A RANDOMIZED, CONTROLLED EFFECTIVENESS TRIAL OF AN AIDS-PREVENTION PROGRAM FOR LOW-INCOME AFRICAN-AMERICAN YOUTHS

Background: Some interventions to reduce the risk of the acquired immu nodeficiency syndrome (AIDS) that target youths have resulted in short -term increases in self-reported condom use. However, long-term interv ention effects have not been assessed. Study Question: Can a theoretic ally and culturally based, AIDS-risk reduction intervention delivered to naturally formed peer groups increase self-reported condom use amon g African-American early adolescents at 6 and 12 months of follow-up? Methods: A randomized, controlled trial of a community-based intervent ion delivered in eight weekly sessions involved 76 naturally formed pe er groups consisting of 383 (206 intervention and 177 control) African -American youths 9 to 15 years of age. A theory-based, culturally and developmentally tailored instrument that assessed perceptions, intenti ons, and self-reported sexual behaviors was administered to all subjec ts at baseline (preintervention) and 6 and 12 months later. Results: A t baseline, 36% of youths were sexually experienced, and by 12 months of follow-up, 49% were sexually experienced. Self-reported condom use rates were significantly higher among intervention than control youths (85% vs 61%; P<.05) at the 6-month follow-up. However, by 12 months, rates were no longer significantly higher among intervention youths. T he intervention impact at 6 months was especially strong among boys (8 5% vs 57%; P<.05) and among early teens (13 to 15 years old) (95% vs 6 0%; P<.01). Self-reported condom use intention was also increased amon g intervention youths at 6 months but not at 12 months. Some perceptio ns were positively affected at 6 months, but the change did not persis t at 12 months. Conclusions: High rates of sexual intercourse undersco re the urgent need for effective AIDS-risk reduction interventions tha t target low-income urban, African-American preteens and early teens. A developmentally and culturally tailored intervention based on social -cognitive theory and delivered to naturally formed peer groups recrui ted from community settings can increase self-reported condom use. The strong short-term improvements in behaviors and intentions followed b y some relapse over longer periods argue for a strengthened program an d research focus on sustainability.