PROJECT SAFE--REDUCING RISK AMONG ADOLESCENTS

Minority group inner-city adolescents are at particular risk for acquiring HIV/STDs. Although theory-based interventions have been successful, the magnitude of effects is small. We propose a 3-group intention-to-treat randomized controlled trial involving 600 minority group inner-city adolescents drawn from two high-risk groups: sexually active youth seeking care at our medical center and adolescent children of HIV+ parents. We will evaluate the effectiveness of Project Safe, an intensive state-of-the-art peer counseling training program for high-risk adolescents 14-17 years of age, in reducing risk for HIV/STDs and drug/alcohol use. There are two control groups. The "attention" control is TEEN, which is intensive as Project Safe and provides peer counseling skills, but omits substance use/sexual risk. The "curriculum" control is StayCool, a risk reduction program using the same curriculum as Project Safe but without the peer counseling delivery system. Project Safe has a paid 15-session peer counselor training program providing communication skills and knowledge/skills about sexual risk reduction and substance use, and a 10-week paid internship of 4-6 hrs/wk in a community organization. Project Safe helps adolescents recognize how gender-specific expectations of sexual behavior increase HIV/STD risk; is more intensive than most risk reduction programs at over 70 contact hours; and uses a peer counseling training program as its "delivery system." We hypothesize that being a peer counselor will increase the participants' own success in personal risk reduction. Adolescents will be interviewed five times over 18 months to evaluate whether Project Safe: increases AIDS/HIV and substance use knowledge; improves communication skills; increases accuracy of risk perception, outcome and efficacy expectancies, personal control, subjective norms and intention to engage in safer behaviors; decreases substance/alcohol use, especially in conjunction with sex; decreases the number of episodes of sexual intercourse without a condom; and increases abstinence/decreases the number of sexual partners.