HIV-positive youths who attended intervention sessions designed to reduce unsafe behaviors were more likely than nonparticipants to make lifestyle changes that improved their own health and less likely than nonparticipants to engage in sexual behaviors that might infect others.

Youths between the ages of 13 and 24 account for 18 percent of reported HIV cases in the United States. If these youths engage in unsafe sexual behaviors or injection drug use, they risk infecting others or becoming infected with new strains of HIV. To help reduce these risks, NIDA-supported researchers at the University of California, Los Angeles (UCLA), have developed intervention programs designed specifically to reduce unsafe behaviors by HIV-positive youths.

Dr. Mary Jane Rotheram-Borus and colleagues at UCLA's Center for HIV Identification, Prevention, and Treatment Services designed the intervention programs -- "Act Safe" and "Stay Healthy" -- and evaluated their impact on risk-related behaviors of 208 youths aged 13 to 24. They found that the Act Safe program reduced both substance abuse and high-risk sexual behaviors that contribute to the spread of HIV and that participants in the Stay Healthy program were more likely than nonparticipants to make lifestyle changes that improved their own health. "It is important to change risk behaviors in infected youth both for their self-protection and to prevent transmission to others," Dr. Rotheram-Borus says.

The participants were recruited from HIV/AIDS care programs for adolescents in Los Angeles, Miami, New York City, and San Francisco and had tested positive for HIV 2 years, on average, before being enrolled. Most (78 percent) were male, 88 percent of whom were homosexual. Roughly 15 percent of participants reported injection drug use. Sexual behaviors were the most likely route of infection for most participants, according to Dr. Rotheram-Borus.

The Stay Healthy program consisted of 12 group counseling sessions conducted over 3 months. In the sessions, 12 to 15 participants and 2 counselors focused on coping with HIV status, developing healthier daily routines, and participating in health care decisions. Six months after the sessions ended, participants had adopted more positive lifestyle changes than those who had not attended the intervention programs. These changes included improved diet, exercise, and sleep patterns as well as improved living arrangements and more frequent visits to health care facilities. Participants also showed improvement in a summary assessment of 23 physical health measures. Overall, females improved more than males.

The Act Safe program consisted of 11 small-group sessions conducted over 3 months.

Participants were counseled in ways to identify and change substance abuse and sexual behaviors that increased their risk of transmitting HIV or of contracting additional infections. The researchers conducted followup assessments 6 months after the sessions ended. Compared with their behavior before participation, those who attended the Act Safe sessions reported having 45 percent fewer sex partners; 50 percent fewer of the sex partners were HIV-negative or had unknown HIV status. Compared with youths who did not participate in the interventions, attendees were more likely to use protection during sex. Protected sex was less common -- for attendees and nonattendees -- with partners known to be HIV-positive than with partners of negative or unknown HIV status, Dr. Rotheram-Borus says. Use of drugs and alcohol dropped by nearly a third (31 percent) among those who attended the Act Safe sessions.

"These results are generally very encouraging," Dr. Rotheram-Borus says. "Risk behaviors went down, healthy behaviors went up, and the effect seems to be persistent; the gains from the interventions were maintained at least through 6 months after the sessions ended."

The youths enjoyed the small-group format, but scheduling problems and fear of stigmatization reduced attendance, Dr. Rotheram-Borus says. Only about half (51 percent) of the participants attended 6 or more of the 12 Stay Healthy sessions, and 53 percent attended 5 or more of the 11 Act Safe sessions.

"These interventions work. The next step is to develop alternative ways to deliver the same product that better accommodate the youth we are trying to reach," Dr. Rotheram-Borus says. "We are now developing group sessions that can be conducted by telephone and evaluating efficient ways to provide individual sessions."

Source

• Rotheram-Borus, M.J., et al. Efficacy of a preventive intervention for youths living with HIV. American Journal of Public Health 91(3):400-405, 2001. [Abstract]

Volume 17, Number 1 (April 2002)