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Street Smart (SS) is an effective HIV preventive intervention for homeless youth selected by the CDC as part of Replicating Effective Programs. However, substantial relapse diminishes the program’s effects over two years. This study examines a computerized strategy for maintaining the efficacy of the SS intervention for 400 homeless youth in Los Angles, CA. A two-stage sampling strategy (agency level and then youth within agency) was conducted in a randomized controlled trial examining the efficacy and cost-effectiveness of SS for reducing risk for HIV among homeless youth aged 12-20 years in three conditions:

• SS, but no maintenance strategy
• SS and a 2. computerized internet-based strategy for behavioral maintenance (Computerized SS; n=100)
• A one-session AIDS video Control Condition (CC; n=100)

Based on a social learning theory, the maintenance strategy provides skill training, social support, informational updates, and access to an expert for consultation, referrals, and coping with emerging crises. Youth are assessed at recruitment, and at three-, six-, 12-, 18-, & 24 month intervals in three domains:

• Youth’s substance use and sexual behaviors.
• Youth’s and staff members perceptions of the program’s acceptability and quality and program. utilization over time.
• Generalization of the program’s effects on youth’s problem behaviors (sex work, delinquent acts,. conduct problems, school truancy/unemployment, emotional distress, and chronic homelessness).

Three recent independent national datasets suggest that the rate of new HIV infections in Botswana appears to be declining, as evidenced by decreased prevalence among pregnant women aged 15-49. However, it is still uncertain why these declines have been observed and the extent to which behavioral changes (e.g., monogamy, condom use) have been causally associated with the decline. The goal of this study is to use qualitative research methods to lend additional depth to existing surveillance data that suggest that HIV prevalence among young people in Botswana is declining. Focus group discussions and individual in-depth interviews are conducted with Local. youth service providers Youth between the ages of 18-24. Adult key informants in three districts selected for regional diversity and variation of trends in HIV. prevalence By gathering information from young people and key informants who provide health-related services to young Batswana, we will gain valuable insight into the behavioral and contextual factors that may assist in explaining the observed decreases in HIV prevalence. Qualitative methods will allow us to explore the meanings and variations of the sexual experiences of young Batswana. This work may also lead to the development of innovative behavior change strategies to help support the decreased spread of HIV in Botswana.

This study will develop a computerized intervention to train youth to regulate their emotions. This strategy is based on our previous successful experiences developing computerized interventions. We will develop a computerized intervention to reduce HIV risk behaviors grounded in a framework that augments Social Cognitive strategies by increasing the adolescents’ skills to manage affect and self-regulate. The CARE (Controlling and Regulating Emotions) intervention will target situations in which sexual risk behaviors occur and develop skills that allow adolescents to recognize intense affect, build strategies for tolerating intense affect and interrupt cycles of maladaptive expressions of affect in those situations.

Studying Youth in Northern California (SYNC) is a public health research study assessing narcotic and stimulant use among 14-25 year-olds in five Northern California counties with an emphasis on how such factors and forces place this population at risk for HIV and related health problems. The SYNC Study is a multidisciplinary collaboration of researchers and public health experts from SFSU, UCSF, & the counties of Alameda, Contra Costa, San Francisco, San Joaquin and San Mateo funded by the California Department of Health Services/Office of AIDS (CDHS/OA). SYNC hopes to provide information to complement previously collected data from the Young Women’s Survey (YWS) and HEYMAN studies, which were also collaborative efforts of the CDHS/OA and CAPS. This study will help to inform future public health interventions and policy targeting youth. The SYNC Study will be conducted in two phases: A formative qualitative information gathering phase regarding drug use in youth and risk of HIV 1. An epidemiological study of the prevalence of narcotics and stimulant use in 2. youth and young adults in the 5 counties. All the information we get will be used to assist county public health agencies and organizations to improve services for the treatment and care of youth at risk, and to develop better methods of helping young people prevent drug use and disease and promote good health.

Among the numerous health disparities disproportionately burdening people of color, HIV/AIDS is among the highest. In the African American community the HIV/AIDS epidemic is one of the most urgent public health issues. In order to address the health disparity in HIV/AIDS, detection of HIV in the African American community is crucial. The benefits for early detection of HIV include potentially prolonged duration and quality of life for those living with the virus. HIV testing has also been proposed as a HIV preventive strategy. Detection of HIV has a number of potential preventive benefits, including reduced transmission risk behaviors by those infected9 and reduced viral load by those taking antiretroviral medications, whereby potentially reducing transmission. The proposed study makes a significant public health impact by developing and pilot testing an innovative strategy to increase the number of high-risk adolescents receiving HIV screening. In response to PA-09-146 (Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials [r34]), we propose a pilot study to examine the acceptability and feasibility of a peer-driven, HIV-testing campaign. Peer education and outreach strategies have been successful at reducing sexual risk behavior and increasing the use of health resources in adolescents and other at-risk groups, including adults residing in census tracts where STI rates are high. A potential vehicle for outreach to adolescents is socially interactive technologies (e.g., text messages). The proposed study makes a scientific impact in examining the effectiveness of messaging diffused through the social network of adolescents. A total of 100 current patients at an urban adolescent health clinic serving predominately African Americans will be recruited to disseminate at least 5 text messages to friends they believe are sexually active. Youth will be provided with a brief guide to help them develop their messages. The youth generated text messages will encourage their friends to visit the clinic and get tested. The specific aims of this project are to: Aim 1: Develop protocols and a theory-informed message guide for a peer-driven text message intervention for adolescents recruited from an adolescent health clinic. Aim 2: Examine the acceptability and feasibility of sending text messages related to obtaining HIV/STI testing. We will obtain participant feedback and examine the recruitment rate, number of youth failing to meet inclusion criteria, number of youth verified to have sent text messages, and number of text messages sent. We will also obtain feedback from the clinic providers regarding impact on patient and services flow, provider reactions, and impact on clinical visit. Aim 3: Preliminarily examine the efficacy of a youth generated messaging intervention to increase the: 1) number of high-risk youth seeking services and 2) clinic volume as measured by: a) number of new patients at clinic, b) increase in rate of new patient appointments, and c) number of STI tests conducted. If successful, the proposed study will significantly contribute to the field of HI prevention by examining the acceptability, feasibility and potential impact of an innovative strategy for delivering messages to high-risk youth, which encourage connection with the healthcare system and screening for HIV. This trial will fill a critical need to improve the sexual health outcomes of high-risk African American youth and lay the groundwork for a subsequent R01 proposal with a larger sample and that would include control sites. PUBLIC HEALTH RELEVANCE: Adolescents exhibit high rates of STI/HIV, which have implications for a myriad of other sexual health issues, including reproductive health. Further, African American youth are disproportionately impacted by HIV. The proposed study will significantly contribute to the field of HIV/STI prevention by examining the impact of an innovative strategy for delivering telehealth messages to high-risk youth that encourage connection with the healthcare system and screening for HIV. This trial will fill a critical need t improve the sexual health outcomes of high-risk youth.