|HIV Prevention Program Reaching Hispanic Youths Reduces Risky
In the first randomized controlled trial of a culturally tailored HIV risk
reduction program for Hispanic adolescents, nurse scientists report long-term
success in reducing risky sexual behavior among this group.
The study, which was funded by the National Institute of Nursing Research (NINR),
a component of the National Institutes of Health (NIH), found that adolescents
reported a lower frequency of sexual intercourse, fewer sexual partners, and
an increased use of condoms during intercourse for up to 12 months after completing
the program. These results also suggest there is a benefit to providing education
on both abstinence and safe sex practices.
The results from this trial add to the growing body of research showing the
importance of using culturally appropriate interventions with minority adolescents
to help them avoid risky health behaviors and adopt positive health behaviors.
The findings appear in the August 2006 issue of the Archives of Pediatric
and Adolescent Medicine.
HIV and AIDS disproportionately affect Hispanic adolescents, with the incidence
of AIDS for adult and adolescent Hispanics in 2001 more than 3 times higher than
among their non-Hispanic white counterparts.
The Centers for Disease Control and Prevention (CDC) reported that in 2001 HIV
infection ranked as the fourth leading cause of death for Hispanics aged 25 to
44. Also, Hispanics were identified as one of the population subgroups with the
highest rates of death from HIV/AIDS in 2001 (6.2 deaths per 100,000).
Untreated HIV (human immunodeficiency virus) disease, characterized by a gradual
deterioration of immune function, can make a person particularly vulnerable to
the opportunistic infections that typify AIDS, the end stage of HIV disease.
Heterosexual contact has been shown to be the major mode of HIV transmission
among Hispanic adolescents. In addition, data from a national Youth Risk Behavior
Surveillance System has shown that the incidence of sexual intercourse before
the age of 13, and of having a history of multiple sexual partners, is higher
among Hispanic youth than among whites, while related studies have consistently
documented lower condom use among Hispanic adolescents compared to black or white
The research program involved 553 adolescents (249 males and 304 females) self-identified
as Hispanic and recruited from three Northeast Philadelphia high schools and
community-based neighborhood organizations. Over 85 percent of the participants
were Puerto Rican, with nearly half born outside the mainland US. Participants
averaged 14.9 years of age, and 87 percent were students in grades 8 through
11. Over 40 percent reported having engaged in sexual intercourse at least once,
with an average age at first intercourse of 13.5 years.
Students participating in this study, called “ˇCuidate! (Take Care
of Yourself) The Hispanic Youth Health Promotion Program,” were randomly assigned
to one of two interventions: the HIV prevention program and a general health
promotion program. Both programs presented Hispanic cultural values as an important
context that supports positive health behaviors.
The HIV prevention program, based on several behavioral theories, emphasized
abstinence and condom use as culturally accepted and effective methods to prevent
sexually transmitted diseases (STDs), such as HIV.
The second intervention, which focused on general health promotion issues, addressed
improving diet, exercise, and physical activity, and reducing the use of cigarettes,
alcohol, and drugs.
Both interventions were similar in length and format, consisting of six 50-minute
modules delivered on consecutive Saturdays to small, mixed gender groups in English
or Spanish. The modules included group discussion, videos, interactive exercises,
and skill-building activities. Most of the program facilitators were Puerto Rican
In follow-up surveys up to a year after these programs, adolescents in the HIV
intervention group were less likely to report engaging in sexual intercourse,
having multiple partners, or having episodes of unprotected intercourse. For
example, adolescents in the HIV risk-reduction group were 34 percent less likely
to report having had sexual intercourse in the past 3 months over the follow-up
period than were those in the control intervention. Similarly, adolescents in
the HIV risk-reduction group were 47 percent less likely to report having multiple
partners across the follow-up time points as compared with adolescents in the
health promotion control group. In addition, adolescents assigned to the HIV
risk-reduction group, and who were sexually inexperienced at the beginning of
the study, reported fewer days of unprotected sex while Spanish speakers were
more than five times more likely to have used a condom at last intercourse and
had a greater proportion of protected sex compared to similar adolescents in
the health promotion control group.
The investigators report that these results support the efficacy of this HIV
intervention in decreasing sexual activity and increasing condom use among Hispanic
adolescents. “This study is an important contribution in assisting Latino adolescents
to decrease HIV sexual risk behavior,” said principal investigator Dr. Antonia
M. Villarruel, Professor, University of Michigan School of Nursing, Ann Arbor. “It
is an important effort in providing an evidence base for practitioners from which
to guide and support adolescents in sexual decision-making. Much more research
is needed with Latino adolescents to address the health disparity in HIV/AIDS,” she
concluded. Dr. Loretta S. Jemmott, University of Pennsylvania School of Nursing,
and Dr. John B. Jemmott III, Professor, University of Pennsylvania Annenberg
School of Communication, also contributed to the study.
“This demonstration of an effective curriculum to reduce HIV sexual risk behavior
among a vulnerable minority population, namely, adolescent Hispanics, personifies
NINR’s ongoing commitment to eliminating health disparities, said Dr. Patricia
A. Grady, Director, NINR. “The findings from this study advance our goal of ensuring
the wellbeing of all individuals,” she added.
The primary mission of the NINR, one of 27 Institutes and Centers at the
National Institutes of Health, is to support clinical and basic research and
establish a scientific basis for the care of individuals across the life span.
For additional information, visit the NINR web site at http://ninr.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U.S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit www.nih.gov.