The results of this study offered useful insight on designing effective prevention programs.
Youth LIGHT was a study to address critical gaps in research on HIV/AIDS prevention with high risk youth, offering an opportunity to shift patterns of sexual risk behaviors among delinquent youth at risk of becoming HIV seropositive adults. An intervention with established efficacy for high risk adults, Project LIGHT, was adapted for high risk adolescents. Youth LIGHT tested the hypothesis that a computerized version of Project LIGHT would be as efficacious as the interpersonal, small-group delivery of the intervention in reducing the sexual risk behaviors of delinquent youths. Youth LIGHT was intended to appeal to youth by changing the traditional methods for teaching and sharing information while getting them to think about their HIV and STI risk behaviors. The study was conducted in partnership with the Los Angeles County Office of Education, and the Juvenile Division of the Superior Court for the County of Los Angeles.
Targeted Risk Group:
Male and female at-risk youth between 14-21 years old, attending LA County alternative education high schools located in the community and in juvenile hall camps.
Interventions, Training Manuals, etc. :
Youth Light Workbook (1099)
|Session 1: Introductory education/preparedness – basic information about HIV/AIDS; motivation for self-protection
- Know one another, and begin to learn each other’s names.v Learn about the project (schedule, ground rules, payment).
- Begin to develop a sense of group cohesion, identity and ownership by participating in group activities and developing group rules and rituals.
- Group activity to distinguish facts and myths about AIDS.
- Identify personal values and positive reasons to stay healthy through group brainstorm.
- Identify one personal risk factor for AIDS.
- Identify positive changes they have already made in their lives.
- Begin to learn about AIDS prevention strategies including condom use and HIV testing.
- Meet the animated characters featured throughout the programv Learn about the project
- Introduce and explain the workbook
- Identify personal values and positive reasons to stay healthy by computer activity and workbook
- Play game to distinguish facts and myths about AIDS.
- Complete computerized personal risk assessment and receive feedback regarding likely risk of contracting HIV or other STD.
- Learn facts and statistics regarding HIV transmission and infection
- Complete quiz regarding HIV transmission
|Session 2: Identifying triggers – personal vulnerability; identifying personal antecedents to risk behavior
- Relate one example of HIV/AIDS content encountered since the last session.v Watch video of persons living HIV
- Verbalize one personalizing comment indicating heightened vulnerability.
- Learn to define and identify “trigger” through a group brainstorm.
- Identify one past incident of personal risk behavior on worksheet.
- Identify one personal risk trigger on worksheet.
- Identify one personal goal for the coming session.
- Read and seriously consider signing a Contract of Commitment given by facilitators.
- Watch video of young people living with HIVv Record in workbook one personalizing comment indicating heightened vulnerability.
- Learn to define and identify “trigger” through computer interaction.
- Record in workbook one past incident of personal risk behavior.
- Record in workbook one personal risk trigger.
- Choose one personal goal from a list to try before logging on again.
- Read and seriously consider signing the Contract of Commitment contained in the workbook.
- Complete quiz regarding triggers
|Session 3: Controlling triggers – problem solving and cognitive self-instruction
- Learn the basic steps of problem solving related to HIV risk reduction through a group exercise.
- Apply the problem-solving steps to a variety of hypothetical situations generated by the group that require the handling of risk triggers.
- Generate ask a group a personal list of self-statements to guide behavior change efforts.
- Set personal goal for handling at least one personally relevant trigger for next session.
- Learn the basic steps of problem solving related to HIV risk reduction through interacting with animated character.v Apply the problem-solving steps through modeling from animated character and computer guided workbook exercise.
- Play game about strength of self-statements to guide behavior and record personal list of self-statements in workbook.
- Choose a goal related to handling a common and relevant trigger to try before logging on again.
- Complete quiz regarding steps to problem solving
|Session 4: Condom skills – practice use of male and female condom; needle cleaning skills
- Sort sexual activities by their safety level as a group.v Identify the safest condom and lubricant types available.
- Demonstrate the proper way to place and remove a male condom.
- Demonstrate the proper way to place and remove a female condom.
- Describe the proper way to clean needles.
- Sort sexual activities by their safety level in a game.v Watch a demonstration of the proper way to place and remove a male condom
- Watch a demonstration of the proper way to place and remove a female condom
- Choose one personal goal from a list related to proper condom choice and use to try before logging on again
- Complete quiz regarding steps to proper use of male and female condoms
|Session 5/6: Protecting myself– assertive communication
- Identify “unwritten rules” of social behavior that can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive.
- Apply the TALK tools for refusing unsafe sex and/or requesting safe sex through role-play with other group members.
- Learn how “unwritten rules” of social behavior can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive.
- Watch video of youth negotiating for condom use
- Apply the TALK tolls for requesting safe sex through interaction with avatar that is recorded and played back.
|Session 6: Maintenance and relapse prevention – reinforcement of previous skills and advocacy
- Identify situations that might lead to relapse.v Learn to deal effectively with potential relapse situations.
- Identify self-rewards for maintaining safer sex behavior
- Identify ways to make safer sex more enjoyable.
- Learn ways in which to “spread the word” about what was learned in the group
- Learn how skills of problem solving and self talk can help one effectively deal with relapse through interacting with animated character.v Watch as animated characters identify self-rewards maintaining safer sex behavior.
- Watch as animated characters identify ways to make safer sex more enjoyable
- Learn steps with modeling from animated characters about ways to “spread the word” about what was learned from the program
To illustrate the operations of the computer intervention, we have constructed a table which illustrates the parallel structure between the small group Project Light, and Project Light delivered via computer.
Students aged 14 to 18 years attending 22 alternative education high schools located in the community and in juvenile hall camps were assessed at baseline and 3, 6 and 12 months. The baseline and follow-up assessments required about 1.5-hour to complete. Each recruitment school was randomized into one of three study conditions: 1) Interpersonal Intervention, 2) Computerized Intervention or, 3) Control. Students attending the same school received the same intervention condition.
Results from the pilot of this study support the use of computers as a tool for HIV prevention. Youths receiving the computerized intervention were successful in reducing their sexual risk behaviors.
Computerized interventions, which are relatively easy to implement and sustain, appear to be a potentially effective means of promoting reductions in HIV-related sexual risk behaviors. Interactive computer programs may help youths learn skills to prevent HIV infection and instill in these youths the self-efficacy to apply these new skills. These attributes may be particularly useful in international settings where concerns of cost-effectiveness and ease in dissemination are of paramount importance.