Original article
A Human Immunodeficiency Virus Risk Reduction Intervention for Incarcerated Youth: A Randomized Controlled Trial

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Abstract

Purpose

To evaluate, by gender, the impact of a structured, comprehensive risk reduction intervention with and without boosters on human immunodeficiency virus (HIV) knowledge, attitudes and behaviors in incarcerated youth; and to determine predictors of increasing HIV knowledge and reducing high-risk attitudes and behaviors.

Methods

This randomized controlled trial involved participants completing structured interviews at 1, 3, and 6 months. Repeated measures analysis of variance was used to analyze changes over time. The study was conducted in secure custody facilities and in the community. The study sample comprising 391 incarcerated youth, 102 female and 289 male aged 12–18, formed the voluntary sample. Participants were randomly assigned to one of three conditions: education intervention; education intervention with booster; or no systematic intervention. The outcome and predictor measures included the Rosenberg Self-Esteem Scale, Youth Self Report, Drug Use Inventory, and HIV Knowledge, Attitudes and Behavior Scale.

Results

The 6-month retention rate was 59.6%. At 6 months, males in the education and booster groups sustained increases in knowledge scores (p < 0.001). Females in these groups sustained increased condom attitude scores (p = 0.004). Males in the booster group sustained increased prevention attitude scores (p = 0.017). Females in the booster group reported more consistent condom use (odds ratio [OR] = 4.20; 95% confidence interval [CI] = 1.81, 9.77). Age, gender, drug use, and psychological profiles were predictive of outcome.

Conclusions

The intervention and boosters led to gender-specific improvements in knowledge, attitudes, and condom use. Result variations by gender underline the importance of gender issues in prevention interventions. Predictors of success were identified to inform future HIV education interventions.

Section snippets

Methods

In this randomized controlled trial, secure custody facilities were selected to reflect two incarceration systems for young offenders in Ontario, separating youth by age: 12–15 years and 16–18 years. Inclusion criteria were as follows: residence in a young offender secure custody facility during the time of the education program; age 12–18 upon recruitment; no current enrollment in other in-depth HIV education program(s) apart from previously established school health curricula; and ability to

Characteristics of the sample

Study recruitment took place between January 2000 and December 2003. Of the 260 participants eligible for the education program, 85% received that intervention. The retention rate postintervention was 71.6% at 3 months and 59.6% at 6 months. Of the 391 participants, 289 were male and 102 were female, reflecting the proportion of male and female youth in custody in Ontario. Demographics are presented in Table 1.

Baseline demographics, behavioral characteristics, and outcome measures for

Discussion

Baseline data confirm that risk behaviors in the study sample are dramatically different from community norms. Research [39] indicates that among Canadian Grade 11 students (average age 16), 40% of males and 46% of females had engaged in sexual intercourse, compared to more than 90% in our study sample. Similarly, the incarcerated youth in this study reported a younger age at first intercourse, 13.0 years for males and 13.7 years for females, as compared to a mean of 14.1 years for males and

Conclusions and Future Directions

This challenging group of adolescents is clearly at elevated risk for HIV infection and in urgent need of effective prevention programs. Our intervention was effective in improving several areas of HIV knowledge, prevention attitudes, and condom use attitudes, and supports the utility of intensive education interventions incorporating a strong attitudinal and skills-building component. Booster sessions were also shown to sustain effects in certain of the areas of HIV knowledge and prevention

Acknowledgments

The authors thank Catherine Moravac for her important contributions to this study, as well as all the interviewers, other staff, institutions and youth who participated in the study. Funding was provided by the Ontario HIV Treatment Network (OHTN). This study was conducted under the auspices of the Divisions of Adolescent Medicine and Infectious Diseases in the Department of Pediatrics at The Hospital for Sick Children and University of Toronto, and the Department of Public Health Sciences,

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