There is a need for community-based, culturally sensitive, cognitive-behavioral interventions to reduce sexual risk behavior among minority adolescents for prevention of STD/HIV, unintended pregnancy and abuse. This study builds on our behavioral interventions developed in the studies, """"""""Modifying STD Risk Behavior among Minority Women."""""""" (Study 1:1991-1995; Study 2:1995-2004). These studies are unique in that they designed and evaluated culturally relevant, minority-women-specific interventions based upon the AIDS Risk Reduction Model (ARRM), and were shown to be effective through controlled randomized trials (90,91,92). These interventions (88,94) are grounded in knowledge of the target populations' behavior and culture and use STD and detailed measures of sexual behavior as primary outcome variables. Results of the first trial demonstrated participants receiving intervention were significantly less likely to be re-infected with STD (90, 91). Although the intervention was successful with the sample as a whole, sexually abused 14-15 year olds were not helped (93). Subsequent studies indicated physically or sexually abused adolescents who used drugs or alcohol (14-18 years) had the highest STD and unintended pregnancy rates and were not benefiting from the intervention (27, 40). This study focuses on reducing rates of abuse recurrence, STD/HIV and unintended pregnancy among these women by changing high-risk sexual behaviors, decreasing substance use and encouraging contraceptive use. Its primary goal is to expand risk-reduction interventions created in previous studies to further increase intervention efficacy for this particularly vulnerable, high-risk group. An adolescent intervention has been created and pilot tested in developmental studies. Findings indicate greater contraceptive use and lower sexual risk behaviors, substance use, abuse recurrence, unintended pregnancy and STD rates than previous studies.
Specific aims i nclude: 1) To obtain a more in-depth understanding of configurations of psychosocial and situational factors associated with high-risk sexual behavior, substance use, STD/HIV and contraceptive use among abused minority adolescent women with STD; 2) To implement a controlled randomized trial of a risk-reduction intervention consisting of small group sessions, individual counseling and support groups for this group; 3) To evaluate the effects of the adolescent intervention model versus enhanced counseling for this group on ARRM-related constructs, high-risk sexual behavior, substance use, abuse recurrence, contraceptive use, unintended pregnancy and STD/HIV at 6 and 12 months follow-up. Participants will include a convenience sample of 600 Mexican-and African American adolescent women, aged 14-18 years with a history of sexual or physical abuse and current STD.
