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Published online November 9, 2009
PEDIATRICS Vol. 124 No. 6 December 2009, pp. e1180-e1188 (doi:10.1542/peds.2009-0679)
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ARTICLE

HIV Risk Reduction Among Detained Adolescents: A Randomized, Controlled Trial

Angela D. Bryan, PhDa, Sarah J. Schmiege, PhDb, Michelle R. Broaddus, PhDc

a Department of Psychology, University of New Mexico, Albuquerque, New Mexico
b Department of Psychology, University of Colorado, Boulder, Colorado
c Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin

OBJECTIVES: Criminally involved adolescents engage in high levels of alcohol-related risky sex. A theory-based sexual and alcohol risk-reduction intervention was designed, implemented, and evaluated in juvenile detention facilities.

Participants and Methods. In a randomized, controlled trial, 484 detained adolescents received 1 of 3 group-based interventions: combined sexual and alcohol risk reduction (group psychosocial intervention [GPI] + group motivational enhancement therapy [GMET]); sexual risk reduction only (GPI); or HIV/sexually transmitted disease prevention information only (group information-only intervention [GINFO]). Follow-up data were obtained 3, 6, 9, and 12 months after the intervention. Behavioral outcomes were condom-use behavior, frequency of intercourse while drinking, and alcohol-related problems.

RESULTS: Condom-use behavior measured as frequency of condom use during sex (ranging from never to always) decreased over time, although the GPI and GPI + GMET interventions mitigated this tendency at the 3-, 6-, and 9-month follow-up assessments. Although both active interventions were significantly more successful than the GINFO condition and the pattern of effects favored the GPI + GMET, there were no statistically significant differences between the GPI and GPI + GMET interventions.

CONCLUSIONS: Findings support the feasibility of integrating alcohol-specific sexual risk content into a theory-based sexual risk-reduction intervention and provide additional evidence that theory-based interventions are effective at reducing risky sex in this population. There was limited evidence of intervention effects on alcohol-use outcomes. Future research should focus on strengthening the GPI + GMET to most effectively target risky sexual behavior among at-risk adolescents.

Key Words: HIV/AIDS • sexually transmitted disease • adolescent • condom use • alcohol • motivational enhancement therapy

Abbreviations: STD—sexually transmitted disease • GINFO—group information-only intervention • GPI—group psychosocial intervention • MET—motivational enhancement therapy • GMET—group motivational enhancement therapy • RAPI—Rutgers Alcohol Problem Index • NS—not significant • RMSEA—root-mean-square error of approximation • CI—confidence interval • CFI—comparative fit index

Accepted Jun 10, 2009.


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