Developmental implications of HIV prevention during adolescence: Examination of the long-term impact of HIV prevention interventions delivered in randomized controlled trials in grade six and in grade 10.

Dramatic changes occur in abstract reasoning, physical maturation, familial relationships and risk exposure during adolescence. It is probable that delivery of behavioral interventions addressing decision-making during the pre-adolescent period and later in adolescence would result in different impacts. We evaluated the intervention effects of an HIV prevention program (Bahamian Focus on Older Youth, BFOOY) administered to grade 10 Bahamian youth and parents to target HIV protective and risk behaviors. We also examined the effects of prior exposure to a similar intervention (Focus on Youth in the Caribbean, FOYC) four years earlier. At six months post-intervention, receipt of BFOOY by youth unexposed to FOYC increased HIV knowledge and condom-use skills. Differences based on BFOOY exposure were not present among FOYC-exposed youth, whose knowledge and condom-use skills were already higher than those of unexposed youth. Youth receiving both interventions displayed a carryover effect from FOYC, demonstrating the highest scores six months post-intervention.

Adolescent Sexual Health Education: Parents Benefit Too!

The inclusion of parents in adolescent-targeted interventions is intended to benefit the adolescent. Limited research has explored whether parents participating in these programs also benefit directly. We examined the impact of Caribbean Informed Parents and Children Together, the parenting portion of an adolescent-targeted HIV prevention intervention, on parent-reported measures. Bahamian parent-youth dyads (N = 1,833) participating in the randomized control trial were assigned to receive one of four conditions. Parents were assessed longitudinally at baseline and 6 and 12 months later. Through 12 months follow-up, parents exposed to Caribbean Informed Parents and Children Together showed higher knowledge of condom use skills, perceptions of improved condom use competence on the part of their youth, and perceived improved parent-child communication about sex-related information. Although youth were the targeted beneficiary, parents also benefited directly from the sexual risk reduction parenting program. Parents demonstrated improved perceptions and knowledge that would enable them to more effectively guide their child and also protect themselves from sexual risk.

When things are not as they appear: assessing the adequacy of cluster randomization when outcome events are rare at baseline.

The present study randomly assigned 15 Bahamian elementary schools to one of three intervention conditions. To assess the adequacy of cluster randomization, we examined two concerns identified by the local research team: inequality of gender distribution and environmental risk among groups. Baseline significant differences in risk and protective behaviors were minimal. There were significantly more males in the intervention group. Males had higher rates of risk behavior at all assessments. Poor school performance was also higher among the intervention condition and was significantly associated with increased rates of many but not all risk behaviors. Prior to adjusting for gender and school performance, several risk behaviors appeared to be higher after intervention among intervention youth. Adjusting for gender and school performance eradicated the group differences in risk behavior rates. Results demonstrate the importance of adequate randomization where outcomes of interest are rare events at baseline or differ by gender and there is an unequal gender distribution and the importance of the local research team's knowledge of potential inequalities in environmental risk (i.e., school performance). Not considering such individual differences could impact the integrity of trial outcomes.

Reduction in human immunodeficiency virus risk among youth in developing countries.

OBJECTIVE: To address the 6-month efficacy of a human immunodeficiency virus (HIV) prevention intervention targeted to youth and delivered with and without a parental monitoring intervention in a developing country (the Bahamas). DESIGN: Randomized, controlled, 3-cell intervention trial with a 6-month postintervention follow-up. SETTING: Elementary schools in the Bahamas. PARTICIPANTS: A total of 1282 Bahamian sixth-grade students (and 1175 parents) in 15 schools. INTERVENTIONS: Youth and parents were randomized at the level of the school to receive the following interventions: (1) Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT), (2) FOYC plus an attention control for parents (Goal for It [GFI]), or (3) an attention control for the youth (Wonderous Wetlands [WW]) plus the GFI. The 10-session FOYC or WW curriculum was delivered as part of the elementary school curriculum. The GFI or CImPACT was delivered to parents in the evenings or on weekends. MAIN OUTCOME MEASURES: Risk and protective knowledge, condom use skills, perceptions, interventions, and self-reported behaviors. RESULTS: Compared with the WW, the FOYC significantly increased knowledge, condom use skills, protective perceptions, and intentions to engage in safer behaviors. Among youth, no differences were found in knowledge or condom use skills based on parent intervention; among parents, those receiving the CImPACT demonstrated superior condom use skills after the intervention. CONCLUSIONS: Protective knowledge, skills, perceptions, and intentions of youth from 1 developing country can be significantly improved by youth intervention delivered through the schools. Longer follow-up is needed to determine if risk behaviors will be reduced and how long protective results will be sustained.