HIV This Week

Deveaux L, Stanton B, Lunn S, Cottrell L, Yu S, Brathwaite N, Li X, Liu H, Marshall S, Harris C. Reduction in human immunodeficiency virus risk among youth in developing countries. Arch Pediatr Adolesc Med. 2007; 161(12):1130-9.

Deveaux and colleagues address the 6-month efficacy of a human immunodeficiency virus (HIV) prevention intervention targeted to youth and delivered with and without a parental monitoring intervention in a developing country (the Bahamas). The authors conduct a randomized, controlled, 3-cell intervention trial with a 6-month postintervention follow-up in a total of 1282 Bahamian sixth-grade students ( and 1175 parents) in 15 elementary schools in the Bahamas. Youth and parents were randomized at the level of the school to receive the following interventions: (1) Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT), (2) FOYC plus an attention control for parents (Goal for It [GFI]), or (3) an attention control for the youth (Wonderous Wetlands [WW]) plus the GFI. The 10-session FOYC or WW curriculum was delivered as part of the elementary school curriculum. The GFI or CImPACT was delivered to parents in the evenings or on weekends. Risk and protective knowledge, condom use skills, perceptions, interventions, and self-reported behaviours were measured. Compared with the WW, the FOYC significantly increased knowledge, condom use skills, protective perceptions, and intentions to engage in safer behaviours. Among youth, no differences were found in knowledge or condom use skills based on parent intervention; among parents, those receiving the CImPACT demonstrated superior condom use skills after the intervention. In conclusion, protective knowledge, skills, perceptions, and intentions of youth from one developing country can be significantly improved by youth intervention delivered through the schools. Longer follow-up is needed to determine if risk behaviours will be reduced and how long protective results will be sustained.

Editors’ note: It is not surprising that a 10-chapter theory-based school-based HIV intervention emphasising skill development, practice in negotiation, and communication/decision-making had greater effects on knowledge and intentions to practice sexual protective behaviour than a 10-chapter curriculum emphasising the importance of water conservation, wild life, and other natural resources in the Bahamas. What is surprising is that there was no difference in adolescent scores when their parents participated in ImPACT, a parental monitoring and communication intervention that had been effective in the USA in reducing adolescent HIV risk behaviours when combined with a similar adolescent risk reduction intervention, compared to a control intervention for parents (a 20 minute video about career goals). The most likely explanation may be that ImPACT, which included a condom demonstration, was modified for the Bahamas for delivery only to parents and not to parents and youth together. The opportunity was missed to foster the parental-adolescent communication that can make all the difference.