Of new HIV infections in the United States, 25% occur among persons under 22 years of age and 50% among those under 25 years of age. Pregnant/parenting teens are at high risk for acquiring HIV through heterosexual transmission due to early onset of sexual activity, multiple sexual partners, and absent or inconsistent condom use. Many adolescent mothers also belong to ethnic groups disproportionately affected by the virus. Objective: The main objective of this study was to evaluate the effects of a modified form of the HIV Prevention Program "Be Proud! Be Responsible" on adolescent mothers. The original curriculum, previously shown to have favorable outcomes with general populations of inner-city minority youth, was adapted to build upon young mothers' concern for the well-being of their children as a motivator for reducing sexual risk-taking. Design: A quasi-experimental research design was employed in this longitudinal study. Population, Sample, Setting, Time: Participants were recruited from four school districts in Los Angeles County offering pregnant/parenting minor programs between 1997 and 1999. In order to be eligible, young women had to be 14-20 years of age, either pregnant or new mothers, and English- or Spanish-speaking. Intervention and Outcome Variables: Developed within a framework based on Social Cognitive Theory and the Theory of Reasoned Action, the HIV Prevention Program (HIVPP) included an 8-hour nurse-facilitated curriculum with small group instruction, interactive activities, a presentation by an HIV-positive mother, condom-use skill building, and role play. The influence of culture and social norms on sexual behavior was addressed. Program outcomes were measured post-intervention and at 3-, 6- and 12-month follow-up, using an instrument packet that contained items evaluating background characteristics, sexual behaviors, drug/alcohol use, AIDS knowledge, attitudes towards condoms, and intentions to use condoms. Methods: Following securing of written informed consent, eligible young women were assigned by school site to either the HIV Prevention Program (HIVPP) or a comparison group that received a Health Promotion Program (HPP). Both interventions were equal in length and facilitated by specially trained nurses. Findings: Findings for this report are based on the 497 participants for whom complete data are available, from an original sample of 572. These young women were predominantly from Latino (n=380, 78%) and African American (n=89, 18%) backgrounds, single, and had a mean age of 16.73 years. At baseline, 328 (66%) were pregnant, and 168 (34%) had already given birth. The participant retention rate was 92%. Results of ANCOVA revealed significant group by time interactions for AIDS knowledge (F[3.4, 1702]=15.89, p=.000), behavioral intentions to use condoms (F[3.6, 1791]=2.91, p=.024), and number of sex partners (F[3.12, 920]=3.18, p=.042). The HIV intervention positively influenced these outcome variables as compared to the other group. A significant increase in intentions to use condoms and AIDS knowledge was observed after the intervention and sustained over time. Young women in the HIVPP had significantly fewer sex partners than those in the HPP at the 6-month follow-up, and the pattern of increase in number of sex partners was delayed for this group. The number of unprotected vaginal sex episodes did not differ significantly between groups; participants in both groups showed a decrease in the number of unprotected sex episodes over time from baseline to the 12-month follow-up. Conclusions: Pregnant and parenting adolescents attending an HIVPP demonstrated an increase in their knowledge about AIDS and an improvement in behavioral intentions to use condoms. In comparison to those receiving the HPP, they also demonstrated safer sex practices; i.e., fewer sex partners over a 3-month period. Condom use was significantly improved for adolescents in both groups. Implications: There are unique challenges involved in promoting safer sex practices to prevent HIV in vulnerable populations of young mothers from ethnic minority backgrounds. These young women often face difficult issues affecting sexual risk-taking behaviors that may be related to their being in a "couple" relationship and their desire to maintain a trusting and peaceful relationship with their baby's father. Involvement of young fathers in HIV prevention programs with their partners is one strategy that may help to improve program outcomes.
* Study supported by grants from the National Institute of Nursing Research (RO1 NR04375 and NR04375-S1).
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