HIV increasingly affects young and impoverished minority communities. Community-level HIV primary prevention interventions are urgently needed and must be focused on populations vulnerable to the disease. Research has shown that intensive cognitive-behavioral small group HIV prevention workshop interventions can promote short-term changes in sexual risk practices. However, interventions which attempt to change only the behavior of the individual may be much less affective than those which also change the social and peer reference group environment so as to provide sustained reinforcement, modeling, and normative support for enacting and maintaining risk avoidance behavior change. Following a successful randomized community- level HIV prevention intervention field trial undertaken with at-risk women who live in public housing developments, our collaborative and multi-institutional research team requests renewal support to extend our research to populations of adolescents in urban housing developments. Formative studies will be undertaken to delineate HIV risk issues facing inner-city adolescents. We will then initiate a community-level intervention trial in 15 low-income public housing developments. All adolescents ages 12 to 17 in all 15 developments will be administered assessment surveys to establish baseline levels of population risk. The 15 housing development populations will then be randomized within matched triads of developments to one of three study conditions: (1) population member followup risk survey assessments only; (2) cognitive- behavioral HIV risk reduction workshops offered to all adolescent population members followed by a sustained community-level 'opinion leader' intervention that creates HIV risk avoidance models, norms, and reinforcement supports; or (3) risk reduction workshop followed by an attention control community intervention in an area unrelated to AIDS. Population members will be reassessed at 6-and 12-month followup points, with data also collected from health clinic records on STD treatment. We hypothesize that the lowest levels of population HIV risk behavior, risk characteristics, and STD treatment rates will be found at followup among adolescents who participated in risk reduction workshops and were then also exposed to a sustained community intervention to provide models, associate reinforcement, and produce peer norms favoring HIV risk avoidance.
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