A family-based, culturally sensitive HIV prevention program for delinquent Hispanic youth in South Florida may have reduced the teenagers’ sexual risk-taking, researchers suggest.1 Six months after baseline, and after participating with their parents in the intervention, 12–17-year-olds were significantly less likely to report inconsistent condom use during recent vaginal and anal sex than were adolescents whose families received services from community agencies. Intervention participants, compared with their counterparts, also reported significantly fewer days of unprotected sex while high on drugs or alcohol, and fewer sexual partners in the past 90 days. Additionally, a smaller proportion of participants than of nonparticipants reported having engaged in unprotected anal sex at last intercourse.
Because family plays a fundamental role in Hispanic populations, Familias Unidas aimed to improve family functioning as a way to prevent HIV risk behaviors. In a randomized controlled trial from August 2009 to June 2010, researchers assigned delinquent youth and their parents either to the intervention or to community agencies that work with troubled youth. Adolescents were referred by the Miami–Dade County Department of Juvenile Services and public school system. To participate, youth had to have at least one parent from Latin America, be 12–17 years old, live in South Florida during the study and be delinquent. Youth were considered delinquent if they had engaged in behavior such as assault, burglary or substance use, or had been arrested.
During a three-month period, parents of intervention youth attended 12 sessions that covered positive parenting, family communication, parental monitoring and adolescent HIV risk behaviors; four of these sessions included youth participation. Nonintervention participants received standard services aimed at reducing delinquent behavior, including individual and family therapy. Families in both groups received the school system’s HIV prevention curriculum. At baseline and at six months, all participants completed questionnaires in English or Spanish using an audio-enhanced, computer-assisted self-interviewing system.
Adolescents were asked about their sexual experience and risk behaviors ever, during the past 90 days and most recently. They also were asked if they ever had contracted an STD. Researchers used measures of positive parenting, parent-adolescent communication and parental monitoring to create a single measure of family functioning. Generalized linear models and chi-square tests were used to compare differences between the intervention and control groups at six months.
In all, 242 families participated, of whom 120 were assigned to the intervention and 122 to community agencies. In both groups, two-thirds of adolescents were male, and youths’ average age was 15.
At baseline, about half of each group had had vaginal sex, and one-quarter had had anal sex. Substantial proportions reported not having used condoms at last vaginal sex (32–44%) or at last anal intercourse (19–43%). In the past 90 days, frequency of condom use, measured on a scale of 1–5, was moderate for both of these activities (means, 2.9–3.2 and 2.5–3.1, respectively). Also in the past 90 days, adolescents in both groups had averaged 4–5 partners and had experienced unprotected vaginal sex while high on drugs or alcohol (on an average of two days for intervention participants and on less than one for controls). Two percent of intervention youth and 4% of controls had had an STD. Family functioning for both groups was moderate.
At six months, intervention youth were significantly less likely than controls to report some HIV risk behaviors. For example, intervention youth were 39% less likely than controls to report inconsistent condom use during vaginal sex and 60% less likely to report it during anal sex in the past 90 days; they were 76% less likely to report unprotected anal sex at last intercourse. Compared with controls, adolescents in the intervention had half the mean number of days of unprotected sex while high on drugs or alcohol (1.7 vs. 3.5, respectively), and significantly fewer partners (4.7 vs. 6.6). Seventeen percent of youth in the family-centered program, compared with 69% of controls, reported unprotected anal sex at last intercourse. Finally, family functioning increased from moderate to moderate-to-high for the intervention group, but remained moderate for controls.
The researchers acknowledged several study limitations. Because of the small sample, results may not apply to all Hispanic teenagers, or even all delinquent Hispanic teenagers. Self-reported measures for sexual risk-taking and STDs may have created underreporting and skewed conclusions about the intervention’s effects. The study lacked data on exposure to physical and sexual abuse, which are associated with HIV risk behaviors, and on the kind or quantity of community services that the control group used. Nevertheless, study results led researchers to conclude that family-centered interventions may improve family functioning and therefore reduce sexual risk-taking and HIV among Hispanic delinquent youth.—A. Kott