Online Program

Efficacy of an HIV/STI prevention intervention for incarcerated African American adolescent girls

Monday, November 4, 2013

Ralph DiClemente, PhD, Rollins School of Public Health and Center for AIDS Research, Emory University, Atlanta, GA
Andrea Swartzendruber, PhD, School of Public Health, Emory University, Atlanta, GA
Teaniese Davis, PhD, School of Public Health, Emory University, Atlanta, GA
Amy M. Fasula, MPH, PhD, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA
Lorin Boyce, MA, School of Public Health, Emory University, Atlanta, GA
Deborah Gelaude, MA, Prevention Research Branch, DHAP, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA
Eve Rose, MSPH, Rollins School of Public Health Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA
Monique Carry, PhD, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Background: Although high rates of sexual risk and adverse sequalae among incarcerated African American girls are well recognized, no efficacious sexual risk-reduction interventions exist. This study examined the efficacy of an HIV/STI prevention intervention, IMARA, for incarcerated African American girls. IMARA is a three-session, individual-level intervention delivered over 3 months inside the facility and post-release. Methods: African American girls, 13-17 years, were recruited from youth detention to participate in an HIV/STI prevention trial. Participants (N=188) were randomized to the intervention (IMARA) or standard-of-care condition. Data were collected prior to randomization and 3- and 6-months post-baseline. At each assessment, participants completed an audio computer-assisted interview, condom skills assessment, and provided a self-collected vaginal swab specimen assayed for Chlamydia and gonorrhea. Generalized estimating equations assessed outcomes over 6-months, controlling for the baseline outcome measure and baseline differences between conditions. Results: Overall retention at each follow-up assessment was 91%, with no differences between conditions. During follow-up, IMARA participants reported higher condom use self-efficacy (p<0.001), partner communication self-efficacy (p=0.040), STI knowledge (p<0.001), condom use skills (p<0.001), and decreased depressive symptomology (p=0.042). There were no significant differences between conditions in consistent condom use, proportion of condom-protected sex acts, number of vaginal sex partners, or Chlamydia or gonorrhea incidence. Conclusions: IMARA was associated with improved mediators of HIV/STI prevention but not with changes in sexual behavior. A critical need for interventions to reduce sexual risk among incarcerated girls remains. Future interventions may benefit by also intervening with parents, social networks and/or partners of incarcerated girls.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss the need for interventions to reduce sexual health risk among detained African American girls Identify the purpose of the IMARA trial and key intervention aspects Discuss the efficacy of IMARA and implications for HIV/STI prevention

Keyword(s): Adolescents, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple federally funded grants focusing on HIV prevention interventions for African American adolescents. Among my scientific interests has been the development of strategies for preventing HIV and STDs in incarcerated adolescents.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.