ABSTINENCE AND SAFER SEX HIV RISK-REDUCTION INTERVENTIONS FOR AFRICAN-AMERICAN ADOLESCENTS - A RANDOMIZED CONTROLLED TRIAL

Context.-African American adolescents are at high risk of contracting sexually transmitted infection with human immunodeficiency virus (HIV) , but which behavioral interventions to reduce risk are most effective and who should conduct them is not known. Objective.-To evaluate the effects of abstinence and safer-sex HIV risk-reduction interventions o n young inner-city African American adolescents' HIV sexual risk behav iors when implemented by adult facilitators as compared with peer cofa cilitators. Design.-Randomized controlled trial with 3-, 6-, and 12-mo nth follow-up. Setting.-Three middle schools serving low-income Africa n American communities in Philadelphia, Pa. Participants.-A total of 6 59 African American adolescents recruited for a Saturday program. Inte rventions.-Based on cognitive-behavioral theories and elicitation rese arch, interventions involved 8 1-hour modules implemented by adult fac ilitators or peer cofacilitators. Abstinence intervention stressed del aying sexual intercourse or reducing its frequency; safer-sex interven tion stressed condom use; control intervention concerned health issues unrelated to sexual behavior. Main Outcome Measures.-Self-reported se xual intercourse, condom use, and unprotected sexual intercourse. Resu lts.-Mean age of the enrollees was 11.8 years; 53% were female and 92. 6% were still enrolled at 12 months, Abstinence intervention participa nts were less likely to report having sexual intercourse in the 3 mont hs after intervention than were control group participants (12.5% vs 2 1.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=. 14; 20.0% vs 23.1%, P=.42, respectively). Safer sex intervention parti cipants reported significantly more consistent condom use than did con trol group participants at 3 months (odds ratio [OR]=3.38; 95% confide nce interval [CI], 1.25-9.16) and higher frequency of condom use at al l follow ups. Among adolescents who reported sexual experience at base line, the safer-sex intervention group reported less sexual intercours e in the previous 3 months at 6- and 12-month follow-up than did contr ol and abstinence intervention (adjusted mean days over prior 3 months , 1.34 vs 3.77 and 3.03, respectively; P less than or equal to.01 at 1 2-month follow-up) and less unprotected intercourse at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85, respectively , P<.001, at 12-month follow-up). There were no differences in interve ntion effects with adult facilitators as compared with peer cofacilita tors. Conclusion.-Both abstinence and safer-sex interventions can redu ce HIV sexual risk behaviors, but safer-sex interventions may be espec ially effective with sexually experienced adolescents and may have lon ger-lasting effects.