HIV/AIDS Risk Reduction Among American Indian Adolescents: Longitudinal Results from a Group-Randomized Trial

Introduction: HIV/AIDS is an urgent, emerging disease for American Indian (AI) populations and there is a paucity of evidence-based interventions (EBI) demonstrated with tribal communities. The White Mountain Apache (WMA) is among the first to adapt, pilot and evaluate an EBI for their youth, in response to already high rates of STDs, drug use and unintended pregnancy.  Methods: Formative qualitative research with WMA tribal leaders, stakeholders and community members yielded the selection of Focus on Youth (FOY) as an EBI for adaption and evaluation in their local community. FOY is an 8-lesson curriculum delivered to peer-groups of adolescents and teaches communication and sexual decision making skills, condom use, contraception, information regarding STDs and HIV/AIDS, values clarification and goal setting.  Informed by the qualitative results, FOY and corresponding evaluation tools were adapted to the WMA context. Ten WMA paraprofessionals were trained to deliver the adapted FOY curriculum. WMA youth ages 13 to 19 participated in an eight-day basketball camp in Whiteriver, Arizona (July 2011 or June 2012) during which the randomized trial was implemented. Youth either received FOY or a non-completing control condition in addition to structured basketball activities. Assessments measuring condom use self-efficacy, HIV prevention knowledge, intention and perceptions, partner negotiation skills, condom use, frequency of sex with substance use, and sexual initiation were conducted at baseline, immediately post-camp, and 6- and 12- months follow-up. Results: 267 WMA youth were recruited and consented; n=116 (43.4%) of participants were male. 138 participants were randomized by group to the intervention condition and 129 to control condition. There was a statistically significant improvement in our primary outcome of condom-use self-efficacy at 6-months follow-up among intervention group participants (p<0.001). We will present baseline, 6-month, and 12-month follow-up data. Conclusions: This project employs novel approaches to behavioral health science and HIV/AIDS prevention in a population rarely targeted for HIV intervention research.  The innovation of integrating a basketball camp within a randomized trial increases potential for recruitment and sample maintenance in a difficult-to-reach AI adolescent male population as well as taps WMA youth’s social and cultural enthusiasm for sport. Further, the promise of WMA paraprofessional interventionists in the delivery of culturally sensitive behavior change messages could have important public health impact.  The WMA leadership in adapting a tribal-specific EBI for HIV/AIDS prevention holds promise for curbing a significant health threat for AI communities.