TLC: Together Learning Choices Print

Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

  • Health promotion intervention for HIV-positive adolescents and young adults
  • Sixteen sessions in two parts: Staying Healthy and Acting Safe modules, each eight sessions
  • Small group intervention
  • Activities to promote problem solving, goal setting, assertive behavior, communication and negotiation skills, and self-awareness
  • Interactive techniques, including role playing, discussions, and appreciation
  • Two trained facilitators

For Use With

  • HIV-positive youth, ages 13 through 24
  • African American youth
  • Latino youth
  • Urban youth

Evaluation Methodology

  • Quasi-experimental design, conducted in nine adolescent clinical care sites in four AIDS epicenters: Los Angeles, New York, San Francisco, and Miami
  • HIV-infected youth receiving care at the clinical sites, randomly assigned to treatment (n=208) and control (n=102) conditions
  • Two pre-intervention assessments, three months apart (n= 310); follow-up at nine months (n=257) and 15-months (n=154) post intervention
     Participants received incentives for taking each survey

Evaluation Findings

  • Reduced numbers of sexual partners
  • Reduced incidence of unprotected sex
  • Increased positive lifestyle changes – females only
  • Increased positive coping actions

Evaluators’ comments: HIV-infected youth who do not change their sexual risk acts or injection drug use may infect others and also become re-infected with new viral strains… It is important to note that the behavioral changes were specific to the content of each module. For example, the Stay Healthy module did not affect sexual risk even though health behaviors did change. The Act Safe module changed substance use and sexual risk but no further changes occurred in health acts.
Rotheram-Borus, Lee, Murphy et al, 2001

Program Description

This small group intervention is designed to help young people who are living with HIV or AIDS to maintain their health, reduce transmission of HIV and other sexually transmitted infections (STIs), and improve the quality of their life. The intervention is based on social action theory and comprises two eight-session modules: Staying Healthy and Acting Safe.[48,49]

Under the guidance of trained facilitators, participants learn skills in solving problems, setting goals, communicating effectively, being assertive, and negotiating safer sex practices. They also improve their self-awareness regarding their feelings, thoughts, and beliefs, especially related to health promotion and positive social interactions. Techniques used in TLC include: role playing; helping youth discern his/her own ideal self; helping participants discuss their feelings of comfort and discomfort; and actions to acknowledge and appreciate participants’ positive behaviors. Sessions are highly interactive and include about 15 participants and two facilitators (usually one male and one female). The program can be delivered in clinical settings or community agencies. The program requires a large room, free from interruptions.[48,49]

Evaluation Methodology

Evaluation comprised nine adolescent clinical care sites in four AIDS epicenters: Los Angeles, New York, San Francisco, and Miami. Evaluation occurred over a 21-month period between 1994 and 1996. Of the 393 HIV-infected youth eligible to participate, 25 refused and 17 were too ill to participate; 351 HIV-infected youth agreed to participate. Every youth gave informed consent and evaluators received parental consent, as well, for non-emancipated youth under age 18. Evaluators conducted two baseline assessments, three months apart, to establish the stability of risk behaviors. Of the 351 recruited, 41 were lost to follow-up at the second pretest. Thus, 310 HIV-infected youth participated in the study: 126 from Los Angeles; 91 from New York City; 49 from San Francisco; and 44 from Miami.[48]

Both baseline assessments were conducted before youth were assigned to treatment or control condition. Then, cohorts of about 15 youth were assigned sequentially to treatment and control conditions. Across nine sites, there were 16 cohorts in the intervention condition (n=208) and nine cohorts in the control condition (n=102). Youth received an incentive of $20 to $25 for each assessment. Regression analysis found no significant differences between treatment and control youth across the two pretests.[48]

Module One, Stay Healthy was delivered over a period of three months to the youth in the treatment cohorts. Treatment and control cohorts were both reassessed at nine months after the second pretest. At nine months, 257 youth were successfully reassessed (treatment youth n=181; control youth n=76). Module Two, Act Safe, was then delivered over a period of three months and youth were re-assessed at 15 months after the second pretest. At 15 months, 154 were successfully reassessed (treatment youth n=124; control youth n=30).[48]

At baseline, 72 percent of participants were male; 88 percent of males self-identified as gay or bisexual. Participants ranged in age from 13 to 24 years; mean age 20.7. Female participants were younger than males by about 1.5 years (P < .001). Most (64 percent) belonged to ethnic minority groups; 55 percent had graduated from high school. For those still enrolled in school (31 percent), the mean grade was 11th. On average, participants had tested positive for HIV more than two years prior to recruitment.[48]

Extensive analyses to assess the presence of selection bias found that subgroups were comparable throughout the study. Evaluation found only three differences. 1) Treatment and control conditions were not balanced by site because seven of nine sites ended with a treatment cohort. 2) Because Miami had more female HIV-infected youth and because Miami’s youth were ineligible for Module Two, more males attended only Module One than attended both modules. 3) Treatment youth were more likely than controls to use social support as a coping strategy (an outcome measure at baseline). In assessment, evaluators controlled for city, gender, ethnicity, and baseline status so that these factors would not confound the findings.[48]

Outcomes

  • Behaviors—
    • Positive lifestyle changes—Evaluation found that female participants in Module One showed a significant number of positive lifestyle changes compared to controls (relative effect size [RES]=46 percent; P=.003) and also compared to intervention non-attendees (RES=35 percent; P =.016).[48]
    • Positive coping changes—Evaluation found that female participants in Module One had a significantly higher positive action coping score than did female controls (RES=18 percent; P =.029). In addition, both male and female participants showed higher social support coping scores than did controls (RES=11 percent; P =.04) or intervention non-attendees (RES=17 percent; P =.006).[48]
    • Reduced incidence of unprotected sex—Compared to control youth, treatment youth reported a lower percentage of unprotected sex acts (RES=82 percent; P =.013). Treatment youth also had a lower percentage of unprotected sex acts than did non-attendees (RES=74 percent; P =.075).[48]
    • Other findings—
      • Reduced substance use—Evaluation found significant reductions in the weighted substance use index between treatment youth and non-attendees (RES=50 percent; P =.024). Differences included prevalence of alcohol or marijuana use (RES=26 percent; P =.045) and the use of hard drugs (RES=45 percent; P =.097).[48]
      • Evaluation found no significant differences between treatment youth and controls or non-attendees in emotional distress or in the number of drugs used.[48]
      • Evaluation also found no significant difference between treatment and control youth or non-attendees in disclosure of serostatus to sexual partners.[48]

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