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Reducing Risky Sexual Behavior in Adolescents: Impossibility?

By Susan M. Persons

Slaying the dragons that lie in the path of adolescent health may seem like an insurmountable feat, especially when it comes to changing sexual behavior to reduce the risk of HIV infection. Yet behavioral research presented by Dr. John B. Jemmott III at the NIH behavioral and social sciences research coordinating committee seminar series demonstrated that HIV risk-associated sexual behavior can be reduced in a key population -- inner-city African American male adolescents -- and that the intervention did not encourage sexual intercourse, but instead decreased it.

Dr. John B. Jemmott III

Jemmott, professor of psychology at Princeton University, gave several reasons why changing the sexual behavior of youth is a significant challenge. According to him, studies have shown that adolescents typically feel invulnerable and do not perceive themselves to be at risk. Adolescents may also hold negative beliefs about safer sex practices -- for example, that condoms adversely affect sexual enjoyment. And negotiating safer sex practices with partners requires confidence and skills that adolescents often do not have. In addition, it is difficult to persuade adolescents to practice abstinence if they have decided to be sexually active.

Despite these challenges to behavioral change, Jemmott and his colleagues are determined to develop interventions that will protect adolescents. "Approximately 56 percent of adolescent females and 73 percent of adolescent males have had sexual intercourse by the time they are 18 years of age," he reported. "Currently, 18 percent of reported AIDS cases involve young adults 20-29 years of age. About 10 to 12 years typically elapse between the time a person is infected with HIV and the appearance of the clinical signs sufficient to warrant an AIDS diagnosis. Thus adolescence is a critical and necessary period to intervene to reduce the number of people contracting HIV and other sexually transmitted diseases," he said.

Jemmott, whose work has been partially funded by NICHD and NIMH, emphasized that interventions most effective in changing HIV risk-associated behavior are based on solid theoretical frameworks. For example, the theory of planned behavior states that specific intentions are the key determinant of a specific behavior. And what influences an individual's intentions? "People intend to perform a behavior when they believe that favorable consequences will result; when they believe that significant others think they should perform it; and when they believe that they have the skills and resources to perform it," he explained.

Although the importance of culture-sensitive interventions has long been documented, Jemmott presented important refinements. Are these interventions effective when implemented by facilitators who do not share the ethnic group membership or gender of the participants? "Our research has shown that the effects of the HIV intervention were about the same irrespective of the race of the facilitator, the gender of the facilitator, the gender of the participants, and the gender composition of the intervention group," stated Jemmott. However, he cautioned that differences may have emerged had the intervention contained inappropriate materials and less structured training for the facilitators. "Still, this finding may have important practical implications. It may mean that public schools, health clinics, community-based organizations, and other organizations that are implementing HIV prevention programs may not have to be concerned about matching the characteristics of the facilitators and the audience, if the content of the intervention is appropriate for the audience and if the facilitators are well trained," he said.

Jemmott also tested the effectiveness of peer educators. His research found that interventions utilizing peer and adult facilitators were equally effective, although adolescents said that they enjoyed the interventions more when counseled by their peers. "This finding has implications for multiple-session interventions," he said. "Using peer co-facilitators might increase attendance and the degree of involvement in activities when adolescents are asked to attend several sessions."

While the debate regarding abstinence-based interventions and safer sex interventions has shed "more heat than light," Jemmott found that both were efficacious. However, only the safer sex intervention reduced unprotected sexual intercourse -- the outcome that is most closely linked to risk of sexually experienced adolescents. Jemmott also allayed the fears of those who believe that exposing adolescents to information about sex will encourage them to engage in sexual activity. "Our data provide some evidence that the opposite may be true. Adolescents who received our AIDS risk-reduction interventions were less likely to engage in sexual activity, and those who did were more likely to engage in safe sexual activity," he said.

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