Learning Objective 1: 1. Briefly describe the components of a culturally-sensitive, couple-focused HIV prevention program designed for young parents.
Learning Objective 2: 2. Discuss the effects of the intervention on behavioral intentions to use condoms, AIDS knowledge and sexual risk-taking of young parents and how parental protectiveness moderated program effects.
BACKGROUND: Current statistics on HIV/AIDS indicate that one-half of all new HIV infections worldwide occur among young people ages 15 to 24. Adolescent mothers, especially those of ethnic minority backgrounds, represent a subset of youth in the United States who are at increased risk of HIV infection due to early sexual initiation and unprotected sex with high-risk and/or multiple partners. Their male partners report similar histories of high-risk sexual behaviors and also frequently engage in illicit drug use, needle sharing for body-piercing and tattoos, and gang activities. Involvement of adolescent mothers and their male partners in HIV prevention programs offers a promising approach to combating the epidemic. However, male partners have traditionally been excluded from scientifically evaluated HIV prevention programs for young mothers.
METHODS: Participants were randomly assigned to the experimental (n=164) or control group (n=172). The 12-hour HIV prevention program (experimental condition) was based on social cognitive theory, the theory of reasoned action, gender and power, and “Healing the Wounded Spirit” (Tello, 1998). The intervention program was designed and pilot tested using community-based participatory research methods. The curriculum, Respeto/Proteger: Respecting and Protecting Our Relationships, built upon indigenous, culturally-rooted concepts and assets of young parents, including their concern about the well-being of their child and family (feelings of parental protectiveness) as a motivator for positive behavior change. A variety of interactive and skill-building activities were included such as identification and delineation of goals and dreams, life-planning exercises, and letter-writing to children. At times the young mothers and the young fathers met in separate groups to explore issues such as sexuality, gender roles, and relationship violence and then came together for a full-group discussion. To promote safer sex behaviors, the program included the positive aspects of sexual norms and values, such as protecting family. The sessions (n=6) were led by specially-trained pairs of male and female facilitators who were health professionals (e.g., nurses, health educators, social workers, psychologists).
The 1 ˝ hour control condition presented standard information on HIV/AIDS through a lecture-type presentation and a videotape. Young mothers and their male partners attended together.
Participants completed questionnaires in pre- and post-intervention and at 3-, 6-, and 12-month follow-ups in either English or Spanish. Main outcomes were evaluated based upon a series of partner-referent items about sexual behaviors, an AIDS knowledge questionnaire and a measure of intentions to use condoms. An 8-item, Likert-type questionnaire measured parental protectiveness.
RESULTS: A total of 168 couples (336 females and males) were enrolled in the study. Participants were predominantly Latino (86% females, 78% males) and ranged in age from 14 to 25 years (female mean=18.54, SD=1.67; male mean=20.35, SD=2.19). High lifetime rates of childhood physical and/or sexual abuse were reported. A history of sexual abuse was more commonly reported among females (34.5%) than males (12.5%).
Findings revealed a significant decrease in the probability of unprotected sex from baseline to the 6-month follow-up for mothers and fathers in the experimental group compared to those the control group. Significant group differences in unprotected sex were maintained from baseline to the 12-month follow-up for mothers only. For males in the experimental group, intentions to use condoms increased over time and parental protectiveness was a strong moderator for treatment effect for themselves and their female partners. AIDS knowledge in both groups significantly improved from baseline to 6 months, but was maintained at 12 months by the experimental group participants only.
CONCLUSIONS: Findings support the efficacy of the couple-focused HIV intervention for decreasing sexual risk-taking and suggest that when working with young parents in health promotion programs, a strengths-based perspective should be used along with a focus on individual behavior change. The intervention was favorably received and provides a promising strategy for combating the HIV/AIDS epidemic among childbearing youth in community settings.
SOURCE OF SUPPORT: National Institute for Nursing Research (R01 NRO4957)
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