Gender-Specific HIV Prevention Intervention for Adolescent Girls: Unanticipated Evidence for Broad Sexual Risk Reduction

Purpose: Worldwide, more than 50% of individuals infected with HIV are women and girls (UNAIDS, 2014). Other sexual morbidities, such as STIs and unplanned pregnancy, negatively impact girls in many ways including delayed or incomplete education, limited workforce options and repeated behavioral patterns across the individual and her children (Chandra-Mouli, McCarraher, & Phillips, et al., 2014; Fallon, 2014). Despite the damage that sexual risk behaviors pose to teen girls, there are still few gender specific evidence-based interventions with documented long-term behavioral outcomes.

Methods: The Health Improvement Project for Teens (HIPTeens) was developed specifically to address HIV risk in sexually-active girls ages 15-19 as this age group bears the burden of STIs, HIV and unplanned pregnancies (Morrison-Beedy, Carey, & Kowalski, et al., 2005). This developmentally-tailored, culturally relevant intervention was developed through extensive formative and community-based participatory research endeavors which resulted in a manualized intervention with content and process fidelity measures. The intervention was guided by the Information-Motivation-Behavioral Skills Model (IMB) (Fisher, Williams, & Fisher, et al., 1999) and delivered by 2 trained female facilitators using motivational interviewing approaches to small groups of girls in community-based settings (Merves, Rodgers, & Silver, et al., 2015). In a two-group randomized controlled trial design, 738 urban, economically-disenfranchised diverse girls, over 60% African American, were randomized to the HIPTeens or the structurally-equivalent control group focused on health promotion behaviors. Intervention dosing included 4 two-hour sessions with briefer boosters at 3 and 6 months post intervention. A focus on intervention strategies that addressed communication and negotiation skills, triggers to risk behaviors, developing a menu of behavioral options and significant role playing among peers to build resilience strategies took place across all sessions. 

Using audio computer assisted self-interviews (ACASI), data were collected at pre-intervention, and 3, 6 and 12 months post intervention on psychological and social determinants of health and behavioral outcome data. We also conducted analysis on health chart data including pregnancy tests. Behavioral data were collected using an intent-to-treat conservative Poisson regression approach for count data.

Results: Those in the intervention demonstrated long term significant behavioral risk reduction in unprotected sex, total number of sexual episodes and number of partners Morrison-Beedy, Jones, & Yinglin, et al., 2012). Although these girls were sexually active at the time of study enrollment, an unanticipated result was a significant increase in sexual abstinence across the one year time frame was documented as compared to those in the structurally-equivalent health promotion control group. Another unanticipated finding, given that the intervention did not focus on contraceptive options or pregnancy prevention, a documented 50% reduction in positive pregnancy tests in girls enrolled in the intervention versus those in the control condition was particularly noteworthy.

Conclusion: Given the limited available evidence-based interventions specific to sexual risk reduction in adolescent girls that have demonstrated multiple behavioral long-term outcomes, HIPTeens contributes to this gap in tailored, translational programs for use in diverse communities and settings. With a focus on increasing motivation to reduce risk and skill building in broad areas of risk identification, communication, negotiation, and expanding a girl’s repertoire of behavior options, this intervention ultimately resulted in a broad reach across multiple morbidities. Recognized by the CDC and U.S. Health and Human Services as an evidence-based intervention across multiple prevention platforms – HIV, STI and pregnancy - HIPTeens is a manualized program tested through multiple scientifically-rigorous studies and available for wide dissemination across the globe.