Influence of program participation and program-level characteristics on HIV risk reduction among adolescents in New York City after-school programs

Background. The amount and quality of participation in out-of-school time programs (OST) is associated with positive adolescent development and fewer HIV risk behaviors. Characteristics of programs themselves may also impact adolescent health outcomes. Methods. This study examined the relationship of OST participation with HIV risk reduction practices. Surveys were administered to 331 ethnically-diverse New York City youth at their OST sites. Survey topics included sexual health promotion and HIV risk reduction practices, social connectedness, program participation and community resources. Program-level variables were created based on findings from 62 in-depth interviews with OST staff and youth participants, and include measures of staff connectedness, opportunities for youth employment and program stability. Data were analyzed using hierarchical linear regression. Results. At the individual level, active participation in OST and higher levels of social connectedness were positively associated with HIV risk reduction scores. At the program level, programs with older participants had mean scores evidencing higher levels of HIV risk and lower levels of protective practices. Conversely, fewer HIV risk behaviors were reported for youth in programs that provided employment opportunities. This model explained 14% of the variance in individual-level HIV risk reduction scores, and 43% of the variance in program-level scores. Conclusions. The results of this study suggest that HIV risk reduction among urban adolescents is impacted by the quality of individual OST participation, as well as the characteristics of the OST program itself. This information can be used to improve services offered to youth.