Teen intervention program reduces at-risk behavior

Participants cut high-risk sex by 82%

HIV-infected youths pose two major problems for the public health community. The first is that it’s difficult to identify these youths, who are less likely to be tested and treated than are HIV-infected adults. The second is that it’s difficult to encourage these youths to reduce their risky sexual and injection drug use behavior. Recently published research shows that HIV-infected youths will decrease their risky behaviors after undergoing a lengthy specially designed intervention program.

"There are about 110,000 HIV-positive youths in the United States, and less than 20,000 of these youths have been identified, and only one in five of those identified is in care," says Mary Jane Rotheram-Borus, PhD, a professor in the department of psychiatry at the University of California - Los Angeles. Rotheram-Borus also is director of the Center for Community Health at the Neuropsychiatric Institute at UCLA and the director of the Center for HIV Identification, Prevention, and Treatment Services at UCLA.

UCLA researchers have been working with HIV-infected youths, defined as those under age 20, since the early 1990s. Over the past decade, these investigators have designed an intervention that focuses on youths’ medical treatment, risk behaviors, and quality of life.

Youths who participated in the comprehensive, three-module program, which involved a facilitator and groups of about 10 youths meeting regularly, were less likely to engage in sexually risky activities. They had significantly fewer unprotected sex acts and fewer HIV-negative partners and were more likely to disclose their serostatus to their sexual partners, according to the study published in the American Journal of Public Health in March 2001. There was less reported use of alcohol, marijuana, or hard drugs in the intervention group than in the control group or among intervention nonattendees.1

For purposes of the study, investigators had participants wait several months after each module before starting another one. The modules were titled, "Staying Healthy," "Acting Safe," and "Being Together." The module-format intervention program was developed out of researchers’ observations and qualitative study over a two-year period, Rotheram-Borus says. Although only the second module focuses on risk behaviors, the program is most effective when all three modules are followed, Rotheram-Borus says. "We thought all three modules were key, particularly, the quality of life module as it was related to relapse issues and dealing with changes," she adds.

Another recently published study focuses on how the intervention can improve quality of life for young people who are infected with HIV. The study found that the third module, focusing on quality of life, had a statistically significant beneficial influence on the youths’ emotional distress when compared with the control group.2

Here’s how the three modules work: The youths meet in a group led by a facilitator, who has a master’s degree or a bachelor’s degree, for 10 sessions. The group meeting begins with introductions and a review of the previous session. Then youths are taught how to develop new skills through structured activities. They set goals for the week and discuss all of the things they liked in this week’s session. The session lasts for about two hours.

The specific modules contain the following information:

1. Staying Healthy.

This module focuses on teaching youths the importance of keeping physician appointments. They’re taught skills that will help them become assertive with their doctors, and the module emphasizes how important it is that the youths begin to receive health care and stay involved in maintaining their health, Rotheram-Borus says. This module initially had the least apparent benefit for the youths, but that has changed in recent years as HIV health care has been transformed through the use of protease inhibitors and multidrug antiretroviral regimens, she adds.

2. Acting Safe.

This module focuses on sex, drugs, and risk behaviors. Participants are taught how to negotiate safer sex, why it’s important to go through detoxification treatment, how to curb their drug use, and how to curb cravings, Rotheram-Borus says. Funded by the National Institute of Drug Abuse in Washington, DC, this module is action-oriented and offers practical training with role-playing and activities that focus on questions such as these:

  • What are you going to do instead of getting high?
  • How are you going to make friends who aren’t using drugs all the time?
  • What places can you go to if you have a drug problem?

Facilitators may identify a person in the group who is the most outgoing and have that person engage in a role-playing scenario in which the person is negotiating safer sex at a bar on a Friday night, Rotheram-Borus offers as an example. "The kids practice and work collectively," she says. "They may ask themselves how they could do it differently next time, and we’ll ask them to write down those choices, put them on a file card, and laminate it to keep in their pocket."

3. Being Together.

Using a cognitive behavioral intervention approach, this module also included meditation practice, relaxation exercises, and strategies for coping with negative emotions. Researchers collaborated with a Zen Buddhist priest in designing some parts of the intervention, Rotheram-Borus says. "We emphasize what we call positive coping style, which is taking positive actions and seeking social support rather than having a self-destructive style like using drugs," Rotheram-Borus says. "The group had little cushions, and they practiced meditation skills, finding ways to gain self control, and this in particular helped them with their substance abuse."

(Editor’s note: UCLA researchers offer the planning sessions and materials for presenting the HIV safety modules at no charge to anyone who want to review and possibly implement the program. This free offer is available only over the Internet, where the program can be downloaded in a PDF file. For more information, visit chipts.ucla.edu and click "Intervention Manuals" and then "Teens Linked to Care.")

References

1. Rotheram-Borus MJ, Lee MB, Murphy DA, et al. Efficacy of a prevention intervention for youths living with HIV. Am J Public Health 2001; 91:400-405.

2. Rotheram-Borus MJ, Murphy DA, Wight RG, et al. Improving the quality of life among young people living with HIV. Evaluation and Program Planning 2001:1-11. Internet: www.elsevier.com/locate/evalprogplan