Long-term Effects of a Middle School- and High School-Based HIV Sexual Risk Prevention Intervention
November 15, 2001
Despite many efforts directed at prevention, adolescents continue to represent a significant proportion of Americans who are diagnosed with STDs. Although only a few of those in the United States with AIDS are adolescents, given the long incubation period for HIV, it is estimated that one fifth of those with AIDS were infected as teenagers. Since neither a cure nor an effective vaccine has yet been developed, primary prevention remains the most powerful strategy for curbing this epidemic. Since behaviors determine the likelihood of HIV infection, prevention programs must focus on maintaining safer behaviors, and interventions need to include many participants to effectively reduce HIV risk in an adolescent population.Adapted from:
The subjects (N=4,001) were drawn from 10 urban schools in a medium-sized northeastern city with a population of approximately 250,000. The criteria for study inclusion were that students were (1) enrolled in required health education classes and (2) fluent in either English or Spanish. Students were recruited within their regular school health education classes to participate in the Rochester AIDS Prevention Project for Youth (RAPP). RAPP is a quasi-experimental classroom-based intervention designed to increase knowledge and skills aimed at safe behavior regarding sexuality and HIV/AIDS. Passive parental consent for student participation was obtained.
Classes were assigned within semesters to one of three conditions: (1) control, the usual health education curriculum taught by the regular health teachers (RHT); (2) RAPP adult health education, the RAPP intervention implemented by a male-female ethnically diverse pair of highly trained adult educators; or (3) RAPP peer educators, volunteer HS students who completed approximately 50 hours of preparation by RAPP staff and taught the RAPP curriculum as pairs of educators. Health education in middle school (MS) was taught in seventh grade only, while in high school (HS), students had the option to take health in 10th, 11th, or 12th grade; most students chose 10th or 11th grade.
The RAPP intervention consisted of 10 HS and 12 MS consecutive health class sessions delivered for two to seven weeks. Students completed a confidential survey at baseline, immediately after the intervention, and at long-term follow-up. The survey instrument, available in English and Spanish, was read to students during a 40-minute health class by the project health educators. More than 90 percent of the students completed the survey pre-intervention. The survey questionnaire, pilot tested on 450 students preceding the main study, measured constructs determined to be important in assessing the impact of the RAPP curriculum and has been described in detail elsewhere. Those variables reported herein include demographics, knowledge, self-efficacy regarding sexual matters, behavior intention within the next year, history of risk behaviors, history of sexual experiences, and self-reports of behavior.
Among 12th graders, 73 percent did not complete long-term follow-up because of graduation or drop out, while the attrition for 10th and 11th grade was 55 percent and 43 percent, respectively. The four intervention groups among the MSs and the three groups among the HSs were compared to determine whether there were significant differences in demographic variables and for the study variables of interest. Overall, in MS, about 30 percent of females and 63 percent of males reported sexual experience at baseline. Among the HS students, the range of sexual experience among females was from 60.6 percent of peer educator-taught students to 73.2 percent of the controls, while the range among males was from 69.3 percent of peer educator-taught students to 82.3 percent of controls.
There was a positive, sustained, long-term effect of the RAPP intervention when compared with the control intervention in the areas of knowledge, self-efficacy regarding sexual matters, behavior intention, and self-reported behaviors. While statistical significance was not universally reached, when compared with control across intervention groups, mean scores were consistently in the desired safer direction.
"It is clear that the goal for school-based interventions of this type should be the primary prevention of risky sexual behavior. Since this can only occur in younger, precoital populations, we propose that late elementary school students, before the transition to sexual activity, should be the target group for the next phase of the study," the authors concluded.
Archives of Pediatrics & Adolescent Medicine
10.01; David M. Siegel, M.D., M.P.H.; Marilyn J. Aten, Ph.D., R.N.; Maisha Enaharo, M.P.H.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.