Efficacy of a Family-Based Intervention for HIV Prevention with Sexual Minority Hispanic Adolescents

Background: Currently, there are no evidence-based, family-centered interventions tailored for sexual minority adolescents that target HIV-related risk behaviors and substance use. Prior to embarking on creation of an entirely new intervention, a prudent first step may be to determine if existing evidence-based interventions are efficacious in reducing risk behaviors. In this study, we test whether a non-sexual orientation specific, family-based intervention for Hispanic adolescents, relative to control condition, is efficacious in reducing past 90-day substance use (cigarette, alcohol, illicit drug) and condomless sex (at last encounter) in sexual minority Hispanic adolescent (SMHA) participants. We hypothesize that adolescent-reported family functioning at 6 months post-baseline mediates intervention-related reductions in risk behavior outcomes measured at 12 and 18 months post-baseline.

Methods: Participant data across five distinct randomized control trials testing the relative efficacy of Familias Unidas were synthesized. SMHA were identified based on same-sex sexual contact. Across conditions, SMHA were 73% male, 59% foreign-born and averaged 14 years of age at baseline (range: 12-17). Participants were randomized to Familias Unidas (SMHA n=94) or a control condition (SMHA n=100). A latent family functioning construct - parental involvement, positive parenting, family communication, parent-adolescent communication – was tested for measurement invariance across trials and over time (baseline and 6 months). The final measurement model was incorporated into the mediation model, which controlled for baseline past 90-day substance use and condomless sex. Significant mediation was determined using the product of coefficients test. Effect sizes are reported as fully standardized coefficients.

Results: Partial measurement invariance was confirmed across studies and over time. Family functioning at baseline was significantly and positively correlated with family functioning at 6 months (B=0.88, SE=0.02). Compared to control condition, Familias Unidas participants reported a significant reduction in reported condomless sex (B=-0.32, SE=0.12). Intervention condition was not associated with family functioning at 6 months, which did not have significant associations with subsequent condomless sex or substance use. No other predictors significantly predicted condomless sex or past 90-day substance use.

Conclusion: Family functioning was unchanged over time and did not the mediate the latter reductions in condomless sex. Other intervention components, such as communication about sex, may explain the observed effect. We recommend that future research consider examining parent reports of family functioning, include additional measures of family characteristics (warmth, support) and parental awareness of child’s sexuality. This study provides preliminary evidence that an evidence-based intervention not specific to sexual minorities may positively impact HIV-related risk behaviors.