Family-Based HIV Preventive Intervention

Summary

Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth's exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth's best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Effects of a peer-led AIDS intervention with university students

Acquired immune deficiency syndrome (AIDS) has become a major health threat to university students. This study evaluated a peer-led AIDS intervention program with university students (1) increase knowledge of human immunodeficiency virus (HIV) transmission and infection; (2) change attitudes to reflect scientific information on AIDS-related facts; and (3) change behavioral intentions to correspond with safer sexual practices. Subjects were students (N = 142) from four undergraduate classes and were predominantly female (65%), white (82%), and sexually active (86%). A non-equivalent control group design was used, with two classes receiving the intervention and two classes receiving no information. For the intervention, peer educators presented AIDS-related information, modeled ways to use condoms safely and ways to discuss condom use with sexual partners, and led discussions on HIV infection and use with sexual partners, and led discussions on HIV infection and AIDS, relationships, sexuality, and condom use. A questionnaire was administered to assess differential changes in AIDS-related knowledge, attitudes, and behavioral intentions between the intervention and control groups. The results showed significant improvements among intervention subjects on the knowledge, attitudes, and behavioral intentions scales compared with the control group.     

HIV/AIDS Prevention in the African American Community:

The high rate of AIDS cases among African Americans, especially women, suggests that HIV risk reduction behavior change programs and messages have not been highly successful in preventing HIV transmission among this population. This paper recommends that the situational and environmental context of African Americans' lives, and their responses to HIV/AIDS be addressed and incorporated into HIV prevention programs in an effort to make these programs more relevant to high risk African Americans. A multilevel system intervention approach grounded in an ecosystem perspective which focuses on the community as the primary target level of intervention is proposed to increase the effectiveness of HIV prevention efforts among African Americans.     

The Guardian Professions Program: Developing an advanced degree mentoring program for California's foster care alumni

Higher education continues to be an elusive social space for too many children and youth in the United States foster care system. Yet a four-year pilot project in California has demonstrated that former foster youth can surmount the detrimental effects of childhood adversity to complete their undergraduate degrees and, with additional preparation, advance to graduate degree programs. Building on the success of campus support programs throughout the state, the Guardian Professions Program (GPP) at the University of California Davis employed a research and implementation framework based on Participatory Action Research (PAR) and made use of surveys, qualitative interviews and ethnographic data to develop the model. In this article the authors describe and analyze the GPP, an initiative that pioneered the use of online technology to assist seventy-four former foster youth successfully gain a level of educational success that is not often associated with this demographic. Not all children and youth who are involved in the child welfare system will have the interest or determination to pursue a university education and undertake an advanced degree. However, services and academic assistance for those students who have the aptitude can promote higher education as a path to achievement and self-sufficiency.     

Camp experiences in the lives of adolescents with serious illnesses

This study explored the experiences of a summer camp for adolescents with serious illnesses and included interview responses from campers with different types of serious illnesses. Twenty-four youth aged 14–15 with cancer, sickle cell disease, HIV/AIDS, or metabolic diseases provided videotaped interviews that were analyzed using an interpretative phenomenological approach, and frequencies of responses per theme and diagnosis were computed. Camp experiences varied across diagnostic groups and featured: a sense of belonging, enjoyment, being myself, positive affect, camp programming, adult staff, personal growth, and escape. Some qualitative variations existed between diagnosis groups. Campers with cancer perceived camp as a place for sense of belonging, personal growth, and escape. Campers with HIV/AIDS perceived camp as an opportunity for a sense of belonging, being myself, camp programming, and escape. Campers with sickle cell disease perceived camp as a place for enjoyment, adult staff, being myself, personal growth, and escape. Campers with metabolic diseases perceived camp as a place for personal growth and positive affect. Professionals caring for youth with serious illnesses should consider adding camp to the list of interventions to promote children's well-being. Future research should include more youth and illness types.     

Risk Factors of Gay,Lesbian, and Bisexual Adolescents

Abstract

Many researchers of gay, lesbian, and bisexual adolescents describe them as an “invisible” minority. These youth are also one of the most “at risk” youth populations, as they often experience a range of problems related to society's stigmatization of same-sex orientation. Although sexual orientation is not necessarily related to heightened difficulties, lack of social support, infrequent positive interactions, and chronic stress may lead to increased problem behaviors for these youth. To further understand the risk and protective factors experienced by sexual minority adolescents, this article explores a number of these factors and reviews the current empirical research on specific topics, including: family, peer and school, substance use, suicide, and HIV/AIDS issues. Finally, practice implications are discussed to guide clinicians in working more effectively with this youth population.     

Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.     

Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

Investigating the Timing of First Sexual Intercourse Among Youth in EDO State,Nigeria in the Context of the Aids Epidemic

ABSTRACT

Objectives: This study examined the timing of sexual debut among youth in Edo state, Nigeria given the role that sexual abstinence plays in HIV prevention in sub-Saharan Africa. Methods: Survey data were collected from rural youth aged 11 to 17 years old enrolled in Junior Secondary Schools in Edo State, Nigeria. Discrete-time hazard techniques were used to examine the effects of theoretically relevant covariates on the timing of sexual debut among youth in Edo State. Results: Results indicate strong, significant relationships between psychosocial predictors and age at first sex for boys and girls. Youth with higher levels of knowledge about HIV as well as those who rejected common myths about HIV transmission delayed first sexual intercourse. Early sexual intercourse was strongly associated with experiencing pressure to engage in sex, while delay was associated with greater confidence that one could decline to participate in sex. On the other hand, youth with higher condom use self-efficacy engaged in first sexual intercourse at an earlier age. Conclusions: These results support the relevance of programs such as Nigeria's Family Life and HIV Education to contribute to delaying sexual intercourse focusing precisely on the forms of knowledge, myth rejection, motivation, and behavioral self-efficacy measured here. They provide policymakers with concrete evidence to increase support for such programming as a means to combat the spread of HIV among youth.     

Evaluation of HIV/AIDS prevention through peer education, counselling, health care, training and urban refuges in Ghana

Since 1996, Ireland Aid has supported UNICEF Ghana in the implementation of five activities that promote behaviour change to limit the spread of HIV/AIDS and STIs. The interventions are run by different local organisations, and have provided over 75,000 in and out-of-school youth and commercial sex workers with preventive education. People retained the information given, are knowledgeable about how HIV is transmitted, and can name key preventive methods. They pass on the information to their friends. Commercial sex workers were empowered to support one another in negotiating for safer sex. The programme was supported by community members, leading to demand for condoms and for education on HIV/AIDS/STIs. One project gave support to pregnant girls, including health care and vocational training. A drawback in the programme has been the occasional delays in the supply of the educational materials to the peer educators.     

Blending Prevention Models: An Effective Substance Use and HIV Prevention Program for Minority Youth

Illicit drug use and rates of HIV infection among youth have increased over the past decade, indicating the need effective substance use and HIV prevention programs. Particularly at risk are minority youth living in poor urban environments. This study examines effectiveness of an innovative prevention program that blends the “All Star” substance abuse prevention model with the “Popular Opinion Leader” model for HIV prevention. In general, the results indicate non-significant increases in drug and sex risk, behavior and significant positive changes and trends in related areas (i.e., changes in perception, self esteem) thought to be related to drug use and risky sexual behavior.Sally Stevens and Velia Leybas-Amedia are affiliated with the Southwest Institute for Research on Women, University of Arizona. Beth Bourdeau is affiliated with the Pima Prevention Partnership, Tucson, AZ. Lovelle McMichael and Alan Nyitray are affiliated with the Southern Arizona AIDS Foundation, Tucson, AZ. Financial assistance for this project was provided by the Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Prevention Grant# SP08916. The opinions expressed herein are those of the authors and do not reflect official positions of the government. The Southern Arizona AIDS Foundation and the authors would like to acknowledge the staff at the Tucson Urban League Academy Charter School and Luz Social Services Charter School for their assistance and support of the Check Yourself Youth Team prevention project.     

Investigating the role of individual characteristics,interpersonal sexual communication,media exposure,and gender differences on condom use among chinese college students in hunan

Objectives: The objective of this study was to investigate factors of condom use among a sample of 490 sexually active Chinese college students. Methods: A cross-sectional survey by systematic sampling was conducted on students' interpersonal sexual communication, media exposure, and condom use. Multiple regression was employed for analysis. Results: Self-efficacy, peer and partner sexual communication, parent norms about condom usage, HIV/AIDS information from brochures, and exposure to sexual content in books were associated with variables related to condom use. Conclusions: The current study underscores the importance of self-efficacy and peer and partner sexual communication in HIV preventive intervention programs that promote condom use among young Chinese.     

Understanding African American Youth HIV Knowledge

Summary

This article presents the results of a study examining correlates of urban African American youth HIV knowledge. The influence of family level factors (e.g., family communication, parental AIDS knowledge and myths regarding HIV transmission, along with family composition and family income) are examined. In addition, the current study explores the influence of racial socialization processes, specifically the influence of religious/spiritual coping, extended family caring, cultural pride reinforcement and racial awareness teaching (Stevenson, 1994; 1995; 1997) on youth HIV knowledge. Multivariate analyses revealed a significant association between youth HIV knowledge and being reared in a single parent home. Further, in every model, controlling for all types of racial socialization processes, family communication was significantly associated with youth HIV knowledge. Implications are drawn regarding the development of culturally and contextually specific HIV prevention programming for African American youth and their families.     

Three high school after-school initiatives: lessons learned

Alarmed by the large numbers of high school-age youth who are disengaged at school and leaving high school without a diploma or the important skills for the workplace, policymakers and youth advocates are beginning to see high school after-school as the new frontier in after-school programming. Although older youth represent a sizable percentage of American students, they garner only a small fraction of the federal, state, and local investments for after-school programs. This chapter reviews the insights and lessons learned from three after-school initiatives that have shown success in attracting high school students to their programs and engaging them in meaningful activities to support their success in school and transition to early adulthood: the After School Safety and Education for Teens, After School Matters, and the After-School Corporation. Emerging from these pioneering efforts are some promising practices and program models that can guide the development of future after-school programs, but not without the help of policymakers and funders, both public and private.     

Peer group self-identification in samples of Russian and U.S. adolescents

Most peer group self-identification research has been conducted in the United States. This article examined the generalizability of self-identified group name research among teens in Ufa, a city in the Russian Federation. A cross-sectional, anonymous collection of data on group self-identification, drug use, addiction concern, sensation seeking, and self-rated school performance was collected from 365 10th grade youth in Ufa and 965 10th grade youth in the United States. The results supported the existence of peer group self-identification by youth in both countries and, in general, replicated the findings that youth who self-identify as a High Risk Youth, are relatively likely to use drugs, show greater concern about becoming an addict, report a greater sensation seeking preference, higher levels of depression, and poorer school performance. Implications of these results are discussed.     

A systematic review of education for the prevention of HIV/AIDS among older adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.     

Social security in Africa: a brief review

Africa is the poorest region of the world and has the youngest and least developed social security programs. Most Africans are not covered by social security programs. The high prevalence of HIV/AIDS in some sub-Saharan countries and internal armed conflicts in others have created difficult problems in some countries for social security programs. As a result, some countries do not have functioning social security programs. The social security programs that do exist in Africa are influenced by their colonial heritage, with the programs in English-speaking Africa differing from those in French-speaking Africa. Six different patterns of social security provision can be identified.