The subjects were adolescents 14-18 years old. They were recruited from schools and health clinics. The subjects completed an in-depth survey and interview at baseline and again 6 months later. The subsequent analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods (N = 179). At baseline, five-scale measures and a single-item measure were used to assess predictive constructs, and at follow-up, the subjects were asked about their frequency of condom use over various periods of recall. The researchers created multivariate models to control for the confounding influence of pregnancy status. They then found that the findings were remarkably distinct, with evidence that strongly supports the predictive role of perceived barriers toward condom use and peer norms. Based on the measure of sexual communication, the researchers found significance for two of the six assessed outcomes. Alternatively, measures of attitudes toward condom use, condom negotiation self-efficacy, and knowledge about STD/HIV-prevention were found to be consistently nonsignificant. The researchers conclude that to improve the effectiveness of individual-level STD/HIV prevention programs, designed for this population, any program must place an emphasis on reducing barriers to condom use, teaching partner communication skills, and fostering positive peer norms relevant to condom use.
One examination of a community-based program is offered by Harvey, Stuart, and Swan (2000), considering a community intervention trial undertaken in KwaZulu Natal, South Africa to evaluate the effectiveness of a high school drama-in-education program. In this study, seven pairs of secondary schools were randomized to receive either written information about HIV / AIDS or the drama program. Questionnaire surveys of knowledge, attitude, and behavior were compared from before and 6 months after the interventions. The sample consisted of 1,080 students in the first survey and 699 in the second. Improvements in knowledge (P=0.0002) and attitudes (P < 0.00001) about HIV / AIDS were demonstrated in students at schools receiving the drama program when compared to pupils receiving written information alone, and these changes were found to be independent of age, gender, school, or previous sexual experience. In schools receiving the drama program, sexually active students increased thier condom use (P < 0.01). The authors state that it is important to provide resources to sustain such programs as well as to get stronger evidence of the effect on behavior by measuring changes in HIV incidence. The authors also note that adolescents' risk of becoming infected with HIV in South Africa is increased by a lifestyle involving a greater degree of exploration, experimentation, and rebellion. The high prevalence of sexually transmitted diseases and the high rate of adolescent pregnancy show a pattern of early onset of sexual intercourse, multiple partners, and a low incidence of condom use. Prevention programs such as the Drama Approach to AIDS (DramAide) were initiated in Africa to reduce HIV transmission. The approach to testing used a randomized community intervention trial, with the results noted above.
Another African study is reported by Munodawafa, Marty, and Gwede (1995), in this case in Zimbabwe analyzing the use of health instruction by students nurse in rural secondary schools and determining how effective such instruction may be.
The project used twelve nurses on community deployment to provide health instruction among rural school-age populations in Zimbabwe. The program was analyzed using a quasi-experimental (pre- and post-test), non-equivalent control group design consisting of 141 school pupils in the intervention group and 144 pupils in the comparison group (N = 285). The curriculum used focused on prevention of STDs, HIV / AIDS, and drugs (alcohol, tobacco and marijuana), and a gain in health knowledge scores among the intervention group was reported at post-test. More than 70% of the pupils who received health instruction from student nurses offered a high approval rating of the student nurses' performance, and student nurses, teachers, and tutors all supported school health instruction by student nurses, although tutors and teachers did differ on teaching about condoms. In the program, the 12 student nurses were sent by nursing schools to five rural secondary schools in Masvingo Province to provide health education over a seven-week period to 141 students (9.33 hours/student). Curriculum topics included AIDS, other sexually transmitted diseases (STDs), and drugs (alcohol, tobacco, and marijuana), and the AIDS/STD educational materials concentrated on modes of transmission, prevention methods, control of transmission, psychosocial issues, responsible sexual behavior, and problem-solving and decision-making strategies. This study really addresses how the student nurses and their instruction were received and did not show the effectiveness of that instruction in changing behavior, which is the analysis that is really needed.
Morrison-Beedy, Nelson, and Volpe (2006) undertake a study to examine the rates of HIV-related risk behaviors and HIV testing rates between Black and White adolescent girls consenting to participate in an HIV prevention intervention. The sample consisted of 116 unmarried sexually active girls ages 15 to 19 enrolled in a pilot randomized controlled trial of a gender-specific HIV prevention intervention who classified themselves as Black (N = 43) or White (N = 73). These girls were unmarried and sexually active with a male partner in the past three months, and the mean age for the Black girls was 16.7 years (SD=1.4) and for the White girls was 17.5 years (SD=1.3). The average level of education completed was 10th grade for Blacks and 11th grade for Whites, and sixty percent of the Black girls were classified as economically disadvantaged, versus 15% of the White participants. The girls were recruited by trained research assistants from an urban health clinic in central New York State that provides gynecologic and reproductive health services to teenagers.
Participants were asked to report on their sexual and substance use history and were then assessed on the basis of criteria set beforehand. Count data were used to report the following behaviors: (a) total number of sex partners in the past year, (b) number of men had sex with over the past 3 months, - number of partners who use IV drugs over the past 3 months, (d) number of times had sex for money or drugs over the past 3 months, (e) number of times had vaginal sex with and without a condom over the past 3 months, (f) number of times had anal sex with and without a condom over the past 3 months, (g) number of episodes received and gave oral sex over the past 3 months, and (h) number of times used alcohol or drugs before sex over the past 3 months.
The Statistical Package for the Social Sciences (SPSS) was used to conduct chi-squared analysis, and independent t-tests were also used to compare the mean variable scores between Black and White adolescent girls on HIV risk related and health promotion behavior items. It was found that Black and White adolescent girls differed on frequency and incidence of several HIV-related risk behaviors (p<.05). White adolescent girls had a greater number of total sex partners in the last year and a greater number of partners who injected drugs than Black girls, and White adolescent girls also reported that they had more vaginal sex with a latex condom, more vaginal sex without a latex condom, and more episodes of oral sex (giving and receiving). No racial differences were found in the self-report of unprotected anal sex. White girls also reported more alcohol use before sex than Black adolescent girls, while there was no difference in the self-report of drug use before sex, or in engaging in sex for money or drugs. No statistical differences were noted in HIV-related risk behaviors based on the variables of socioeconomic status and education level, though some behaviors did differ by age so that younger and older adolescent girls differed on frequency and incidence of some HIV risk related behaviors. White adolescent girls were significantly less likely to get tested for HIV than Black girls, though they engaged in more risky behavior.
One situation that appears to lead to greater awareness and more behavior change is noted by Staub et al. (2007), and that is when there is a case-finding for human immunodeficiency virus (HIV), and especially among high-risk youth. The researchers conduct a study that shows that there is a significant increase in participation in voluntary HIV counseling and testing services immediately after implementation of a brief sexually transmitted infection (STI)/HIV educational program in alternative education and juvenile detention facilities. The effectiveness of such programs, however, may be short-lived, an issue that needs to be given more attention.
Rotheram-Borus and Miller (1998) offer a similar finding, noting first that the number of youths infected with HIV has been rising and that secondary prevention programs are therefore needed to help youths living with HIV meet three goals: (1) increase self-care behaviors, medical adherence, and health-related interactions; (2) reduce transmission acts; and (3) enhance their quality of life. The authors describe such an intervention program for youths living with HIV, one delivered over 30 sessions in three modules. The program…