Efficacy of an Abstinence-Only HIV Risk-Reduction Intervention for Young African-American Adolescents

Adolescents risk the negative consequences of early sexual involvement, including not only
HIV, but other sexually transmitted diseases (STDs) and unintended pregnancies. Compared with
older adults, young people, especially African-American young people, are at higher risk of
acquiring an STD. Specifically, people 15 to 24 years of age acquire nearly 50% of all new
STDs in the United States, but this age group represents only 25% of the sexually active
population. Adolescents are especially vulnerable to STD infections because of a lack of
education about proper condom use and consequences of sexual risk behaviors. Previous
research has suggested that behavioral interventions can reduce adolescents' sexual behaviors
tied to risk of acquiring STDs. Nevertheless, there is continuous debate over the
appropriateness and effectiveness of different types of adolescent sexual-risk-reduction
interventions, including abstinence education or comprehensive sexual education. Few studies
have tested the long-term effectiveness of abstinence education, which emphasizes delaying
sexual initiation for sexually inexperienced adolescents. This study will compare the
effectiveness of an abstinence-only HIV/STD risk-reduction intervention with other types of
interventions in reducing sexual risk behavior among young African-American adolescents.

Participation in this study will last 24 months. Participants at participating schools will
be randomly assigned to one of five treatment groups:

- Abstinence-only group participants will attend two sessions consisting of eight 1-hour
modules that are designed to increase knowledge, motivation, and skill for practicing
abstinence. This is not an abstinence-until-marriage intervention; the target behavior
is abstaining from sexual activity until later in life when the adolescent is more
prepared to handle the consequences. The intervention is not designed to affect condom
use.

- Safer-sex-only group participants will attend two sessions consisting of eight 1-hour
modules that are designed to increase knowledge, motivation, and skill for using condoms
during sexual intercourse. The intervention is not designed to influence abstinence.

- Long comprehensive group participants will attend three sessions consisting of twelve
1-hour modules that are designed to increase knowledge, motivation, and skill for
practicing abstinence and for using condoms if participants decide to be sexually
active. The intervention will consist of 4 hours each of the safer-sex-specific content,
the abstinence-specific content, and the general content that is common to both of the
single-component interventions.

- Short comprehensive group participants will attend two sessions consisting of eight
1-hour modules that are designed to increase knowledge, motivation, and skill for
practicing abstinence and for using condoms if participants decide to be sexually
active.

- Health promotion control participants will attend two sessions consisting of eight
1-hour modules that are designed to increase knowledge, motivation, and skill for
avoiding cigarette smoking and for incorporating a healthful diet, aerobic exercise, and
breast and testicular self-examinations. The control intervention will focus on reducing
risk of heart disease, hypertension, diabetes, and certain cancers.

Sessions for all groups will be led by trained adult facilitators and will include group
discussions, videos, games, brainstorming, experiential exercises, and skill-building
activities designed to be educational, interactive, and entertaining. All participants will
complete self-reports concerning sexual behaviors, condom use, and knowledge about STDs at
baseline and Months 3, 6, 12, 18, and 24 of follow-up.

Inclusion Criteria:

- Grade 6 or 7 student at a participating school

- Written parent or guardian consent to participate

- Self-identifies as African American or black

Exclusion Criteria:

- Those not meeting inclusion criteria were excluded.