Respecting the circle of life: one year outcomes from a randomized controlled comparison of an HIV risk reduction intervention for American Indian adolescents

Abstract

Potential for widespread transmission of HIV/AIDS among American Indian (AI) adolescents exists, yet no evidence-based interventions (EBIs) have been adapted and evaluated with this population. Intensive psychoeducation may improve knowledge and decision-making which could potentially translate to reductions in HIV risk behaviors. A peer group randomized controlled comparison of an adapted EBI vs. control was delivered over an eight-day summer basketball camp in one reservation-based tribal community to adolescents ages 13-19. Outcome data were gathered immediately post-camp and at 6 and 12 months follow-up. Self-selected peer groups were randomized to intervention (n = 138) or control (n = 129) conditions for a total sample of 267 participants (56.2% female), mean age 15.1 years (SD = 1.7). Intervention participants had better condom use self-efficacy post-camp (Adjusted Mean Difference [AMD] = -0.75, p < 0.005) and at 6 (AMD = -0.44, p < 0.005) and 12 months (AMD = -0.23, p < 0.05) follow-up. Intervention participants also had higher HIV prevention and transmission knowledge (post-camp: AMD = 0.07, p < 0.01; 6 months: AMD = 0.06, p < 0.01) were more likely to believe condoms prevent sexually transmitted infections (post-camp: RR = 1.41, p < 0.005; 6 months: RR = 1.34, p < 0.05), to talk with an adult about HIV/AIDS (post-camp: RR=1.78, p < 0.005; 6 months: RR = 1.14, p < 0.005), had higher partner negotiation efficacy related to substance use during sex (post-camp: AMD = 0.37, p < 0.01), and were more likely to intend to use a condom (post-camp: RR = 1.39, p < 0.01). The adapted intervention had short- and medium-term impacts on AI adolescent risk for HIV/AIDS, but attenuated at 12 months. Intervention delivery through a community-based camp is feasible and acceptable with strong retention. Additional study is needed to evaluate the adapted intervention's impact on sexual risk behaviors and if booster sessions and parent involvement translate to long-term impacts.

The Impact of a Sexual and Reproductive Health Intervention for American Indian Adolescents on Predictors of Condom Use Intention

“…Participants were 267 self-identified American Indians ages 13–19 who participated in the evaluation of RCL [7, 8]. We used a nonprobability sampling frame and recruited through local schools and at public events in the participating tribal community.…”

“…We analyzed data from the sample of American Indian youth (ages 13–19) who participated in the evaluation of RCL [7, 8]. In the primary analysis, RCL intervention participants were more likely than control participants to have condom use intention immediately post-intervention.…”

“…In the primary analysis, RCL intervention participants were more likely than control participants to have condom use intention immediately post-intervention. That analysis did not explore differences by age-group or sexual experience and intervention impact on condom use intention attenuated by 6- and 12-months follow-up [8]. The majority of participants were sexually inexperienced, thus exploring RCL intervention impact on condom use intention is important for strengthening the RCL intervention to sustain long-term impact.…”

“…Yet, to our knowledge, no published evaluations of a sexual health intervention implemented with AI adolescents has explored intervention impact on baseline variables predictive of condom use intention, including psychosocial and intervention theoretical constructs. This paper presents results from a secondary analysis of the evaluation of Respecting the Circle of Life: Mind, Body and Spirit (RCL), a culturally-adapted sexual health and HIV risk-reduction intervention for AI adolescents [7, 8]. RCL was evaluated through a randomized controlled trial with AI adolescents and demonstrated promising intervention impacts, which have been described in detail elsewhere [7, 8].…”

“…This paper presents results from a secondary analysis of the evaluation of Respecting the Circle of Life: Mind, Body and Spirit (RCL), a culturally-adapted sexual health and HIV risk-reduction intervention for AI adolescents [7, 8]. RCL was evaluated through a randomized controlled trial with AI adolescents and demonstrated promising intervention impacts, which have been described in detail elsewhere [7, 8]. (Note: information about the tribal-academic partnership and the participatory process shaping the RCL intervention and evaluation design are described in the aforementioned citations).…”