HORIZONS

HORIZONS is a culturally tailored STD/HIV intervention program for sexually active African American adolescent females. African American adolescent females are at high risk for human immunodeficiency virus (HIV) infection. Studies have consistently found a significantly higher HIV prevalence among African American adolescents than among their white or Hispanic female peers. Interventions specifically designed for this population are necessary to reduce HIV risk behaviors.

The HORIZONS intervention is comprised of 2 group sessions (4 hours each) followed by 4 individual telephone calls (15 minutes each) 9 months after the group sessions. The group sessions occur on two consecutive Saturdays and consist of approximately 8 adolescents. The individual follow-up calls are designed to reinforce prevention concepts discussed in the group sessions. Female African American health educators conduct the group sessions and calls.

The interactive group sessions foster cultural and gender pride and help participants set goals to empower themselves and chart a positive life course. Moreover, the health educators explain why adolescents are at a higher risk of STDs and HIV. Discussion topics include individual factors (perceived peer norms, condom use skills), relationship factors (communication with male partners), socio-cultural factors (douching), and structural factors (male partners’ access to services). Participants practice effective communication techniques through role-play in order to comfortably talk with their sexual partners about their STD status and their willingness to use condoms. Participants also receive $20 vouchers redeemable by their male partner(s) towards the cost of STD services.

The goal of the HORIZONS program is to reduce sexually transmitted diseases (STDs), particularly HIV, by increasing condom use and partner communication about safer sex.

The HORIZONS program empowered African American female adolescents to pursue safer sex and reduced the number of STDs among those in the program.

In a randomized-controlled trial, adolescents who participated in the HORIZONS program were more likely to report consistent condom use in the 60 days preceding follow-up assessments (risk ratio [RR] = 1.41; 95% confidence interval [CI], 1.09 to 1.80; p-value = 0.01), and condom use at last intercourse (RR = 1.30; 95% CI, 1.09 to 1.54; p-value = 0.005) when compared with a group of adolescents who did not participate in the group sessions but who received a moderate amount of sexual health information when they sought services for sexual health. Moreover, fewer adolescents who participated in HORIZONS had a chlamydia infection (42 vs. 67; RR= 0.65; 95% confidence interval, 0.42 to 0.98; p-value = 0.04) or recurrent chlamydia infection (4 vs. 14; RR = 0.25; 95% CI, 0.08 to 0.83; p-value = 0.02).