Characteristics and Impacts of HIV Risk-Reduction Interventions Targeting African American Adolescent Women: A Systematic Review

Introduction: African American (AA) young women are overwhelmingly disproportionately burdened by HIV/AIDS throughout the United States today. AA adolescent females make up only 15% of the U.S. adolescent female population; yet, by the end of 2012, they comprised 64% of the female adolescents in the U.S. living with HIV. Moreover, as AA women are often diagnosed late in the disease process, it is believed that many AA women receiving their diagnosis in early adulthood were infected with HIV during adolescence (ages 13-24). Thus, there is a critical need to identify efficacious strategies for reducing the burden of HIV for all AA women, starting with adolescent AA women before many of the risk factors associated with HIV infection are already well embedded in women’s lives. The purpose of the current study is to identify the characteristics of interventions with demonstrated efficacy in reducing HIV risk factors among AA adolescent women (ages 13-24) to inform future intervention development and dissemination. Methods: PubMed and PsychInfo databases were searched for peer-reviewed journal articles published between 2005 and 2015 reporting the efficacy of HIV risk-reduction interventions in the U.S. targeting AA adolescent women less than 25 years of age. Included articles were analyzed to identify the characteristics and impacts of efficacious interventions. Results: Twenty-four articles assessing the efficacy of 15 interventions were eligible for inclusion. Interventions represented a total of 7,659 AA adolescent women and primarily drew from self-efficacy and power-based theories. Most interventions consisted of in-person knowledge and skills-based group or individual sessions led by trained AA female health professionals. Three interventions were delivered via personal electronic devices and one via television and radio ads. All programs intervened directly at the individual-level; two additionally targeted mothers of girls; one targeted friends; three targeted sexual partners. Most interventions successfully improved HIV risk-reduction knowledge, intentions, and self-efficacy. Half resulted in improvements in consistent condom use, three reduced other STI incidence, and 3 improved communication with sexual partners or parents. Conclusions: Overall, efficacious interventions targeting AA adolescent women promote gender and ethnic pride and HIV risk-reduction self-efficacy and skills building. They target multiple socio-ecological levels and tailor content to the specific age range, developmental period, and baseline behavioral characteristics of participants.  Demonstrated sustainability of program impacts to date are limited and should be addressed for program enhancements and scale up.