ContextAfrican 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.ObjectiveTo 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 ParticipantsRandomized 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.InterventionAll 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
and nutrition.Main Outcome MeasuresThe 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.ResultsRelative 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.ConclusionInterventions 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.

/pdf/efficacy-of-an-hiv-prevention-intervention-for-african-1p8kwauzhe.pdf

Efficacy of an HIV Prevention Intervention for African American Adolescent Girls: A Randomized Controlled Trial

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

. Objective. The purpose of the study was to examine the association between adolescents’ psychological distress and their sexually transmitted disease/ human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. Method. Sexually active black adolescent females (N 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, .84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. Results. In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: 2.0), have had unprotected vaginal sex (AOR 2.1), have nonmonogamous sex partners (AOR 1.7), and not use any form of contraception (AOR 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR 2.2), be fearful of the adverse consequences of negotiating condom use (AOR 2.0), perceive less control in their relationship (AOR 2.0), have experienced dating violence (AOR 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR 1.7). Discussion. The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment,those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/ HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.

https://pediatrics.aappublications.org/content/pediatrics/108/5/e85.full.pdf

A prospective study of psychological distress and sexual risk behavior among black adolescent females.

In response to high rates of sexual risk behaviors and negative outcomes among adolescents delaying the initiation of sexual intercourse and increasing condom use among adolescents are identified as two public health priorities in Healthy People 2000. Recent studies have challenged popular beliefs that parents have no influence over the sexual behavior of the adolescent children. Several well-designed studies found parents’ sexual values and sexual communication with their children exert significant influences on adolescents’ attitudes toward sexuality their initiation and participation in sexual activity and their use of contraceptives and condoms. Although mothers have consistently been found to be the primary sexual communicators with children particularly daughters fathers may play an important role through the discussion of sociosexual issues with daughters. Fathers may be able to provide daughters with unique perspectives enhance their overall understanding of men and provide opportunities to role-play communication strategies with men. However much of the recent research on parent-adolescent sexual communication and family influences of adolescent sexual risk behaviors has been limited to communication and relationships with mothers. The purpose of the present study was to examine the influence of sexual communication with mothers and fathers on the sexual risk behaviors of adolescent daughters. (excerpt)

The influence of sexual risk communication between parents and daughters on sexual risk behaviors.

http://scs.fhi360.org/publications/Psychosocial.pdf

Initiation of sexual intercourse among middle school adolescents: the influence of psychosocial factors

Adolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.

D. Kirby

Papers

Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion.

Interventions to prevent pregnancy and sexually transmitted diseases, including HIV infection.