Effectivenss of Behavioral HIV Prevention Interventions for African American Youth and Young Adults: A Systematic Review

Purpose: African American youth and young adults (YYA) are disproportionately affected by HIV. In 2010, approximately 60% of new HIV cases among those ages 13-24 years occurred in African Americans, 80% of whom were male (CDC, 2012). Although several behavioral HIV prevention interventions have been developed and tested with African American YYA, there has not been a systematic review that has examined the effectiveness of these interventions while taking into account the methodological rigor of the studies.  Thus, the purpose of this review was to 1) identify and describe the types of  behavioral HIV prevention interventions  delivered to African American YYA and 2) to determine what interventions are most effective (group vs. individual; low vs. high intensity)  when considering the rigor of the study’s methods.  

Methods: A systematic search of 6 databases was conducted to identify articles in peer-reviewed journals published between 1996 and 2012. Studies were included if they met the following criteria:  1)  conducted in the United States; 2) included a sample that was at least 50% African American with a mean age between 13-29 years; and 3) reported condom use as an outcome. All types of study designs were included. Methodological rigor of each study was assessed using an adapted version of the Methodological Quality Rating Scale (Miller, 1995), which was used to distinguish between low and high levels of methodological rigor, as well as to identify areas of methodological strengths and weakness in each study. Eleven studies targeted only females, and two only males. Level of methodological rigor was combined with statistical significance for each outcome of interest to create an outcome attainment score.  The primary outcome of interest for this review was condom use. Secondary outcomes included self-efficacy for condom use and knowledge of HIV risk. These outcomes were compared by intervention modality (group vs. individual) and number of sessions (single session vs. multiple sessions).

Results: Fourteen studies met inclusion criteria. Eleven of the studies were group-level interventions, three of which included a supplemental component (e.g. follow-up phone call, single session for parents). All group interventions used trained facilitators and included educational and skills-training components. All individual-level interventions also included education, but only one focused on skills training. Overall methodological rigor was high, with a median score of 10 on a 14-point scale. Eleven of the studies reported significant results for increased condom use, 8 of which also had high methodological rigor. Group-level interventions, specifically those with the supplemental component, were most effective at increasing condom use. Outcome attainment for secondary outcomes was also consistently higher for group-level interventions. Number of intervention sessions did not appear to be associated with effectiveness for increasing condom use, self-efficacy, or knowledge of HIV risk.  

Conclusions and Implications: This review found that group-level interventions have the strongest evidence for effectively increasing condom use among African American YYA, regardless of number of sessions. These interventions may be more cost-effective than individual level interventions or those requiring more sessions, a finding that may be useful for organizations with limited resources.