Introduction to the Special Section on Families, Youth, and HIV: Family-Based Intervention Studies

Abstract

Every year, a new generation at-risk for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) emerges, posing unique challenges for prevention and intervention. Young people are now at the center of the acquired immunodeficiency syndrome (AIDS) epidemic; 25% of STIs reported annually occur among youth, and around half of the people who acquire HIV become infected before they turn 25. AIDS is currently the leading cause of death in 15- to 24-year olds (National Center for Health Statistics, 2005). Most young people acquire HIV through unprotected sexual activity, and, thus, reducing adolescent sexual risk taking has become a national and international public health priority. Substance use also confers increased risk of exposure to HIV by impairing sexual decision-making and leading to inaccurate condom use. Unfortunately, rates of adolescent sexual behavior and substance use remain high. National surveys indicate that 60.7% of males and 62.3% of females report having had sexual intercourse by 12th grade, whereas only 67% of males and 48.5% of females report using a condom during their last sexual encounter (Grunbaum et al., 2004). Similarly, by 12th grade, males and females report high rates of alcohol (82.6 and 83.3%, respectively) and marijuana (51.7 and 44.9%, respectively) use, and notably 17.6% of females and 33.5% of males report using alcohol or drugs before last sexual intercourse (CDC, 2004). Reducing adolescent risky sexual and drug use behavior requires innovative solutions that are tailored to youths’ unique risk mechanisms. This special section describes four cutting edge prevention programs designed to reduce exposure to HIV/STIs among youth. HIV and STI prevention programs for young people have changed over the course of the epidemic. At the beginning of the 1980s, the first generation of AIDS prevention programs designed for youth focused on increasing knowledge about HIV transmission and prevention. These efforts assumed that knowledge alone would produce necessary behavioral changes. Unfortunately, although these programs successfully increased accurate knowledge about the modes of transmission and strategies for prevention, they did not lead directly to behavior change (Coyle, Boruch, & Turner, 1991). The second generation of HIV prevention programs sought to address these limitations by going beyond increasing knowledge. In the 1990s, HIV prevention interventions for youth drew on social cognitive theories to address perceptions of risk, safer-sex intentions, assertive communication, and condom use skills, in addition to HIV/STI knowledge. These programs yielded promising results, showing targeted reductions in sexual risk taking and other proximal factors, such as exposure to risk situations. Like HIV knowledge-based interventions, however, these programs focused on individual behavior, and few have produced long-term behavioral changes.