Fathers in the Atlanta area who participated in a program designed to improve men’s ability to talk to their 11–14-year-old sons about HIV prevention subsequently reported more sexuality-related discussion and greater intention to discuss relevant topics with their sons than did a control group of men who had not taken part in the program.1 Furthermore, their sons were more likely than sons in the control group to say that they intended to postpone intercourse until they married and, if they were sexually experienced, were less likely to report having had unprotected intercourse.
The program was tested in four randomly selected sites of a community-based organization that operates after-school and summer programs for disadvantaged youngsters; another three sites served as controls. At intervention sites, fathers (including nonbiological father figures) of 11–14-year-old males were invited to attend a program that presented information on communicating with adolescents about general topics (e.g., relationships with peers), sexuality-related topics and specific topics related to HIV and AIDS. Seven weekly two-hour group sessions were scheduled, during which information was delivered through lectures, discussions, role-playing exercises, games and videotapes. In addition, participants received a manual that was designed to help them complete weekly take-home activities and set personal goals. At control sites, fathers were invited to participate in seven weekly two-hour group sessions on nutrition and exercise; the format of these sessions was similar to that of the HIV program. At both the intervention and the control sites, youth were invited to accompany their fathers to the last session.
Participating fathers and sons completed baseline questionnaires and follow-up interviews conducted three, six and 12 months later. The baseline questionnaire gathered data on their socioeconomic and demographic characteristics; the follow-up interviews explored fathers’ discussions about sex and intentions to discuss sex with their sons, and adolescents’ sexual behavior and condom use. Researchers used chi-square and t tests to examine differences between the program and control groups.
In all, 277 father-and-son pairs enrolled in the study; participants were roughly evenly divided between the intervention and control sites. Virtually all of the participants were black; on average, fathers were about 40 years old, and youth were 13 years of age. Seventy percent of fathers and sons lived together; 40% of the pairs included the adolescent’s biological father, 15% his stepfather and the rest other friends or relatives. About half of fathers had a high school education or less, and slightly more than half had a yearly income of $10,000–49,999. In the initial interview, 70% of fathers reported ever having discussed a sexuality-related topic with their son, 76% of sons said that they had never had sex and 27% of those who were sexually experienced had ever had unprotected intercourse. At baseline, the intervention and control groups differed only in the proportion of fathers and sons who lived together (63% and 76%, respectively); analyses of outcomes took this difference into account. On average, fathers at the intervention sites attended fewer than half of the scheduled program sessions.
During each follow-up interview, fathers were asked how frequently they had talked to their sons about each of 16 sexuality-related topics and how likely they were to talk to them about each. The groups differed little at the first and second follow-up assessments. However, at 12 months, fathers in the intervention group reported both significantly more discussion than those in the control group (average scores, 23 and 20, respectively, on a scale of 0–48) and significantly greater intention to have such discussion (70 vs. 67 on a scale of 16–80).
The two groups of adolescents showed no difference in the outcomes measured three months after the intervention. At the six-month assessment, youth whose fathers had attended the HIV program reported participation in fewer intimate behaviors than those in the control group (4.0 vs. 4.6 out of a possible eight) and a higher level of sexual inexperience (75% vs. 69%). At the final assessment, these differences were no longer significant. Sexually inexperienced youth in the intervention group were more likely than those in the control group to say at both the six-month and the 12-month assessments that they planned to delay first intercourse until marriage (52% vs. 38% and 42% vs. 34%, respectively). In the six-month interview, sexually experienced adolescents in the intervention group were less likely than comparable controls to report having had intercourse without a condom (32% vs. 57%); the difference persisted at the final assessment (23% vs. 57%).
Given the program participants’ low attendance rate, the researchers consider the results "fairly impressive." Nevertheless, they suggest a number of possible strategies to improve and better measure the intervention’s effectiveness—for example, decreasing the number of sessions but increasing their length, providing booster sessions and replicating the study with a community-based random sample of father-and-son pairs. Further development and evaluation of the program will determine whether "involving fathers [is] an effective means of promoting HIV prevention practices among adolescent males." —D. Hollander
1. DiIorio C et al., REAL Men: a group-randomized trial of an HIV prevention intervention for adolescent boys, American Journal of Public Health, 2007, 97(6):1084–1089.