Compendium of Evidence-Based HIV Behavioral Interventions
Safe on the Outs
Adolescents in juvenile detention facilities
Goals of Intervention
- Reduce risky sex behavior
- Reduce sex while drinking
Safe on the Outs is a group-level intervention delivered in a single session to typically 3-5 adolescents of the same sex. It combines a group psychosocial intervention (GPI) for sexual risk reduction with group motivational enhancement therapy (GMET). The GPI portion uses group activities, videos, condom demonstrations, a videogame, general HIV transmission information, and local information and health services resources to increase HIV knowledge, and develop self-efficacy, normative perceptions, and positive attitudes toward condoms. A movie depicting ethnically representative young people emphasizes and explicitly models being prepared for safer sex and the importance of good communication skills with current and potential sex partners. In a videogame participants make a series of choices related to sexual activity to consider how negative consequences of unprotected sex would impact life goals. Participants then pick a safer sex goal they want to accomplish in the next 3 months to increase positive intentions. The GMET portion focuses on alcohol use, including feedback on drinking behaviors, and uses the FRAMES (Feedback, Responsibility, Advice, Menu, Empathy, and Self-Efficacy) to organize its structure. It uses motivational interviewing (MI) and empathetic, open, and non-confrontational motivational-enhancement-therapy style group discussion to address awareness about alcohol consumption level, consequences of alcohol use, strategies to develop self-efficacy to reduce alcohol use risk, and motivation to change alcohol use behavior during sexual activity. Participants watch an additional video depicting ethnically representative young people at a party with alcohol to provide an example of the negative consequences from alcohol use in sexual situations and provide options for positive decisions. The emphasis is on specific alcohol-related sexual risk reduction skills (e.g., understanding one’s limits, not putting oneself in a situation in which a risky sexual encounter may happen, having a “buddy system”).
- FRAMES structure
- Motivational interviewing / motivational enhancement therapy
- Social cognitive theory
- Theory of planned behavior
Single session lasting 3 to 4 hours
Juvenile detention facility classroom
Masters-level intervention leaders, gender-matched with participants
- Goal setting/plan
- Group activities
- Skills building
An intervention package is not available at this time. Please contact Angela D. Bryan, Ph.D., University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Department of Psychology, MSC03 2220, Albuquerque, NM 87131. Email: firstname.lastname@example.org for details on intervention materials.
The original evaluation was conducted in Denver, Colorado between 2004 and 2006.
Key Intervention Effects
- Reduced risky sex behavior
- Maintained condom use
The baseline study sample of 484 adolescents is characterized by the following:
- 37% White, 28% Hispanic, 13% Black, 13% Biracial/Mixed, 5% Native American, 3% Asian, 2% Other ethnicity
- 83% Male, 17% female
- 91% heterosexual, 6% bisexual, 3% gay
- Mean age of 16 years
Three juvenile detention facilities in the Denver, Colorado judicial district
Adolescents were eligible if they were 14 to 17 years old, English speaking, and current residents at one of the detention facilities.
Groups of 1-10 adolescents of the same sex (N=117 groups) were randomly assigned to 1 of 3 study groups: Group Psychosocial Intervention and Group Motivational Enhancement Therapy (GPI+GMET; n = 39 groups; 165 adolescents), GPI only comparison group (n = 36 groups; 157 adolescents), or Group Information Intervention comparison group (GINFO; n = 42 groups; 162 adolescents).
The Group Psychosocial Intervention only (GPI) comparison group was one 3-hour group session delivered by masters-level intervention leaders. Participants in this group received the Group Psychosocial components described in the intervention box.
The Group Information (GINFO) comparison was a 1-hour group session delivered by masters-level intervention leaders. The session focused on basic HIV/STD prevention information and definitions, modes and body fluids of HIV transmission, and effectiveness of condom use in HIV prevention. Group discussions covered the need for condom use despite trusting one’s partner and how it is impossible to know who may be infected with HIV. Additional information was presented in a video that discussed common STIs with a question and answer session after the video. Participants also received lists of area resources for testing and other sexual health services.
Relevant Outcomes Measured and Assessment Time
- Sex behaviors (including frequency of condom use during past 3 months; and risky sex behavior during past 3 months) were measured at 3, 6, 9, and 12 months post-intervention. Risky sex behavior was an indicator of risk that combined condom use (reverse scored) and frequency of intercourse; the scores ranged from 0 to 20; higher scores indicated more risky sexual behavior.
- GPI + GMET Intervention:
71% retained at 3 months
72% retained at 6 months
69% retained at 9 months
72% retained at 12 months
- GPI only Comparison:
64% retained at 3 months
62% retained at 6 months
66% retained at 9 months
71% retained at 12 months
- GINFO Comparison:
61% retained at 3 months
58% retained at 6 months
60% retained at 9 months
66% retained at 12 months
- Among those who engaged in sex between baseline and assessment, GPI+GMET (Safe on the Outs) intervention participants reported a significantly lower score on the risky sex behavior indicator than GINFO comparison participants at 3-months post-intervention (F = 1, 77) = 6.05, p < .05)*.
- Among those who engaged in sex between baseline and assessment, GPI+GMET (Safe on the Outs) intervention participants reported a significantly greater frequency of condom use than the GINFO control participants at 9 months (p < .05) and 12 months (p < .05) post-intervention.*
- The GPI+GMET (Safe on the Outs) intervention fails to meet the best-evidence criteria due to <70% retention rate per arm at each included assessment.
- Changes in frequency of condom use over time (from baseline to 12 months) were significantly different between GPI+GMET (Safe on the Outs) intervention participants and GINFO comparison participants (p < .05). Frequency of condom use significantly declined among GINFO comparison participants (p <.01) while remaining relatively stable among GPI+GMET intervention participants. However, the retention at the 6-month follow-up does not meet the minimum retention rate of > 60%. With removal of the 6-month follow-up data, this finding became non-significant, with changes over time not being significantly different.*
- There were no statistically significant differences in changes over time for condom use or risky sex between the GPI only group and GPI+GMET intervention group and between the GPI only group and the GINFO group.
- Bryan, A. D., Schmiege, S. J., & Broaddus, M. R. (2009). HIV risk reduction among detained adolescents: A randomized, controlled trial. Pediatrics, 124, e1180-e1188.
- Schmiege, S. J., Broaddus, M. R., & Bryan, L. M. (2009). Randomized trial of group interventions to reduce HIV/STD risk and change theoretical mediators among detained adolescents. Journal of Consulting and Clinical Psychology, 77, 38-50.
Researcher: Angela D. Bryan, Ph.D.
University of New Mexico
Center on Alcoholism, Substance Abuse, and Addictions
Department of Psychology
Albuquerque, NM 87131
*Information obtained from author