title: Psychological and behavioral interventions to reduce HIV risk: evidence from a randomized control trial among orphaned and vulnerable adolescents in South Africa.
abstract: Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions. With 95% retention, 1014 adolescents were interviewed three times over a 22-month period. Intent-to-treat analyses, applying multivariate difference-in-difference probit regressions, were performed separately for boys and girls to assess intervention impacts on sexual risk behaviors. Exposure to a single intervention did not impact behaviors. Exposure to both interventions was associated with risk-reduction behaviors, but the outcomes varied by gender: boys reported fewer risky sexual partnerships (β = -.48, p = .05) and girls reported more consistent condom (β = 1.37, p = .02). There was no difference in the likelihood of sexual debut for either gender. Providing both psychological and behavioral interventions resulted in long-term changes in sexual behavior that were not present when either intervention was provided in isolation. Multifaceted approaches for reducing sexual risk behaviors among vulnerable adolescents hold significant promise for mitigating the HIV epidemic among this priority population.
authors.affiliation: a Tulane University School of Social Work, Highly Vulnerable Children Research Center , New Orleans , LA , USA.|b Tulane International LLC South Africa , Cape Town , South Africa.
authors.forename: T R
authors.initials: TR
authors.lastname: Thurman
authors.affiliation: c Department of Preventive Medicine , Stony Brook Medicine, Health Sciences Center , Stony Brook , NY , USA.
authors.forename: R
authors.initials: R
authors.lastname: Kidman
authors.affiliation: d Health Services Research , Louisiana Public Health Institute , New Orleans , LA , USA.
authors.forename: T W
authors.initials: TW
authors.lastname: Carton
authors.affiliation: e Impact Research International , Pretoria , South Africa.
authors.forename: P
authors.initials: P
authors.lastname: Chiroro
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D054540:Child, Orphaned / Q000523:psychology*; D055812:Community-Based Participatory Research; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D013315:Stress, Psychological; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000523:psychology*; D055815:Young Adult
keywords: HIV prevention; Orphans and vulnerable children; South Africa; evaluation; sexual risk behavior