标题：Mass Media as an HIV-Prevention Strategy: Using Culturally Sensitive Messages to Reduce HIV-Associated Sexual Behavior of At-Risk African American Youth
摘要：The evidence base and theoretical frameworks for mass media HIV-prevention campaigns in the United States are not well-developed. We describe an intervention approach using culturally sensitive mass media messages to enhance protective beliefs and behavior of African American adolescents at risk for HIV. This approach exploits the potential that mass media messages have, not only to reach a large segment of the adolescent population and thereby support normative change, but also to engage the most vulnerable segments of this audience to reduce HIV-associated risk behaviors. The results from an ongoing HIV-prevention trial implemented in 2 medium-sized cities in the United States illustrate the effectiveness of this intervention approach. The incidence rate of HIV in the United States is 7 times higher among African Americans than among Whites, 1 with disproportionate transmission through heterosexual contact. 2 Although adolescents with HIV/AIDS represent a minority of US cases (approximately 5%), they constitute one of the fastest growing groups of newly infected persons in the country, and African American adolescents are disproportionately affected. Of the estimated 18 849 persons under the age of 25 years who were diagnosed with HIV/AIDS during 2001 through 2004, 61% were Black. 3 Given these data, it is imperative that interventions focus on African American adolescents and specifically address the concerns that are unique to this population. In addition, it is especially desirable for HIV-prevention interventions to reach as large an audience as possible. Mass media campaigns are well-suited to meet these goals because media have wide reach. 4 , 5 Adolescents in general, and African American adolescents in particular, are heavy users of media; and media messages can be culturally targeted to this audience. Furthermore, experience from commercial marketing suggests that African Americans respond favorably to mass media messages designed to address their specific interests. 6 , 7 Unfortunately, the evidence for the effectiveness of general HIV mass media prevention campaigns in the United States is weak, 8 and this is particularly true for campaigns targeting African American adolescents. This is partly because researchers face problems in isolating media effects in multicomponent interventions. 4 , 9 In addition, most HIV prevention in the United States has been conducted on an individual level with small group counseling or school-based programs. 10 This practice has been justified through the belief that face-to-face interventions have greater power than mass media to alter HIV-associated risk behaviors, 4 in part because these interventions permit greater opportunities for active participation (e.g., skills training, modeling, and rehearsal) relative to viewing a media message. 11 Here we describe a culturally sensitive approach to using mass media to promote greater acceptance of safer sexual behavior in the wider African American youth audience and, more importantly, to encourage behavior change (condom use) in the youth most at risk for sexually transmitted infections (STIs), including HIV. Interventions can be sensitive to the “surface structure” or “deep structure” of an audience's culture. 12 Surface structure refers to the use of change agents whose background and use of language is similar to that of the audience and the use of channels of communication that can best reach the audience. Sensitivity to deep structure reflects an understanding of how members of the audience conceptualize the health risk in their lives and the barriers they encounter in reducing or managing the risk. We designed an intervention to be sensitive to both types of structures, and we argue that culturally sensitive messages can be designed to actively engage youth, especially those who are most at risk for HIV infection. First, we review what is known about the use of media to influence the adoption of HIV preventive behaviors. We then illustrate the approach with preliminary data from a randomized controlled trial that was designed to rigorously test the effectiveness of such an intervention.
