Street Smart: Reducing HIV Risk Among Runaway and Homeless Youth

The Research

The Science Behind the Package

Street Smart is a multisession, skills-building program designed to help groups of runaway youth reduce unprotected sex, number of sex partners, and substance use. The program is based on social learning theory, which describes the relationship between behavior change and a person’s beliefs that he/she has the ability to change a behavior and that changing that behavior will produce a specific result.

Target Population
Runaway youth, ages 11 to 18

Intervention
The intervention consists of eight, 1.5 to 2 hour drop-in group sessions delivered over a 2- to 6-week period. Sessions are held after dinner at the runaway shelter where the youth are staying and are led by trained counselors. Approximately 10 youth attend each group session. During early sessions, information on HIV prevention is conveyed in video and art workgroups where the youth review and discuss commercial HIV/AIDS prevention videos and then develop their own soap opera dramatizations, public service announcements, commercials, and rap songs. The majority of the sessions address improving youth’s social skills, particularly assertiveness and coping, through exercises that teach them to identify their emotional and behavioral reactions and unrealistic expectations in situations with potential risk for HIV transmission. The small group format permits collective support for safer behaviors and behavior change to be developed and mobilized. In addition to the group sessions, private sessions with a counselor are included to give youth the opportunity to assess their own barriers to safer sex and discuss their dysfunctional attitudes and behavior patterns. Youth also are given access to medical and mental health care through weekly visits from a public health nurse, visits to a community-based agency that provides comprehensive care, and referrals for specific individual health concerns.

Research Results
After participating in Street Smart:

• Youth reduced their substance use and number of unprotected sex acts
• Young women reported greater reductions in substance use and unprotected sex than young men reported
• African American youth reported greater reductions in substance use than youth of other ethnic groups reported

For Details on the Research Design
Rotheram-Borus MJ, Koopman C, Haignere C, & Davies M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 266(9), 1237-1241.

The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in developing a user-friendly package of materials designed for prevention providers. Street Smart is one of the REP interventions. The Street Smart intervention package is the product of extensive collaboration among researchers, staff from public and private agencies serving homeless and runaway youths, and youth from diverse backgrounds. This package was pilot-tested at community-based agencies that serve homeless and runaway youths, where staff and youth were instrumental in identifying key strategies to plan, implement, and evaluate the intervention. Street Smart is meant to supplement existing services for homeless and runaway youth.

Core Elements
Core elements are intervention components that must be maintained without alteration to ensure program effectiveness.

The core elements of Street Smart include:

1. Enhancing affective and cognitive awareness, expression, and control
2. Teaching HIV/AIDS risk hierarchy and its personal application
3. Identifying personal triggers, using peer support and small group skills-building sessions
4. Building skills in problem solving, personal assertiveness, and HIV/AIDS harm reduction

Package Contents

• Facilitator training manual for program staff
• Workbook for participants
• Sample social marketing and recruitment materials, which may be reproduced
• Handouts for intervention-specific educational and skills-building exercises
• Computer diskettes containing above-mentioned materials for easy customization
• Orientation video for program staff

Timeline for Availability
The package is available from CDC along with training on program implementation and technical assistance.

For More Information on the Street Smart Package
To find out more about future trainings, please visit Effective Interventions.