HIV Prevention in Young Adults

Individual-and Group-Level Intervention

HIV prevention interventions targeting individual-level change are face-to-face interventions implemented with individuals, couples, and groups of at-risk individuals. The majority of randomized, controlled trials have primarily described the effects of cognitive-behavioral group interventions that are intended to develop risk reduction skills. Most interventions combine in various ways HIV risk education, encouraging beliefs and intentions to reduce risk behavior, development of skills related to sexual communication and negotiation, condom use skills, risk behavior self-management skills, problem solving related to risk reduction, peer support of behavior change efforts, and maintenance of behavioral changes. These studies have been shown to be effective in reducing HIV risk behaviors, as assessed by increased condom use, decreased number of partners, and decreased drug use and injection behavior.

Project RESPECT, the largest randomized, controlled trial of individual HIV prevention counseling, was conducted among young adults in STD clinics (Kamb et al., 1998). In a comparison of three individual counseling models, both a two-session brief counseling and an enhanced four-session intervention reduced the frequency of unprotected sexual intercourse and the incidence of new STDs among participants, in comparison to a standard of care, didactic risk education only, control condition. A limited number of couples intervention studies have been implemented. For example, Padian, O'Brien, Chang, Glass, and Francis (1993) conducted a cognitive-behavioral counseling intervention for HIV serodiscordant couples that resulted in a significant increase in consistent condom use and no seroconversions among the HIV-negative partners.

The most extensively studied HIV prevention approach has been the small-group, cognitive-behavioral risk reduction intervention. A large number of randomized controlled trials have documented the efficacy of this approach across a variety of populations, including gay and bisexual men, at-risk women, drug users, adolescents, STD patients, homeless persons, and those with serious mental illness. The National Institute of Mental Health (NIMH) Multisite Prevention Trial (1998), conducted with nearly 3,700 men and women from STD and primary care clinics across seven cities in the United States, exemplifies this intervention approach. Participants were randomly assigned to a seven-session, cognitive-behavioral skill training group, as described, or a one-session educational control group. One year following the intervention, those assigned to the multisession group exhibited a reduction in HIV risk behavior across a variety of sexual behaviors, including consistent condom use, abstaining from sexual intercourse, reductions in the frequency of unprotected intercourse, and reduction in STD symptoms and STD incidence (in males). This type of multisession skills training group intervention is considered state-of-the-science in HIV prevention and has been broadly disseminated for use in community-based HIV prevention services.

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