标题：Effectiveness of Circle of Life, an HIV-Preventive Intervention for American Indian Middle School Youths: A Group Randomized Trial in a Northern Plains Tribe
摘要：Objectives. We assessed the effectiveness of Circle of Life (COL), an HIV-preventive intervention developed specifically for American Indian and Alaska Native (AI/AN) middle school youths. Methods. By partnering with a tribal community, we conducted a longitudinal wait-listed group randomized trial with 635 seventh and eighth graders in 13 schools of a Northern Plains tribe. We surveyed participants at baseline, 3 months, and 12 months from 2006 to 2007. Results. COL was found to increase HIV knowledge in the short term, but had no effect on sexual activity compared with those who did not receive it. However, COL was found to be effective for delaying the onset of sexual activity, with the greatest reduction in risk occurring for those receiving COL at early ages. Conclusions. Community partnership was key to successful project design, implementation, and analysis. The project confirmed the importance of the timing of interventions in early adolescence. COL may be a key resource for reducing sexual risk among AI/AN youths. The HIV/AIDS epidemic in American Indian and Alaska Native (AI/AN) persons has received little attention to date. This population, less than 2% of the nation’s total, has yielded relatively small case numbers in national surveillance statistics. 1 Yet, more than 25% of AI/AN individuals living with HIV were estimated to be undiagnosed, a level second only to Asians and Pacific Islanders. 2 Once diagnosed with AIDS, AI/AN persons have the lowest survival rate at 12, 24, and 36 months compared with all other race groups. 1 Moreover, for AI/AN individuals, the epidemic is disproportionately borne by youths, with 23.1% of all HIV diagnoses among this group occurring among those younger than age 25 years. 1 Coupled with high levels of sexually transmitted infections (STIs), early age of first sexual activity, and early onset of substance use, 3–5 AI/AN youths are vulnerable to HIV. Targeted prevention should begin at early ages. However, few youth-focused HIV preventive interventions exist for the AI/AN population. 6–8 None have been rigorously evaluated. We began discussions with our partners in a Northern Plains (NP) tribe about addressing HIV risk in their community. Our partners requested we focus prevention messages on young adolescents using a culturally meaningful HIV risk reduction intervention. Their requests mirrored research on sexual risk-taking among youths: persons initiating sexual intercourse at young ages are at greater risk of an STI 9 and becoming pregnant 10 ; report higher levels of sexual risk-taking 11 ; and respond to culturally appropriate prevention content. 12 Here, following standard guidelines for clustered randomized trials, 13 we present the results of our effort to rigorously evaluate Circle of Life (COL), a theory-based HIV preventive intervention designed especially for AI/AN adolescents.
