HIV and Its Prevention Amid Brooklyn's Adolescents Term Paper

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HIV Prevention Among Adolescents in Brooklyn

Intervention studies are an approach to health conditions that is being used globally. For any given community, there can be success with intervention studies, or the intervention studies can be insufficient to decrease the effect of health issues upon the community. One medical condition which has been the subject of intervention studies is HIV. While there have been numerous intervention studies of HIV, their result has been both success and failure. In this report, five intervention studies for HIV are reviewed. From these data, a new method to decrease HIV effects upon adolescents in Brooklyn is proposed.

Define HIV

The human immunodeficiency virus (HIV) is a retro-virus that can be passed from one human to another via contact with broken skin, eyes, or vaginal and/or anal tissue (HIV Basics). The process of viral growth includes reproduction, during which structural mutations may occur (HIV Basics). Unfortunately, each of these mutations may include new resistance to drug therapy that was formerly efficacious. Present HIV therapy includes pharmaceutical combinations that function via considerable slowing of the HIV organism's ability to develop resistance (HIV / AIDS)

I. PrEP, Pre-Exposure Prophylaxis

The intent of the PrEP intervention for HIV prevention is to offer those at high risk a daily prophylactic medication. Participants are given Truvada, which is a pharmaceutical combination of emtricitabine and tenofovir, two drugs often used in HIV-treatment. Use of Truvada can aid in prevention of permanent HIV-infection for those at risk due to sexual or drug-use via injection (PrEP).

Even for high-risk individuals, a 92% decrease in HIV-risk has been shown with consistent usage of Truvada and the PrEP intervention / however, failure to take the drug consistently makes it far less effective. While it is known that PrEP can be a powerful weapon in the arsenal against HIV, particularly if combined with condoms and other methods for HIV-prevention, it is only effective with the consent and appropriate behavior of the individual at risk. Basic requirements for the PrEP intervention program include a daily commitment to taking the pharmaceutical as well as an agreement to have a follow-up visit with a health care provider every three months (PrEP).

In the PrEP Intervention Study, participants who took the pill constantly had the lowest HIV infection/transmission risk:

A 49% reduction in risk of HIV-infection was observed for users of injection drugs who took tenofovir once daily (PrEP). A 74% decreased risk of HIV-infection was observed for study participants whose blood levels indicated they were taking tonofovir appropriately (Bangkok Tenofovir Study )

There was a 44% lower probability for those bisexual and gay men given PrEP to become HIV-infected than for those who took a placebo (PrEP). A 92% decrease in risk of HIV-infection was observed for those men who consistently took the pill (iPrEx Study

Comparison of HIV-discordant couples indicated a 75% lower likelihood of infection for those receiving PrEP than for those receiving the placebo (PrEP). As well, PrEP decreased the risk of HIV infection by as much as 90% for those having detectable blood levels of PrEP (Partners PrEP Study )

There was a 62% reduction for HIV-risk for women and men who were heterosexually active and following the PrEP protocols (PrEP). Comparison of participants who became infected with those who did not revealed that the HIV-infected had lower blood levels of the pharmaceutical (TDF2 Study )

No significant evidence of health safety issues, or toxicity, was reported for daily use of the oral PrEP pharmaceutical. Minor side effects such as loss of appetite and/or upset stomach were reported upon initial use of PrEP; however, these generally occurred only during the initial period of usage and generally did not recur (PrEP).

II. Intervention via CHAT

Another HIV-prevention model is called the CHAT Intervention. CHAT consists of one individual 'counseling' session, and five sessions in groups of 4-8 participants. The CHAT model utilizes a philosophy of 'harm reduction' (CHAT Intervention). Peer mentor women are trained in communication methods to discuss HIV and STD risk reduction with family, friends, and sex partners (social network) (CHAT Intervention). The acronym CHAT represents four communication skills taught to participants. These are (a) Choose the correct place and time for the discussion; (b) Hear the other person; (c) Ask questions when possible; and (d) Talk with respect for the other person.

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The CHAT intervention is intended to enhance risk reduction for the peer mentions as well as the members of their social network (CHAT Intervention).

CHAT Intervention Key Effects

Decreased sexual behavior considered 'risky'

Decreased sexual partners

Decreased sex without protection

CHAT Intervention Goals

Decrease HIV-related drug and/or risky behavior

Increase use of condoms

Enhance communication skills re STD/HIV

Decrease sex partners

Enhance social network understanding of sexual risk reduction

Duration of CHAT Intervention

Three week training consisting of semi-weekly 2-hour sessions for a total of six meetings (CHAT Intervention)

Chat Intervention Method Findings of Significance

At 6 months post-intervention, participants self-reported fewer sexual partners (two or fewer) than self-reporting comparison participants (Adj OR = 0.28, CI = 0.13, 0.63, p

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