New research on family-based HIV prevention presented at annual NIH conference

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Previous research has shown that teens in mental health treatment have high rates of risky sexual behavior, such as not using condoms, which can increase their risk for HIV. Now a new study suggests that family interventions are successful in encouraging these teens to engage in safe sex, despite the cognitive and emotional effects of their mental illness.

According to researchers at the Bradley Hasbro Children's Research Center (BHCRC), parental supervision (such as knowing where your child is and what they're doing) and parent-child communication about sex both play important roles in decreasing the HIV and sexual risks of teens with mental health issues.

"It's clear that family involvement is critical in the development of the sexual attitudes and behaviors of teenagers. However, this is particularly important for teens with psychiatric disorders whose decision-making abilities may be hindered by their illness, causing them to engage in risky behaviors that can potentially expose them to HIV," says lead author Wendy Hadley, PhD, of the BHCRC.

More than 700 teens (ages 13 to 18) in psychiatric programs participated in the study, known as Project STYLE (Strengthening Today's Youth Life Experience). Teens were randomized into one of three HIV interventions - family-based, adolescent-only, and a general health promotion. The family-based intervention focused on parent-teen sexual communication, condom use skills and assertiveness training around sexual discussions. The adolescent-only intervention was nearly identical except that it did not include parent-teen communication. General health promotion highlighted topics such as smoking, diet and exercise.

Among teens in the study, researchers noted that those who were sexually active used a condom 40 percent of the time and engaged in unprotected sex an average of six times in the previous 90 days. Approximately 15 percent of teens said they had been pregnant or had gotten someone pregnant and 14 percent had a sexually transmitted disease at some point.

When Hadley and colleagues compared the results of the family-based and adolescent-only intervention groups, they discovered that those teens receiving family-based intervention reported more open sexual communication with their parents. This was associated with approximately one-third fewer unprotected sexual acts among those participating in the family-based intervention at the six-month follow-up.

Hadley is also an assistant professor of psychiatry at The Warren Alpert Medical School of Brown University. Study co-authors were Larry Brown from the BHCRC and Alpert Medical School, Ralph DiClemente from Emory University, Geri Donenberg from the University of Illinois at Chicago, and the Project STYLE study group.

Juvenile offenders may benefit from family-based HIV prevention

Improving a family's ability to appropriately and emotionally respond to one another and be genuinely interested in each other's activities may help reduce risky sexual behaviors among juvenile offenders, say researchers at the Bradley Hasbro Children's Research Center (BHCRC).

"Juvenile offenders are at increased risk for HIV, since they have higher rates of risky sexual behavior and substance abuse and are more likely to have other mental health issues," says lead author Marina Toulou-Shams, PhD, of the BHCRC. "We wanted to take a closer look at the relationship between family factors and HIV risk among this population in hopes of developing more effective family-based HIV prevention interventions."

Tolou-Shams and colleagues examined data collected from 57 teens participating in a pilot HIV prevention intervention program for juvenile drug court offenders. All participants completed a computerized survey designed to measure sexual risk behaviors, parenting issues (including parent-child communication and parental supervision) and family involvement and responsiveness.

Researchers discovered that teens who reported that their families had greater involvement and appropriate responsiveness were more likely to have protected sex. General family functioning, parent-child communication, parental monitoring and positive parenting were not significantly associated with changes in adolescent sexual risk behaviors.

"Novel intervention approaches, such as family-based HIV prevention and a focus on teaching parents and teens how to manage their feelings rather than the more traditional skills-based tactics, may be important in reducing the HIV risk of juvenile offenders," says Tolou-Shams, who is also an assistant professor of psychiatry (research) at The Warren Alpert Medical School of Brown University.

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