Results of this randomized controlled trial provide evidence of the efficacy of a culture- and theory-based intervention on HIV sexual risk behavior. Specifically, participation in the HIV risk-reduction intervention resulted in fewer reports of sexual intercourse and number of sexual partners compared with participation in the health-promotion control intervention. In addition, the HIV risk-reduction intervention caused an increase in consistent condom use and frequency of condom use compared with the control intervention.
Results of this study are important for several reasons. First, to our knowledge, this study is the first randomized controlled trial of an HIV risk-reduction curriculum developed specifically for Latino adolescents to demonstrate long-term (12-month) effects on frequency of sexual intercourse and condom use. Other intervention studies that have included Latino adolescents either have been ineffective or have examined only short-term effects.7-9,11
Second, to our knowledge, this study is the first randomized controlled trial to demonstrate efficacy with Spanish-speaking Latino adolescents. The intervention used in this study was tailored to Latino culture, and we found that it had greater effects among Spanish-speaking adolescents on several outcomes. Specifically, Spanish speakers who participated in the HIV risk-reduction intervention had a higher proportion of days of protected sex and more frequent condom use at last sexual intercourse. To our knowledge, this is the first randomized controlled trial to demonstrate greater efficacy of a culturally tailored HIV risk-reduction intervention among people who speak the language of the culture for which it was tailored.
Third, results of this study demonstrate the efficacy of a safer sex intervention in decreasing sexual intercourse and increasing condom use. In addition, Latino adolescents who were sexually inexperienced before the intervention and who were assigned to the HIV risk-reduction intervention reported fewer days of unprotected sex in the past 3 months than did adolescents in the control group. Results of this study demonstrate that addressing abstinence and condom use within a curriculum can affect both behaviors. In addition, the increased efficacy of the intervention on some outcomes for Latino adolescents who were Spanish-language dominant and sexually inexperienced provides support for tailoring intervention approaches. Furthermore, additional strategies may be needed for English-dominant Latino adolescents, as well as those who are sexually experienced, to enhance the efficacy of the intervention with these groups.
Finally, results of this study support the growing body of research that indicates that interventions based on behavioral theories and tailored to the culture of adolescents are effective.24-26
The HIV risk-reduction curriculum used in this study was based on an existing curriculum15
and integrated culturally relevant concepts and approaches.19
Results of this study should be considered in light of several limitations. First, most participants were of Puerto Rican descent, attending school, and living in northeast Philadelphia, and they were self-selected. Further research is needed to determine the extent to which findings are generalizable to other Latino adolescents. Second, the outcome measures used in this study were based on self-report. We did, however, include several procedures to increase the validity of self-reports. Furthermore, our measure of social desirability21
did not interact with intervention results to affect self-reported outcomes, suggesting that adolescents’ responses were not motivated by the desire to please others.
Despite these limitations, this study is an important contribution in assisting Latino adolescents to decrease HIV sexual risk behavior. It is an important effort in providing practitioners an evidence base from which to guide and support adolescents in sexual decision making. Much more research is needed with Latino adolescents to address the health disparity in HIV and AIDS.
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