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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 c!
ompared 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.
The National Institutes of Health (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. It is the primary federal agency
for conducting and supporting basic, clinical and translational medical
research, and it investigates 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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