High-Risk HIV, Sexual Behavior Among Youth in Criminal Justice System Reduced by PHAT Life Intervention

Author(s):

This is one of the first interventions to successfully reduce sexual risk among juvenile offenders on probation.

Geri R. Donenberg, PhD, lead study author and Professor in the Departments of Medicine and Psychology at the University of Illinois

Geri R. Donenberg, PhD

A proactive interventional approach titled PHAT (Preventing HIV/AIDS Among Teens) Life, comprised of videos, games, role-playing and skill-building educational exercises, is effective for teaching high-risk teens in the juvenile justice system about HIV/AIDS and for reducing the risk for high-risk sexual behavior, according to study findings from the School of Public Health at the University of Illinois at Chicago.¹

“PHAT Life is one of the first interventions to successfully reduce sexual risk among juvenile offenders on probation, a population at exceptionally high risk for poor health outcomes,” Geri R. Donenberg, PhD, lead study author and Professor in the Departments of Medicine and Psychology at the University of Illinois at Chicago, told MD Magazine.

According to Donenberg, findings from this study indicate that the importance of PHAT Life, in addition to other evidence-based interventions, should be “delivered and sustained in juvenile justice settings to alter these teens’ negative trajectories.”

In this study, researchers enrolled a total of 163 male and female adolescents (aged 13—17 years) who were recently arrested and placed on probation. The majority of participants were African American (90%), and over half were male (66%). Investigators compared participants’ sexual behavior at baseline with behavior reported at 6-month follow-up.

Participants were randomized to PHAT Life (n= 163) or a similar health promotion program (n= 147). At 6 months, participants randomized to PHAT Life who engaged in highest baseline sexual behavior risk (composite or multiple partners and irregular condom use) reported a significantly lower risk level (no sex or 1 partner plus regular condom use) compared with high-risk participants in the control group (odds ratio [OR] = 4.28, 95% CI [1.37, 13.38], SE = 0.58, P =.01).

Additionally, sexually active participants assigned to PHAT Life and engaged in sexual activity prior to the age of 12 years reported significantly fewer sexual partners than controls at 6-month follow-up (partial eta squared= .32, P= .002).

The short follow-up period of 6 months was a likely limitation of this study, and the self-reported nature of the results may have led to social desirability bias. Despite these limitations, the researchers demonstrated that an educational program may be feasible and effective in at-risk teens for reducing high-risk sexual behavior, ultimately decreasing the chances of HIV/AIDS.

“The 17-year research-to-practice gap is unacceptable, and future study is needed to determine how best to disseminate programs like PHAT Life to ensure that they are self-sustaining," according to Donenberg.

Although the current findings are promising, implementation of this program in the juvenile criminal justice system is needed to see real-world results.

“Several of the strategies used in PHAT Life could be adapted for the clinical setting and doctor’s office visit. Clinicians have the added advantage of the doctor-patient relationship to address some of the key predictors of risk behavior and help teenagers plan for prevention,” explained Donenberg. “As an example, PHAT Life helps youth identify their unique risk-related triggers, namely people, places, moods and situations that promote unhealthy behavior, and then develop personalized plans to manage these triggers. This approach could be adopted and implemented during the medical visit.”

REFERENCE

Donenberg G, Emerson E, Kendall AD. HIV-Risk Reduction Intervention for Juvenile Offenders on Probation: The PHAT Life Group Randomized Controlled Trial [published online February 1, 2018]. Health Psychol. doi: 10.1037/hea0000582.