Family‐Based HIV and Sexually Transmitted Infection Risk Reduction for Drug‐Involved Young Offenders: 42‐Month Outcomes

• Author: Craig E. Henderson,Linda Alberga,Rocio Ungaro,Howard A. Liddle,Cynthia L. Rowe,Gayle A. Dakof
• DOI: http://doi.org/10.1111/famp.12206
• Date: 01 June 2016
• Published date: 01 June 2016

Family-Based HIV and Sexually Transmitted

Infection Risk Reduction for Drug-Involved Young

Offenders: 42-Month Outcomes

CYNTHIA L. ROWE*

LINDA ALBERGA*

GAYLE A. DAKOF*

CRAIG E. HENDERSON

†

ROCIO UNGARO*

HOWARD A. LIDDLE*

This study tested a family-based human immunodeficiency virus (HIV)/sexually trans-

mitted infection (STI) prevention approach integrated within an empirically supported

treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT).

A randomized, controlled, two-site community-based trial was conducted with 154 youth

and their parents. Drug-involved adolescents were recruited in detention, randomly

assigned to either MDFT or Enhanced Services as Usual (ESAU), an d assessed at intake,

3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured

HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI

*Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.

†

Department of Psychology, Sam Houston State University, Huntsville, TX.

Correspondence concerning this article should be addressed to Cynthia Rowe, Department of

Public Health Sciences, Center for Treatment Research on Adolescent Drug Abuse, University of

Miami Miller School of Medicine; 1120 N.W. 14th Street, Miami, FL 33136. E-mail: crowe@med.

miami.edu

This study was funded under a cooperative agreement from the National Institute on Drug Abuse, Grant

U01DA15412-01, as well as R01DA13298-01A1, National Institutes of Health (NIDA/NIH), with support

from the Center for Substance Abuse Intervention, SAMHSA; the Centers for Disease Control and Preven-

tion (CDC); the National Institute on Alcohol Abuse and Alcoholism (all part of the U.S. Department of

Health and Human Services); and the Bureau of Justice Assistance of the U.S. Department of Justice. The

authors gratefully acknowledge the collaborative contributions by NIDA, the Coordinating Center (George

Mason University/University of Maryland at College Park), and the Research Centers participating in

Criminal Justice–Drug Abuse Intervention Studies (CJ-DATS) (Brown University, Lifespan Hospital;

Connecticut Department of Mental Health and Addiction Services; National Development and Research

Institutes, Inc., Center for Therapeutic Community Research; National Development and Research Insti-

tutes, Inc., Center for the Integration of Research and Practice; Texas Christian University, Institute of

Behavioral Research; University of Delaware, Center for Drug and Alcohol Studies; University of Ken-

tucky, Center on Drug and Alcohol Research; University of California at Los Angeles, Integrated Sub-

stance Abuse Programs; and University of Miami Miller School of Medicine, Center for Intervention

Research on Adolescent Drug Abuse). The contents are solely the responsibility of the authors and do not

necessarily represent the views of the Department of Health and Human Services, the Department of Jus-

tice, NIDA, or other CJ-DATS participants. We gratefully recognize the research teams and clinicians;

Ralph DiClemente and his team at Emory University; Pinellas and Miami-Dade County juvenile justice

personnel; Operation PAR in Pinellas County; Here’s Help in Miami; and as always, the adolescents and

families who participated in the study.Conflict of Interest Disclosure: Dr. Rowe receives financial compen-

sation for her roles as Associate Director, trainer, and member of Board of Directors for MDFT Interna-

tional. Dr. Dakof receives financial compensation from MDFT International as its Director. Dr. Liddle

receives financial compensation for his roles as Chairman, member of its Board of Directors, and consul-

tant for MDFT International. Trial Registry Name: Clinical Trials.gov, Identified NCT01910324

305

Family Process, Vol. 55, No. 2, 2016 ©2016 Family Process Institute

doi: 10.1111/famp.12206

prevention as part of ongoing treatment following detention release. Youth in both

conditions and sites significantly reduced rates of unprotected sex acts and STI incidence

from intake to 9 months. They remained below baseline levels of STI incidence (10%) over

the 42-month follow-up period. At Site A, adolescents who were sexually active at intake

and received MDFT showed greater reduction in overall frequency of sexual acts and num-

ber of unprotected sexual acts than youth in ESAU between intake and 9-mont h follow-

ups. These intervention differences were evident through the 42-month follow-up. Interven-

tion effects were not found for STI incidence or unprotected sex acts at Site B. Intensive

group-based and family intervention in detention and following release may reduce sexual

risk among substance-involved young offenders, and a family-based approach may

enhance effects among those at highest risk. Site differences in intervention effects, stud y

limitations, clinical implications, and future research directions are discussed.

Keywords: Adolescents; Families; Human Immunodeficiency Virus; Sexually Transmitted

Infection; Juvenile Justice; Detention; Intervention

Fam Proc 55:305–320, 2016

Juvenile justice involved adolescents frequently have significant drug use problems.

Due to early age at first intercourse, infrequent use of condoms, and other risk behav-

iors (Teplin, Abram, McClelland, Washburn, & Pikus, 2005), these young people are at

high risk for acquiring human immunodeficiency virus (HIV) and sexually transmitted

infections (STIs). Adolescence is a critical risk period for HIV transmission (Lightfoot,

2012), and STI rates among detained youths are several times higher than those for ado-

lescents generally (Golzari, Hunt, & Anoshiravani, 2006). Incarcerated youth are not only

among the most vulnerable populations for HIV/STI infection, but are also least ade-

quately served (Donenberg, Paikoff, & Pequegnat, 2006). Substance use and delinquen cy

influence sexual risk taking into young adulthood (Aalsma, Tong, Wiehe, & Tu, 2010;

Oshri, Tubman, Morgan-Lopez, Saavedra, & Csizmadia, 2013; Tolou-Shams et al., 2007),

thus it is imperative to develop effective interventions to interrupt this cycle of risk

(Donenberg et al ., 2006; Teplin et al., 2005).

Behavioral interventions with adolescents can increase condom use, increase safe sex

practices, and reduce incident STIs (Johnson, Scott-Sheldon, Huedo-Medina, & Carey,

2011). However, serious questions remain about the impact of existing interventions on

the most vulnerable youth (Lightfoot, 2012), including ethnic minorities and those with

highest familial and behavioral risk (Jackson, Geddes, Haw, & Frank, 2012; Liddle, 2014;

Prado, Lightfoot, & Brown, 2013). HIV prevention programs for adolescents that do not

address systemic risk factors have shown small effects on behavioral change and rarely

sustain improvements beyond 1 year (DiClemente, Salazar, & Crosby, 2007; Noar, 2008;

Pedlow & Carey, 2003).

HIV/STI prevention programs have been developed and delivered in juvenile justice set-

tings (Tolou- Shams et al., 2011), yet methodological limitations and lackluster results

leave questions about their efficacy (Bryan, Schmiege, & Broaddus, 2009; Magura, Kang,

& Shapiro, 1994; Robertson et al., 2011; Schlapman & Cass, 2000; Shelton, 2001). For

instance, a sexual risk reduction intervention with incarcerated adolescent girls was more

effective than health education on social and condom use skills postintervention, but

effects were not sustained at 9 months (Robertson et al., 2011). Another HIV preven tion

program incorporated in juvenile drug court showed no effects on sexual risk at 3 months

(Tolou-Shams et al., 2011). More effective HIV/STI prevention for this population is

needed (DiClemente et al., 2007).

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