Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985-2000: a research synthesis.

OBJECTIVE: To summarize studies that have tested the efficacy of human immunodeficiency virus (HIV) sexual risk-reduction interventions in adolescents. DATA SOURCES: Reports were gathered from computerized databases, by contacting individual researchers, by searching conference proceedings and relevant journals, and by reviewing reference sections of obtained articles. STUDY SELECTION: Studies were included if they investigated any educational, psychosocial, or behavioral intervention advocating sexual risk reduction for HIV prevention; used experimental designs (or other designs with adequate comparison groups); had behavioral-dependent measures relevant to sexual risk; sampled adolescents (age range, 11-18 years); and had sufficient information to calculate effect size (ES) estimates. Data from 44 studies and 56 interventions (N = 35 282 participants) that were available as of January 2, 2001, were included. DATA EXTRACTION: Study information was coded, and individual ESs were calculated in SD units (the difference between the intervention and comparison condition means, divided by the pooled SD), with ESs coded so that positive signs indicated greater risk reduction. DATA SYNTHESIS: Across the studies, reductions in sexual risk were greater for adolescents who received the HIV risk-reduction intervention compared with those in the comparison conditions for 5 dimensions: condom use negotiation skills (mean ES, 0.50; 95% confidence interval CI, 0.41-0.59), condom use skills (mean ES, 0.30; 95% CI, 0.09-0.51), communications with sexual partners (mean ES, 0.27; 95% CI, 0.19-0.36), condom use (mean ES, 0.07; 95% CI, 0.03-0.11), and sexual frequency (mean ES, 0.05; 95% CI, 0.02-0.09). Interventions achieved greater success with condom use (1) in noninstitutionalized populations, (2) when condoms were provided, (3) with more condom information and skills training, (4) when the comparison group received less HIV skills training, and (5) when the comparison group received more non-HIV-related sexual education. CONCLUSION: Intensive behavioral interventions reduced sexual HIV risk, especially because they increased skill acquisition, sexual communications, and condom use and decreased the onset of sexual intercourse or the number of sexual partners.