Health Promotion Strategies for Prevention of Human Immunodeficiency Virus Infection among Minority Adolescents

The STD and HIV Epidemics in African American Youth: Reconceptualizing Approaches to Risk Reduction

Sexually transmitted infections, including human immunodeficiency virus (HIV), disproportionately affect African American adolescents and young adults. Many of our current strategies and approaches have been inadequate in the promotion of risk reduction among youth and need to be reconceptualized. This article identifies issues that may guide researchers to better address the risks faced by African American youth. Some of these issues include tailoring of intervention messages and programs, timing of intervention delivery, consideration of contextual factors that influence risk behaviors, and increasing the breadth of our intervention focus. Discussions of how these strategies and approaches may enhance intervention effectiveness are highlighted.

Examining strategies for culturally grounded HIV prevention: a review

Since the early 1990s culture has been considered an essential concept for understanding the HIV/AIDS epidemic and the prevention of HIV (Parker, 2001). Despite consensus that culture is an important issue in HIV prevention programming, the field lacks a common vision for how culture ought to inform intervention design and implementation. In this article, we review the HIV prevention literature published through 2001 to examine interventions that have explicitly sought to address cultural concepts. We describe the types of strategies used to integrate culture into HIV prevention, how culture has been evaluated as a component of preventive interventions, and to whom these culturally grounded programs are targeted. We highlight gaps in the current body of literature and provide recommendations for future research on culturally grounded HIV prevention programs.

Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action

The study examined the applicability of the Theory of Reasoned Action to the study of condom use intentions of students at a university in southern Ghana. The data supported the model, explaining 33% of the variance in students' condom use intentions. Subjective norms and the perceived disadvantages of condom use were significant determinants of intention, with the former being more important. Respondents who intended to use condoms consistently ("intenders") and those with no such intentions ("non-intenders") were equally motivated to comply with the wishes of their significant referents (sexual partners, close friends, parents and medical doctors). The critical difference was that "intenders" consistently held a stronger belief than "non-intenders" that their significant referents approved of condom use. Significantly, whereas "intenders" believed that their sexual partners would approve of condom use, the "non-intenders" held the contrary belief that their partners would disapprove of such behavior. This suggests that AIDS education interventions targeting a similar audience like the university students in this study should shift their foci away from individuals alone and instead, focus simultaneously on individuals, their sexual partners and their broader social networks in order to enhance perceptions of peer acceptance of condom use.

Identifying the social contexts of effective sex refusal

A factorial survey was conducted to identify social situations that inhibit or promote college students' sex-refusal skills. Respondents evaluated five different situations in which sexual intercourse might occur and ranked each according to how certain the respondent would be to refuse to have sexual intercourse in that context. Regression analysis of the survey data showed that knowing the other person well, being with one's boyfriend or girlfriend, having condoms available, wanting to have sex, and both persons' wanting to have sex reduced the probability of refusal. On the other hand, having no condoms and the presence of drugs in the situation increased the probability the individual would refuse to have sex. In addition, men, individuals with previous sexual experience, and drinkers displayed diminished ability to refuse sex. However, the lack of condoms, when combined with these three respondent characteristics, acted to increase the ability to refuse sex.

Adolescent heterosexual experience: a new typology

PURPOSE

The purpose of this paper is to define a typology that encompasses the full range of adolescent heterosexual behavior; to compare the usefulness of the new typology with that of the traditional dichotomy of "sexually active"/"sexually inactive" for understanding sexual behavior among adolescents; and to determine the implications of the new typology for the design and implementation of HIV prevention programs targeting adolescents.

METHODS

Detailed face-to-face interviews were conducted with a cross-sectional sample of 907 mothers and their adolescents, ages 14-17 years, recruited from public high schools in Alabama, New York, and Puerto Rico. Information from the adolescent survey on precoital sexual behaviors and STD/HIV sexual risk and risk reduction behaviors was examined. A typology of adolescent heterosexual experiences was constructed using four behavioral dimensions.

RESULTS

Ninety-nine percent (n = 894) of the sample was classified into one of the five patterns of sexual experience: Delayers, Anticipators, One-timers, Steadies, and Multiples. Among the participants who were not sexually active, precoital behaviors differed significantly between the 22% who anticipated initiating sexual intercourse in the next year (Anticipators) and those who did not (Delayers). Among those traditionally classified as "sexually active", One-timers and Steadies were significantly older when they first had penile-vaginal intercourse than those who had multiple partners. One-timers were more likely to use condoms than Steadies or Multiples, and only Multiples reported previous STDs.

CONCLUSION

A typology that defines a range of adolescent heterosexual experiences was developed, and it was possible to classify 99% of our sample. The traditional dichotomy between "sexually active" vs. "not active" hides important behavioral intentions and sexual practices. These differences must be taken into account in the development and implementation of HIV prevention programs that target adolescents.

Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review

OBJECTIVE

(1) To review evaluations of Acquired Immunodeficiency Syndrome (AIDS) prevention interventions targeting adolescents to determine whether these efforts have been effective in reducing risk behaviors. (2) To examine the relation between intervention design issues and outcomes measures.

METHOD

A systematic review of five electronic databases and hand-searches of 11 journals, were undertaken for articles published from January 1983 through November 1995 that reported evaluations of adolescent AIDS risk-reduction interventions conducted in the United States. Outcomes examined include: improved attitudes about AIDS risk and protective behaviors, increased intention to abstain from sexual intercourse or to use condoms, and reduced sexual risk behaviors.

RESULTS

Forty studies that met preestablished inclusion criteria were found. For each outcome assessed, a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge; 58% changes in attitude, 60% changes in intention to use condoms, 73% in condom use, and 64% in decreasing number of sexual partners). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100% vs. 0%, p = .048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes.

CONCLUSIONS

AIDS risk reduction interventions can be effective in improving knowledge, attitudes, and behavioral intentions and in reducing risk practices. The positive relationship between improved outcomes and several elements of intervention design underscores the need for increased focus on intervention design in future studies.

PERCEPTIONS OF VULNERABILITY TO AIDS AMONG AFRICAN AMERICAN MEN: CONSIDERATIONS FOR PRIMARY PREVENTIVE COUNSELING FOR UNDERGRADUATES

The purpose of this paper is to suggest some factors counselors should consider in dealing with perceptions of vulnerability to HIV/AIDS among African American college-age males. For this study, perceived vulnerability to AIDS is a latent variable that refers to an individual's belief of their likelihood of contracting HIV when not using a condom. The objective of the study is to contribute to the knowledge needed by counselors, school educators, and health professionals to develop and implement effective educational programs and counseling interventions that are race and gender specific. In particular, programs that promote the use of AIDS risk-reduction practices among African American male, college-age adolescents. We acknowledge that any potent effort to prevent the spread of the disease among men in the African American community must: a) evaluate existing prevention strategies used with a similar population, b) utilize activities that focus on collective cultural experience, c) utilize activities that enhance communication and accent collective participation, d) utilize strategies that focus on acceptance of sexuality, e) focus on reccurring patterns of communication, f) base intervention on the current social and political climate, g) consider threats and belief in genocide as real, h) include messages which consistently emphasize the potential benefits and gains of community and i) consider racial/ethnic composition in the counselor-client relationship.

Exploring a model of symbolic social communication: the case of 'magic' johnson

We propose a model of symbolic social communication to explain the process whereby sociocultural identity mediates relationships among receivers, sources and messages to shape message effects. This exploratory study examines how two at-risk groups of African American men responded to various HIV prevention messages delivered by celebrity and professional sources. We interviewed 47 men from a homeless shelter and 50 male college students. Members of both groups were likely to select Johnson as the best person to deliver HIV prevention messages among a list of African American celebrity and professional sources. Results suggest the symbolic meanings embedded in celebrities and message topics are important and enduring influences on message effects. The images and ideas that a source represents are transferred to the advocated behavior, attitude or knowledge change and thus shape how messages are interpreted and received. Further understanding of how culture influences the effects of persuasive messages is critical for the improvement of health-communication campaigns.

Design issues addressed in published evaluations of adolescent HIV-risk reduction interventions: a review

OBJECTIVE

This study was conducted to determine: (1) issues in intervention design that have been addressed in behavioral interventions targeting human immunodeficiency virus (HIV)-risk behaviors among adolescents; (2) specific choices made in intervention design; (3) historic changes in the likelihood that issues in intervention design will be addressed; and (4) if an association exists between quality of evaluation design and the number of intervention design issues addressed.

DESIGN

Literature search employing five electronic databases and 11 journals for articles published from January 1983 through December 1993 reporting evaluations of adolescent HIV-risk reduction interventions.

MAIN OUTCOMES MEASURES

The frequency with which 12 issues in intervention design were addressed: basing the intervention on a theory of behavioral change; specifying a target population; involving the targeted community in the formulation of the intervention; addressing developmental issues; providing facts; strengthening interpersonal skills; describing the media (format) for delivering the intervention; specifying potentially relevant characteristics of the interventionists; describing the duration of the intervention; providing boosters; pilot testing the intervention; and including other potentially augmentative elements.

RESULTS

Twenty-eight published intervention articles were included in these analyses. The median number of intervention design issues addressed in any study was six (range three to nine), although this number increased significantly over time (p < .01). There was substantial variability in the frequency with which each individual design issue was addressed, with some design issues (e.g., inclusion of specific facts and the description of the channel employed) being addressed in all studies. Other design issues were addressed in less than one-quarter of studies [e.g., basing the intervention on a theory of behavioral change (18%) and addressing developmental issues (21%)]. The targeted community was involved in one-third of studies. More recent studies and studies employing a randomized evaluation design with both preintervention and postintervention assessments addressed more intervention design issues than did earlier studies and studies employing other evaluation designs (p = .01 and p = .03, respectively).

CONCLUSION

The majority of published adolescent HIV-risk reduction studies have not addressed important issues in intervention design. However, more recent studies and studies employing a strong evaluation design have addressed a greater number of these issues. Frameworks to guide intervention efforts (e.g., to serve as "practice guidelines") are needed to allow for both accurate replication and meaningful comparison of differing intervention approaches.

Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa

An AIDS education programme was developed and evaluated in a high school in a socio-economically disadvantaged, urban, African area in South Africa. The programme, which addressed the whole school community, aimed to raise awareness about AIDS using a variety of educational methods and operating through a number of channels. Students and teachers were actively involved in its design and implementation. Students' knowledge of and attitudes towards AIDS prevention were investigated before and after the AIDS programme, and compared to a neighbouring school, in which no AIDS education was conducted. The programme greatly improved student knowledge of HIV transmission and prevention. It increased levels of acceptance of people with AIDS and had a small impact on behavioural intentions. The process of involving the school community in the design of the AIDS education programme is discussed.

Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter

Using data from a cross-sectional survey of 531 predominantly black and Hispanic 10th graders in two New York City schools, the explanatory power of predictors of intentions to engage in sexual intercourse, to have multiple intercourse partners, and to use condoms was compared. Theoretically derived predictor variables (i.e., susceptibility, severity, benefits, barriers, self-efficacy, values, norms) were derived from the health belief model, social cognitive theory, and a model of social influence. One half of sampled students definitely intended to have sexual intercourse in the next year, one tenth definitely intended to have multiple partners, and two thirds definitely intended to use condoms. In multivariate analyses, variables derived from the model of social influence and from social cognitive theory were most strongly associated with the three investigated behavioral intentions; however, certain background and health belief variables also contributed to the explained variance in intercourse and multiple partner intentions.