The proposed study addresses the persistent disconnect between HIV prevention science and community practice as urgently identified by the Institute of Medicine (1998,2000) and the NIH (2000,2001). Of noted priority is the need to transfer effective HIV prevention interventions targeting adolescents to community-based settings that directly serve the highest risk groups. This study's primary aim is to assess the effectiveness of a Cognitive Behavioral (CB) HIV adolescent prevention intervention in an adapted design (CB-A) for implementation in Community-Based Organizations (CBOs) by CBO staff. The CB-A will be compared to a time and attention matched Standard Care condition (SC) in a randomized clinical trial, in which delivery of both is by well-established CBOs and staff. Similar to our originally developed CB that has shown great promise in a research-based efficacy clinical trial, CB-A incorporates the same innovative mix of behavioral skills training, motivational enhancement, and relapse prevention components of interventions previously demonstrated to be effective and identified in the CDC's (1999) Compendium of HIV Prevention Interventions with Evidence of Effectiveness. In designing the randomized clinical trial and the CB-A intervention for optimal translation and technology transfer, our academic university medical center research team has formed a close partnership and collaboration with a network of CBOs, well-integrated as HIV prevention and treatment providers serving the surrounding, socioeconomically disadvantaged racial/ethnic minority communities of Miami-Dade County, Florida. This county carries the greatest HIV/AIDS burden and is the most densely multicultural and urban area within the state. Using youth-serving CBOs as recruitment sites, the proposed sample of 160 male and 160 female adolescents will be predominantly minority, low income, culturally diverse, sexually active youths with recent histories of Alcohol and Other Drug (AOD) abuse. The scondary aims of this proposed study are to evaluate if key variables mediate and moderate relationships between the intervention and HIV risk behavior outcomes. This study is significant because it addresses the urgent need to develop an effective, highly targeted intervention that is usable by CBO practitioners to reduce HIV transmission behaviors in this extremely vulnerable and risky population subgroup, in an area of the country that is disproportionately affected by HIV and the pervasive national problem of racial/ethnic health disparities.
