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Monday, August 7, 2006
HIV Prevention Program Reaching Hispanic Youths Reduces Risky Sexual Behaviors
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 adolescents.
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 “¡Cuidate! (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.
About the National Institutes of Health (NIH): 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. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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