Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial
Jemmott, J.B.; Jemmott, L.S.; Fong, G.T.
JAMA 279(19): 1529-1536
1998
ISSN/ISBN: 0098-7484 PMID: 9605896 Document Number: 273824
A total of 659 African American adolescents (mean age 11.8 years; 53% female) from 3 middle schools serving low-income African American communities in Philadelphia, Pennsylvania, USA, recruited for a Saturday programme, were included in the study to determine the effects of abstinence and safer-sex HIV risk-reduction interventions on HIV sexual risk behaviours. Based on cognitive-behavioural theories and elicitation research, interventions involved 8 one-hour modules implemented by adult facilitators or peer cofacilitators. Abstinence intervention stressed delaying sexual intercourse or reducing its frequency; safer-sex intervention stressed condom use; control intervention concerned health issues unrelated to sexual behaviour. 92.6% of the adolescents were still enrolled at 12 months. Abstinence intervention participants were less likely to report having sexual intercourse in the 3 months after intervention than were control group participants (12.5% vs. 21.5%, P=0.02), but not at 6- or 12-month follow-up (17.2% vs. 22.7%, P=0.14; 20.0% vs. 23.1%, P=0.42; respectively). Safer-sex intervention participants reported significantly more consistent condom use than did control group participants at 3 months (odds ratio=3.38; 95% confidence interval, 1.25-9.16) and higher frequency of condom use at all follow-ups. Among adolescents who reported sexual experience at baseline, the safer-sex intervention group reported less sexual intercourse in the previous 3 months at 6- and 12-month follow-up than did control and abstinence intervention (adjusted mean days over prior 3 months, 1.34 vs. 3.77 and 3.03, respectively; P<=0.01 at 12-month follow-up) and less unprotected intercourse at all follow-ups than did control group (adjusted mean days, 0.04 vs. 1.85, respectively, P<0.001, at 12-month follow-up). There were no differences in intervention effects with adult facilitators as compared with peer cofacilitators. It is concluded that both abstinence and safer-sex interventions can reduce HIV sexual risk behaviours, but safer-sex interventions may be especially effective with sexually experienced adolescents and may have longer-lasting effects.