott JB 3rd, Jemmott LS, Fong GT. Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Arch Pediatr Adolesc Med 2010; 164:152-159.
  4. Centers for Disease Control and Prevention, HIV/AIDS Prevention Research Synthesis Project. Compendium of HIV Prevention Interventions with Evidence of Effectiveness. Atlanta: Centers for Disease Control and Prevention. Accessed at cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm.