The effect of HIV/AIDS prevention intervention for Israeli adolescents in residential centers: Results at 12-month follow-up

Abstract

The research reported in this article assessed the effect of a cognitive--behavioral program to prevent HIV/ AIDS among 139 adolescents in residential centers in Israel. Sixty-one adolescents underwent an intensive HIV/AIDS-prevention intervention program (treatment group), and 78 adolescents did not receive this treatment (control group). Self-report instruments were used to assess the participants' knowledge, attitude, coping skills, and behavior about HIV/AIDS before the intervention, immediately after the intervention, and 12 months later. The intervention had a significant effect on the treatment group's knowledge about HIV/AIDS, attitudes towards prevention, and coping with HIV/AIDS-related high-risk situations. The changes were still evident at the 12-month follow-up. In addition, at follow-up participants in the treatment group were 2.5 times more likely to have vaginal sex with a condom than the control group participants. Key words: adolescents; cognitive--behavioral model; HIV/AIDS; juvenile delinquents; prevention; residential centers Many studies have shown that adolescents who are experiencing social difficulties, including juvenile delinquents, abused and neglected children, and runaway and homeless adolescents, are at high risk of HIV/AIDS infection. For example, Nader, Wexler, Patterson, McKusick, and Coates (1989) reported that adolescents in a detention facility perceived a less-personal threat of HIV/AIDS, felt less confident about preventing HIV/AIDS, and were more prone to engage in high-risk sexual activities than unincarcerated high school students. DiClemente (1991) also reported a high prevalence of unsafe sexual behavior among incarcerated adolescents. Slonim-Nevo, Ozawa, and Auslander (1991) found that delinquent and abused adolescents in residential centers in the United States were highly knowledgeable about HIV/AIDS, but had low positive attitudes toward prevention and reported engagement in unsafe HIV/AIDS-related behaviors. Similar findings were found among juvenile delinquents in Israel (Slonim-Nevo, 1992/1993) and among adolescents in a juvenile detention home in Seattle, Washington (Morrison, Baker, & Gillmore, 1994). Studies by Rotheram-Borus and Koopman (1991), and Rotheram-Borus et al. (1992), on runaway youths reported the same problem. Other researchers reported involvement in HIV risk behaviors among homeless youths (Athey, 1991; Clatts, Davis, Sotheran, & Attilaso, 1998; Rosenthal, Moore, & Buzwell, 1994). The question we raise is What type of HIV/ AIDS prevention program could be effective for this high-risk population? Unfortunately, only a few controlled studies address this question. It already has been demonstrated that interventions that dispense only information about HIV/AIDS are ineffective in reducing high-risk behavior among delinquent and abused adolescents living in residential centers (Morrison et al., 1994; Slonim-Nevo et al., 1991). Empirical studies have indicated that cognitive--behavioral interventions that focus on attitudinal changes, coping skills, and assertiveness could be effective in changing HIV/AIDS-related high-risk behaviors among adolescents who are experiencing difficulties. The cognitive--behavioral approach assumes that behavior can be changed by acquiring skills that would include planning, problem solving, and assertiveness. Consequently, the acquisition of skills can lead to safer sexual behavior (Bandura, 1977, 1990; Kelly, 1995). Rotheram-Borus, Koopman, and Haignere (1991) found that among runaway adolescents, the use of a condom increased and engagement in high-risk sexual behavior decreased as the number of intervention sessions increased. Yet, Gillmore et al. (1997), who assessed the relative efficacy of group skill training, comic books, and videotapes in reducing engagement in high-risk behavior among adolescents in juvenile detention homes, reported very few differences among these intervention techniques. …