摘要：Objectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence. HIV prevention interventions have been developed for several at-risk adolescent populations, including homeless and HIV-positive adolescents, and these programs have been conducted at a range of venues such as schools and clinics. 1 – 4 However, 1 subgroup of adolescents at considerable risk for HIV—young women who have experienced gender-based violence—has been relatively neglected by HIV prevention programs. Research has shown that the prevalence of gender-based violence among adolescents ranges from 9% to 39% 5 – 9 and that rates may be higher among African American female adolescents than among female adolescents from other racial/ethnic groups. 5 , 7 In addition, a seroepidemiological study of Job Corps applicants showed that HIV prevalence rates among African American female adolescents were significantly higher than rates among their White or Hispanic female peers (4.9, 0.7, and 0.6 per 1000, respectively) and exceeded those observed among White, Hispanic, and African American male adolescents (0.8, 1.5, and 3.2 per 1000, respectively). 10 Several studies have shown that adolescents with sexually or physically violent partners engage in HIV risk-taking practices, including having multiple sexual partners, initiating sexual intercourse at an early age, and abusing drugs. 11 – 17 Moreover, studies have revealed associations between gender-based violence and HIV infection. 18 – 21 According to this body of research, gender-based violence may either operate indirectly, through social mechanisms (e.g., women are predisposed to engage in HIV risk taking because they perceive that they lack the power to negotiate and practice safe sex), or operate directly, through biological mechanisms (e.g., having nonvolitional intercourse with an HIV-infected partner). Given the relation between gender-based violence, HIV risk, and HIV infection, designing HIV prevention programs for this vulnerable population is critical. In an earlier study, DiClemente et al. 22 described the efficacy of an HIV prevention program, conducted among sexually experienced African American women, in reducing risky sexual behaviors, decreasing the incidence of sexually transmitted diseases (STDs), and enhancing psychosocial mediators (e.g., HIV prevention knowledge, condom use self-efficacy) associated with HIV-preventive behaviors. We examined the efficacy of the intervention among a subsample of participants in the same study who reported a history of gender-based violence.
