HIV RISK REDUCTION FOR SUBSTANCE-DEPENDENT ADOLESCENTS

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This application requests funding to evaluate two behavioral HIV risk reduction intervention models with substance dependent adolescents and to compare their outcome against a comprehensive health education control condition. 150 substance dependent adolescents entering a residential treatment program will be recruited for participation. 50 participants (10 in each of 5 cohort waves) will be randomly assigned to a 12 session small group intervention based on behavior skills training (BST); 50 (10/group, 5 groups) will be randomly assigned into a 12 session program based on the same behavior skills training model plus an HIV risk sensitization component (BST+RS); and 50 participants (10/group, 5 groups) will be randomly assigned to a comprehensive health education control condition of the same duration. Before and after the intervention and at 6- and 12-month follow up assessments, all subjects will complete measures of AIDS risk knowledge, health locus of control, attitudes toward HIV prevention, attitudes toward condoms, social support, self-reported frequencies of sexual behavior and substance use, self- and response- efficacy, personalization of AIDS risk, impulsivity, and sensation seeking, as well as audiotaped assessments of problem solving competency and behavioral skill in role play simulations of high risk situations. As corroborative measures, STD and pregnancy information will be collected from the treatment program. All youths will be recruited upon entry into drug treatment and will participate in one of the interventions concurrent with treatment for their substance dependency and then be followed for one year post discharge. Multivariate data analyses will compare the two experimental programs against the education control condition to evaluate the interventions' impact in lowering risk behavior. It is hypothesized that all three interventions will increase knowledge about HIV/AIDS, but that only the two intervention incorporating behavior skills training will produce a more internal locus of control, more favorable attitudes toward risk reduction and condom use, greater behavioral skill in role play enactments, increase social support and personal values consistent with precautionary behavior, and lower STD and pregnancy rates following the intervention. Subjects who receive the risk sensitization component (BST+RS) are predicted to demonstrate greater change in personalization of risk, self- and response-efficacy, and sexual behavior than those who received skills training alone (BST). The results will be useful to settings that work with high risk substance dependent adolescents.