Sexual Risk Reduction for Adolescents
Adolescents continue to make up a significant portion of new HIV cases in the U.S. In 2018, 21% of new HIV cases were identified in youth
aged 13 to 24. Programs that focus on adolescent HIV prevention may develop or adapt programs that aim to reduce
sexual risk-taking behaviors of youth.
Comprehensive risk reduction (CRR) for adolescents is recommended
by the Guide to Community Preventive Services, which reports that both CRR interventions and
interventions which integrate community service have been effective in reducing sexual risk behaviors among
adolescents 10-19 years old. CRR
interventions promote behaviors that have been shown to prevent or reduce the risk of HIV infection.
Interventions are group-based, aim to build skills and increase knowledge for youth, and can be implemented in
school or community settings.
The Centers for Disease Control and Prevention (CDC) in collaboration with the Association for Supervision and
Curriculum Development (ASCD) developed the Whole
School, Whole Community, Whole Child (WSCC) model that represents an approach to keep youth healthy,
safe, and engaged. This model has been used by different communities to develop and implement programs in
schools targeting HIV, STI, and pregnancy
prevention. The WSCC model emphasizes keeping youth at the center of program development and
implementation, and may be helpful for rural communities planning interventions to reduce adolescent sexual
Examples of Rural Comprehensive Risk Reduction Programs for Adolescents:
Native STAND is an example of an adapted CRR program to target and
improve decision-making for American Indian/Alaska Native youth in several rural states. STAND, or Students
Together Against Negative Decisions, is a curriculum developed to train peer educators in rural Georgia to
work with other adolescents to improve knowledge and decision-making related to HIV, pregnancy, and sexually
transmitted infections (STIs). An evaluation of
STAND found that the program was effective in improving specific sexual knowledge and behaviors
among participants in the school group.
African American Families-Teen (SAAF-T) is a risk reduction intervention included in the Centers for
Disease Control and Prevention Compendium of
Evidence-Based Interventions and Best Practices for HIV Prevention. This model was designed to
target African American adolescents and their families living in the rural South. The intervention aims to
reduce unprotected sex and increase condom use through group-level skills training. An evaluation of program
implementation in Georgia public high schools from 2007 to 2010 demonstrated that participants
reported significantly lower frequency of unprotected sex after completion of the program.
Considerations for Implementation
Programs targeted at adolescents must consider the most appropriate setting for the intervention, including
location, gender composition of the group, transportation issues, and group leadership. CRR interventions
implemented in public schools in particular must be aware of state laws that could
prohibit discussion of sexual risk behaviors. Some states may mandate or encourage abstinence-only education,
which may not be compatible with the curricula of some interventions or with condom distribution programs. State
laws also vary about whether parental
consent is required or can be revoked (through “opt-out” policies) for sexual education or
HIV education in the schools.
Programs implementing HIV prevention interventions
aimed at adolescents should consider the many challenges specific to prevention efforts with this
population. Some of these challenges may include:
- Lack of sufficient and quality sex education in schools that covers HIV and STI prevention
- Low rates of HIV testing and low rates of condom use
- Engaging in riskier sexual behaviors, including having multiple partners and older sexual partners
- Lower likelihood of using HIV medication (Pre-exposure prophylaxis (PrEP)) to prevent transmission
- Stigma about HIV and prevention
For more implementation considerations for programs working with adolescents, please see Module 4: Implementation Considerations/Adolescents.
Resources to Learn More
HIV Risk Reduction Tool
Customizable profile allowing individuals to gauge their HIV risk or reduce their risk based on gender and
lifestyle habits. Presents information about different methods of HIV prevention and includes a feature to
identify the availability of local testing and prevention services.
Organization(s): Centers for Disease Control and Prevention (CDC)
HIV, STIs and Teen
Offers a variety of evidence-based HIV prevention intervention resources categorized by the target population
with a focus on adolescents10-19 years of age.
Organization(s): Community Preventive Services Task Force (CPSTF), The Community Guide