Black teen girls at very high risk for HIV infection

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Sexually active black teenage girls are at particular risk for infection with the virus that causes AIDS, but specially tailored prevention programs built around race and culture can help reduce their risk, according to a new report published in the Journal of the American Medical Association.

"Adolescents are acknowledged as a population at increased risk of human immunodeficiency virus (HIV) infection. Among adolescents, African American girls are a subgroup at particularly high risk of HIV infection," writes Ralph J. DiClemente of the Rollins School of Public Health at Emory University in Atlanta, the report's lead author.

But until now, "no intervention designed specifically for this population has demonstrated efficacy in reducing HIV-associated risk behaviors," Mr. DiClemente adds.

As for the risk HIV poses black female teens, Mr. DiClemente cites a study of Job Corps applicants that found the virus prevalence in this group was "significantly higher than among their white or Hispanic peers" and also exceeds that of white, Hispanic and black male adolescents.

The report in JAMA, which had a total of 13 contributors, noted that the Job Corps study found that black teenage girls had an HIV prevalence rate of 4.9 per 1,000. That compared with rates of 0.7 and 0.6 per 1,000 for Hispanic and white girls, respectively.

Among teenage boys, HIV prevalence among blacks was 3.2 per 1,000; 1.5 per 1,000 for Hispanics; and 0.8 per 1,000 for whites, the study says.

"African American adolescent girls in the South had the highest prevalence (6.4 per 1,000) relative to adolescents from other geographic regions," Mr. DiClemente writes.

The report by Emory investigators, which is to be presented this weekend at the 15th International AIDS Conference in Bangkok, comes one month after the release of frightening data by the federal Centers for Disease Control and Prevention. The CDC data show that AIDS is the leading cause of death among black women ages 25 and 34 in the United States and that it is also one of the top killers of black women ages 20 to 44.

In the JAMA study, which ran from December 1996 to April 1999, researchers focused on 522 black girls between the ages of 14 and 18 who were sexually experienced. They came up with a new education and prevention program specifically earmarked for this population.

About half of the girls were randomized to the "intervention" group, in which they were given information about "ethnic and gender pride," HIV, communication, condom use and application skills, and "healthy relationships."

"Peer educators (also black) were instrumental in ... creating group norms supportive of HIV prevention," the study says.

Other girls in the study received information only about exercise and nutrition.

Investigators evaluated the intervention program to determine its effectiveness in reducing risky sexual behaviors, sexually transmitted diseases, and pregnancy in this population and to see if it improved HIV-prevention behaviors.

Outcomes the researchers were looking for did not include sexual abstinence, as they thought this goal was unrealistic. Instead, they were seeking changes such as routine condom use and fewer sexual partners, recognizing that many Americans do not believe unmarried teens should be having sex.

The study found that in the 30 days before the six-month and one-year follow-ups, about three-fourths of the girls in the HIV intervention group reported using condoms. By comparison, fewer than 60 percent of girls in the second group said they used condoms.

Black girls in the intervention group also were less likely to report a pregnancy or STD, or indicate that they had a new sexual partner.

They held that it is "compellingly urgent" to develop new HIV-prevention strategies for at-risk groups. But to be "optimally effective" among teens, the authors say, HIV "must emerge from the stigma of a hidden epidemic and become a public health priority."