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Rural Health Information Hub
Rural Health Information Hub

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 risk-taking behaviors.

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.
  • Strong 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
Website
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 Pregnancy
Website
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