HIV sexual risk-reduction interventions for youth: a review and methodological critique of randomized controlled trials

Abstract

The authors review and provide a methodological critique of randomized controlled studies of HIV risk reduction interventions that measured sexual risk behavior outcomes with adolescents. Studies conducted in school, community, and health care settings were reviewed. Overall, 13 of 23 interventions (57%) were effective in reducing sexual risk behavior. Methodological strengths of extant studies included an emphasis on a theoretical framework, evaluation of both individualized and group-intervention formats, use of multiple assessments of risk behavior (including biological outcomes), and inclusion of efficacy and effectiveness trials. Methodological limitations included limited evaluation of theoretical mediators of risk reduction, failure to report effect sizes, and lack of sustained findings. Inconsistencies were found in data analytic procedures and reporting, including how nested designs, skewed data, and attrition were addressed. Recommendations for designing methodologically rigorous interventions are provided.

Figure 1

Sexual risk reduction outcome variables measured by 22 randomized, controlled HIV risk reduction interventions with adolescents. The direction of the variables indicates greater HIV risk reduction, such as reduced STDs, sexual partners, frequency of sex or unprotected sex and greater condom use, abstinence, and delay of onset of sex.