The Long-Term Impact of AIDS-Preventive Interventions for Delinquent and Abused Adolescents

Article excerpt

In recent years, the rapid increase in AIDS cases among teens and young adults has been noted. There were 8,441 cases of AIDS among persons 13 to 24 years of age through August 1991, and the number increased to 14,127 by September 1993 (Centers for Disease Control, 1991, 1993). Moreover, reports suggest that this is just the tip of the iceberg; thousands more are likely to be infected with human immunodeficiency virus (HIV) and millions more are at risk (Hein, 1992).

Some characteristics of high-risk adolescents are already known - juvenile delinquents, abused and neglected children, and those who run away are at high risk of being infected with AIDS (DiClemente, 1991; Nader, Wexler, & Patterson, 1989; Rotheram-Borus & Koopman, 1991; Slonim-Nevo, Ozawa, & Auslander, 1991). In particular, Nader et al. (1989) reported that compared with public high school students, youth in a detention facility knew less about AIDS, perceived less personal threat of AIDS, felt less confident about preventing AIDS, and reported engagement in high-risk sexual activities. Their behaviors placed them at greater risk compared with those of high school students or gay adolescents. DiClemente (1991) also reported a high prevalence of unsafe sexual behavior among incarcerated youth. Slonim-Nevo et al. (1991) found that delinquent and abused youth in residential facilities were highly knowledgeable about AIDS, but had little positive attitudes toward prevention, and reported engagement in unsafe AIDS-related behaviors. A study by Rotheram-Borus, Becker, and Kaplan (1991) on runaway youth reported the same problem.

These studies clearly show that AIDS prevention programs are needed to change the beliefs and behaviors of troubled youth. A few researchers have conducted controlled programs and have evaluated their effectiveness. An exploratory study by Slonim-Nevo et al. (1991) with troubled youth indicated that a short-term information-only intervention was ineffective in increasing AIDS-related knowledge and reducing high-risk activities. The authors suggest that in addition to information, youth would need to acquire skills for dealing with high-risk situations and negotiating less risky activities with friends or partners. Several recent efforts have been made to prevent or reduce HIV among adolescents through skills training. Rotheram-Borus et al. (1991), instituted a program with runaway youth and found that as the number of intervention sessions increased, condom use increased and engaging in high-risk patterns of sexual behavior decreased at 3- and 6-month follow-up assessments. Jemmott, Jemmott, and Fong (1992) found that male adolescents who attended an AIDS prevention intervention program reported fewer occasions of coitus, fewer coital partners, greater use of condoms, and a lower incidence of anal intercourse than did their counterparts in the control group at a 3-month follow-up. Finally, Auslander et al. (1992) found that a cognitive/behavioral intervention is effective in changing AIDS-related knowledge, attitudes, and intentions to cope with AIDS-risk situations among delinquent and abused adolescents at the post-test assessments.

These findings suggest that AIDS prevention programs for youth at risk of HIV infection are likely to yield short-term changes in attitudes and behaviors. It is not clear, however, if such changes can be maintained over time. Therefore, it is important to follow troubled youth who received an AIDS prevention intervention over longer periods. This study examined whether cognitive/behavioral interventions that produced immediate changes in AIDS-related knowledge, attitudes and intentions among delinquents and abused adolescents (Auslander et al., 1992), are capable of producing long-term benefits assessed at the 9 to 12-months follow-up. Specifically, it was hypothesized that adolescents who participated in an intensive 9-session AIDS prevention program will (a) know more about AIDS, (b) hold more positive attitudes toward prevention, and (c) report engagement in fewer unsafe activities than would their counterparts in a control group at follow-up. …