Compendium of Evidence-Based HIV Behavioral Interventions
Intensive AIDS Education
Incarcerated, male adolescent drug users
Goals of Intervention
- Eliminate or reduce HIV risk behaviors
This intervention is a four-session, small-group, interactive, AIDS education program based on problem solving therapy delivered to youth in jail. The intervention is delivered to small groups of 8 male inmates and focuses on relevant health education issues, emphasizing HIV/AIDS-related issues. The Problem-Solving Therapy approach is used to guide group discussions and includes the following steps: problem orientation, defining and formulating the problem, generating alternative solutions, decision-making, and implementing a solution. As part of the first step in the discussion – problem orientation – participants share and discuss facts and beliefs about HIV. Then, participants define and formulate the problem by identifying specific attitudes or behaviors that need to be modified in order to prevent against HIV. For generating alternative solutions, participants suggest and compile possible courses of action. During the decision-making step, participants critique and evaluate the alternative solutions. Finally, participants engage in role-play and rehearsal exercises to practice implementing the solution. Topics covered during the group discussions are general HIV education information, factors related to drug initiation or drug use, the meaning and consequences of sexual activity, and the relationship between drug use and sexual activity and HIV risk, and how to seek health care services, social services, and drug treatment.
Four 1-hour sessions delivered twice a week over a 2-week period
New York City Department of Correction’s Adolescent Reception and Detention Center, Rikers Island
- Group Discussion
- Problem Solving Therapy
- Role Play
An intervention package is not available at this time. Please contact Dr. Stephen Magura, Director of Evaluation Center, Western Michigan University, 1903 West Michigan, Kalamazoo, Michigan 49008-5237, email: Stephen.firstname.lastname@example.org for details on intervention materials.
The original evaluation was conducted at the New York City Department of Correction’s Adolescent Reception and Detention Center on Rikers Island between 1991 and 1992.
Key Intervention Effects
- Increased condom use
The analytic study sample of 157 incarcerated adolescents is characterized by the following:
- 66% African American, 33% Hispanic, 2% White
- 100% Male
- 95% heterosexual, 5% homosexual or bisexual
- Median age of 18 years, range: 16-19 years
- 41% attending school at time of arrest
New York City Department of Correction’s Adolescent Reception and Detention Center on Riker’s Island
Male adolescent inmates were eligible if they were incarcerated in 11 dormitories at the New York City Department of Correction’s Adolescent Reception and Detention Center.
Participants (N = 411) were assigned to 1 of 2 groups: Intensive AIDS Education intervention (n = 110) or wait-list control (n = 301). The assignment was based on a convenience or logistical factor, that is, youth who could not be offered the intervention immediately after baseline were assigned to the wait-list control
The comparison was a wait-list control group, where those who could not attend the intervention immediately were placed on a waiting list, but were later released from jail or transferred before receiving the intervention.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors measured during time in the community since release from jail were: having multiple sex partners, having any high-risk sex partners, having any anal sex, and frequency of condom use during vaginal, oral, and anal sex
- Outcomes were measured at a median of 10 months after baseline, which was a median of 5 months after release from jail, indicating a follow-up of at least 5 months (but less than 10 months).
- Overall study sample:
66% retained at the 5-month or greater follow-up
- Intensive AIDS Education (retention not reported):
≥ 60% retained at the 5-month or greater follow-up (based on calculation; see Considerations)
- Waitlist control (retention not reported):
≥ 65% retained at the 5-month or greater follow-up (based on calculation; see Considerations)
Intervention participants reported a significantly greater frequency of condom use during vaginal sex than the control participants (p = .02, one-tailed test) at the 5-month or greater follow-up.
- This intervention fails to meet the best-evidence criteria due to a potential small to moderate bias resulting from the assignment method, low retention rates, and using a one-tailed test.
- Intervention participants reported significantly greater frequencies of condom use during anal and oral sex (p= .04, one-sided test) and during general (vaginal, anal, and oral) sex (p = .002, one-sided test) compared to the control participants at the 5-month or greater follow-up.
- Intervention participants had significantly more favorable attitudes towards condoms than control participants (p = .05, one-tailed test) at the 5-month or greater follow-up.
- The separate retention rates for the intervention and control groups were not reported and the original data are no longer available. The author conducted back-calculations to try to establish these follow-up rates. Follow-up rates as low as 59% in either group would be inconsistent with the published statistics; thus, the rate must have been greater than 59% for both study groups. The author does not recall a follow-up rate of less than 60% for either group.
- The intervention and original research targeted male teens, including mostly youth aged 16 to 18, but the study sample also included a few 19 year olds who were in the detention center.
- Magura, S., Kang, S. Y., & Shapiro, J. L. (1994). Outcomes of intensive AIDS education for male adolescent drug users in jail. Journal of Adolescent Health, 15, 457-463.
Researcher: Dr. Stephen Magura
Director of Evaluation Center
Western Michigan University
1903 West Michigan
Kalamazoo, Michigan 49008-5237