A randomized controlled trial testing an HIV prevention intervention for Latino youth

Abstract

Objective: To test the efficacy of a prevention intervention to reduce sexual risk behavior among Latino adolescents.

Design: Randomized controlled trial from April 2000 through March 2003, with data collection before and after intervention and at 3, 6, and 12 months.

Setting: Northeast Philadelphia schools.

Participants: Latinos aged 13 through 18 years (249 males and 304 females); 81.6% retained at 12-month follow-up.

Interventions: The HIV and health-promotion control interventions consisted of six 50-minute modules delivered by adult facilitators to small, mixed-gender groups in English or Spanish. Main Outcome Measure Self-reported sexual behavior.

Results: Analyses using generalized estimation equations over the follow-up period revealed that adolescents in the HIV intervention were less likely to report sexual intercourse (odds ratio, 0.66; 95% confidence interval [CI], 0.46-0.96), multiple partners (odds ratio, 0.53; 95% CI, 0.31-0.90), and days of unprotected intercourse (relative risk, 0.47; 95% CI, 0.26-0.84) and more likely to report using condoms consistently (odds ratio, 1.91; 95% CI, 1.24-2.93). Baseline sexual experience and language use moderated intervention efficacy. Adolescents assigned to the HIV intervention who were sexually inexperienced at baseline reported fewer days of unprotected sex (relative risk, 0.22; 95% CI, 0.08-0.63); Spanish speakers were more likely to have used a condom at last intercourse (odds ratio, 4.73; 95% CI, 1.72-12.97) and had a greater proportion of protected sex (mean difference, 0.35; P<.01) compared with similar adolescents in the health-promotion intervention.

Conclusion: Results provide evidence for the efficacy of HIV intervention in decreasing sexual activity and increasing condom use among Latino adolescents.

Figure 1

Progress of participants through the trial. Asterisk indicates reason unknown; HIV, human immunodeficiency virus.

Figure 2

Self-report of sexual intercourse in the past 3 months. This graph does not represent results of generalized estimation equation analyses. The percentage (SE) was calculated for the outcome variable; unadjusted scores are presented for each time period. Values for the human immunodeficiency virus (HIV) risk-reduction group are as follows: pretest, 25.9% (0.44%); 3 mo, 26.0% (0.44%); 6 mo, 28.4% (0.45%); and 12 mo, 35.7% (0.48%). Values for the health-promotion group are as follows: pretest, 28.4% (0.45%); 3 mo, 31.0% (0.46%); 6 mo, 33.3% (0.47%); and 12 mo, 40.7% (0.49%).

Figure 3

Self-report of multiple partners in the past 3 months. This graph does not represent results of generalized estimation equation analyses. The percentage (SE) was calculated for the outcome variable; unadjusted scores are presented for each time period. Values for the human immunodeficiency virus (HIV) risk-reduction group are as follows: pretest, 10.4% (0.31%); 3 mo, 14.0% (0.35%); 6 mo, 9.0% (0.29%); and 12 mo, 10.7% (0.31%). Values for the health-promotion group are as follows: pretest, 7.8% (0.27%); 3 mo, 11.7% (.0.32%); 6 mo, 10.3% (0.30%); and 12 mo, 17.3% (0.38%).

Figure 4

Consistent condom use in the past 3 months. This graph does not represent results of generalized estimation equation analyses. The percentage (SE) was calculated for the outcome variable; unadjusted scores are presented for each time period. Scores were calculated only for participants who were sexually active at baseline (human immunodeficiency virus [HIV] risk-reduction group [n = 106], health-promotion group [n = 127]). Values for the HIV risk-reduction group are as follows: pretest, 46.8% (0.50%); 3 mo, 42.6% (0.50%); 6 mo, 44.8% (0.50%); and 12 mo, 42.2% (0.50%). Values for the health-promotion group are as follows: pretest, 34.8% (0.48%); 3 mo, 25.7% (0.44%); 6 mo, 28.8% (0.46%); and 12 mo, 27.6% (0.45%).