African American adolescent girls are at high risk for human immunodeficiency
virus (HIV) infection, but interventions specifically designed for this population
have not reduced HIV risk behaviors.
To evaluate the efficacy of an intervention to reduce sexual risk behaviors,
sexually transmitted diseases (STDs), and pregnancy and enhance mediators
of HIV-preventive behaviors.
Design, Setting, and Participants
Randomized controlled trial of 522 sexually experienced African American
girls aged 14 to 18 years screened from December 1996 through April 1999 at
4 community health agencies. Participants completed a self-administered questionnaire
and an interview, demonstrated condom application skills, and provided specimens
for STD testing. Outcome assessments were made at 6- and 12-month follow-up.
All participants received four 4-hour group sessions. The intervention
emphasized ethnic and gender pride, HIV knowledge, communication, condom use
skills, and healthy relationships. The comparison condition emphasized exercise
Main Outcome Measures
The primary outcome measure was consistent condom use, defined as condom
use during every episode of vaginal intercourse; other outcome measures were
sexual behaviors, observed condom application skills, incident STD infection,
self-reported pregnancy, and mediators of HIV-preventive behaviors.
Relative to the comparison condition, participants in the intervention
reported using condoms more consistently in the 30 days preceding the 6-month
assessment (unadjusted analysis, intervention, 75.3% vs comparison, 58.2%)
and the 12-month assessment (unadjusted analysis, intervention, 73.3% vs comparison,
56.5%) and over the entire 12-month period (adjusted odds ratio, 2.01; 95%
confidence interval [CI], 1.28-3.17; P = .003). Participants
in the intervention reported using condoms more consistently in the 6 months
preceding the 6-month assessment (unadjusted analysis, intervention, 61.3%
vs comparison, 42.6%), at the 12-month assessment (unadjusted analysis, intervention,
58.1% vs comparison, 45.3%), and over the entire 12-month period (adjusted
odds ratio, 2.30; 95% CI, 1.51-3.50; P<.001).
Using generalized estimating equation analyses over the 12-month follow-up,
adolescents in the intervention were more likely to use a condom at last intercourse,
less likely to have a new vaginal sex partner in the past 30 days, and more
likely to apply condoms to sex partners and had better condom application
skills, a higher percentage of condom-protected sex acts, fewer unprotected
vaginal sex acts, and higher scores on measures of mediators. Promising effects
were also observed for chlamydia infections and self-reported pregnancy.
Interventions for African American adolescent girls that are gender-tailored
and culturally congruent can enhance HIV-preventive behaviors, skills, and
mediators and may reduce pregnancy and chlamydia infection.