Expanding the range of interventions to reduce HIV among adolescents.
OBJECTIVE
Structural interventions are identified to reduce adolescents' HIV risk.


METHODS
The goals, strategies, approaches, and delivery sites of adolescent HIV prevention programs are reviewed.


RESULTS
In addition to reducing sexual activity and substance use, HIV prevention programs may also reduce adolescents' HIV risk by: decreasing poverty; ensuring access to HIV testing, healthcare, general social skills training, and employment opportunities; and requiring community service for students. Adolescent HIV prevention programs do not currently utilize diverse modalities (computers, videotapes, television, telephone groups, computerized telephones) or sites (parents' workplaces, religious organizations, self-help networks, primary healthcare clinics) for delivering interventions. Diversifying current approaches to HIV prevention include: economic development programs; mandating delivery of programs at key developmental milestones (e.g. childbirth, marriage) and settings (school-based clinics, condom availability programs); securing changes in legislative and funding policies through ballot initiatives or lawsuits; and privatizing prevention activities.


CONCLUSIONS
To implement structural HIV interventions for adolescents requires researchers to shift their community norms regarding the value of innovation, adopt designs other than randomized controlled trials, expand their theoretical models, and adopt strategies used by lawyers, private enterprise, and lobbyists.
Rotheram-Borus
M J
MJ
Department of Psychiatry and the AIDS Institute, University of California, Los Angeles, USA.
D000293:Adolescent; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D012931:Social Environment; D014481:United States