Prevalence and correlates of adolescent females who do not change condom use behavior following participation in an HIV prevention intervention

Background: Despite the availability of evidence-based HIV prevention interventions, such programs are not uniformly effective for all participants. Not everyone exposed to an intervention will reduce their sexual risk behaviors. Unfortunately, little is known about the prevalence of adolescents who fail to change high risk behaviors post-intervention or factors associated with “failure to change”.

Method: Data were collected via ACASI from 715 sexually active African American adolescent females (15-21 years) prior to and again 6-months post-participation in an HIV prevention intervention. Sociodemographic, psychosocial, and self-reported behavioral data related to condom use were collected. Adolescents who did not increase their proportion of condom use 6 months after intervention participation from their baseline levels were classified as “non-changing”. Bivariate analyses were conducted to identify correlates of “non-change”.

Results: 43% of intervention participants did not increase their condom use behavior in the 14 days prior to 6 month post-intervention assessment, and 40% did not increase their condom use in the 60 days prior to post-intervention assessment. Having peers who support high risk sexual behavior and having a history of physical abuse were the only significant correlates of “non-change”.

Conclusion: The prevalence of adolescent females who did not increase their condom use behavior following intervention participation is substantial. Peer norms supporting risk and a history of physical abuse were associated with failure to increase condom use. However, more research is needed to more fully explore, identify, and understand factors prohibiting some adolescents from changing high risk sexual behaviors.