The goal of this project is to eliminate and/or to reduce risk acts that transmit HIV and to enhance health care behaviors among HIV+ youths, changes that are likely to influence disease progression. An intensive intervention designed on the AIDS Risk Reduction Model (ARRM) will be evaluated among 200 HIV+ youths and 100 HIV- youths aged 15-19 years, recruited from multiple adolescent HIV clinical sites in AIDS epicenters. Youths will receive three 15-20 hour modules (Act Safe, Stay Healthy, and Booster Modules), each delivered during a three-month time block. Substance use, sexual risk behaviors, health practices, and disease progression will be assessed at each clinical site at intake and at three month intervals over 36 months to evaluate changes in response to the intervention using a lagged, multiple baseline design. Half of the HIV+ youths (N = 100) will be randomly selected to begin receiving the sequenced modules at 3 months following intake; half of the HIV+ youths (N = 100) will begin receiving the sequenced intervention at 15 months following intake. HIV- youths (N = 100) will be followed over time, but receive no intervention; thus, these HIV- youths will serve as a control group providing information on developmental changes in risk acts and measurement reactivity over time. The lagged design allows us to evaluate the incremental benefits of each intervention module and the cumulative impact of the modules while complying with ethical standards of care for HIV+ youths. Preliminary information will be gathered on the effectiveness of the intervention based on three sets of mediating factors: means of acquiring HIV (i.e., homosexual transmission, IV drug use), acquisition of the skills and norms taught in the intervention, and site. Finally, we will examine whether changes in HIV risk acts are associated with changes in health status (e.g., sexually transmitted diseases), other problem behaviors (e.g., school and conduct problems, suicidality), and disease progression.
