Increasing numbers of youth are infected with HIV & are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, & improving their quality of life. Over the last 4 years, an intensive, 31-session, 3-module intervention was designed, implemented, & evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study & new scientific breakthroughs: 1) only 30% of YLH continue their substance use & sex risk after learning they are seropositive; 2) 30% of YLH never attended any group session; and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, & the role of substance use in adhering to new medical regimens. Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (changing Lifestyles: Effort And Rewards), will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami & LA. The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions) that is delivered in either: a) anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will: 1) in Module 1, reduce substance use & sexual behaviors that may transmit or enhance transmission of the ~V virus; 2) in Module 2, reduce the negative impacts of substance use on seeking & utilizing health care, & increase assertiveness & adherence to health regimens; & 3) in Module 3, enhance quality of life & self-actualization in order to maintain behavior changes over time. In addition, we will examine I ) how YLH's substance use influences seeking & adhering to combination antiretroviral therapies, & youth's reinitiation of transmission acts based on their viral loads & beliefs regarding transmissivity of undetectable viral loads, as well as beliefs in post-exposure prophylaxis & life expectancies; 2) how well the components of the Social Action Model predict reductions in substance use, sexual behaviors, & relapse, & improvements in health adherence, acquisition of knowledge of the program, & quality of life; & (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical & nonmedical services & differential benefits of telephone groups, individual sessions, & small groups (from previous study).
| Arnold, Elizabeth Mayfield; Rotheram-Borus, Mary Jane (2009) Comparisons of prevention programs for homeless youth. Prev Sci 10:76-86 |
| Comulada, W Scott; Weiss, Robert E (2007) On models for binomial data with random numbers of trials. Biometrics 63:610-7 |
| Comulada, W Scott; Weiss, Robert E; Cumberland, William et al. (2007) Reductions in drug use among young people living with HIV. Am J Drug Alcohol Abuse 33:493-501 |
| Lightfoot, Marguerita; Tevendale, Heather; Comulada, W Scott et al. (2007) Who benefited from an efficacious intervention for youth living with HIV: a moderator analysis. AIDS Behav 11:61-70 |
| Lightfoot, Marguerita A; Kasirye, Rogers; Comulada, W Scott et al. (2007) Efficacy of a culturally adapted intervention for youth living with HIV in Uganda. Prev Sci 8:271-3 |
| Lightfoot, Marguerita; Rotheram-Borus, Mary Jane; Tevendale, Heather (2007) An HIV-preventive intervention for youth living with HIV. Behav Modif 31:345-63 |
| Rice, Eric; Batterham, Philip; Rotheram-Borus, Mary Jane (2006) Unprotected sex among youth living with HIV before and after the advent of highly active antiretroviral therapy. Perspect Sex Reprod Health 38:162-7 |
| Song, Juwon; Lee, Martha B; Rotheram-Borus, Mary Jane et al. (2006) Predictors of intervention adherence among young people living with HIV. Am J Health Behav 30:136-46 |
| Swendeman, Dallas; Rotheram-Borus, Mary Jane; Comulada, Scott et al. (2006) Predictors of HIV-related stigma among young people living with HIV. Health Psychol 25:501-9 |
| Batterham, Philip; Rice, Eric; Rotheram-Borus, Mary Jane (2005) Predictors of serostatus disclosure to partners among young people living with HIV in the pre- and post-HAART eras. AIDS Behav 9:281-7 |
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