The rates of AIDS/HIV, declining in the general population, are increasing for the young and those of minority status. New HIV/AIDS diagnoses in Native communities are on the increase, with the median age of the American Indian/Alaskan Native (AI/AN) HIV/AIDS population being younger than the overall U.S. population. The rising trend among Native people is not isolated to this country; rather the epidemic pervades international borders to impact Native people across the North American continent. A host of risk factors across demographic, social, and health domains are associated with increased risk for HIV infection and unduly affect the Native population. More live below the poverty line and are unemployed, disproportionately experience school failure and drop out, and evidence low adherence to health services. For Native families, European contact and subsequent colonization led to historical trauma that had an impact on cultural practices, individual functioning, parenting skills, family relations, and subsequently child adjustment. When compounded by society's failure to address the educational literacy needs of these youth, they have been rendered vulnerable, particularly when residing in urban areas fraught with contextual risks linked to substance use and HIV/AIDS infection. The current study proposes to implement and examine the efficacy of a literacy embedded family-based substance use/HIV risk intervention within an inner city, at-risk population of Native adolescents. Interventions will be implemented in the schools and the community by regular staff in those settings. Participants will be 180 Native adolescents (ages 12-14) in grades 6-8 residing in the Eastside area of Vancouver, British Columbia and their families. Families will be randomly assigned to either an academic + family or academic alone intervention with 90 families in each condition. Three academic assessments (pre-, mid-, and post school year) will include measures of reading fluency and comprehension, written expression, current grades, and attendance. Three family assessments (pre-, post-, and 6- month follow-up) will also be conducted to measure HIV risk behaviors, substance use, family functioning, and other problem behaviors. Intervention fidelity, interventionist cultural competence, and other culturally relevant variables will also be assessed. In targeting the intra- and interpersonal functioning in Native families as well as adolescent literacy deficits in a single intervention approach, we are attempting to address the widest array of risk and protective factors known to influence Native adolescent drug use and HIV-risk behaviors. In addition to testing the efficacy of our family-based intervention approach, this study will allow for development and testing of a culturally sensitive conceptual process model of theoretical constructs related to Native adolescent HIV risk and substance use behavior.
