Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017


Páginas 167 a 183

Effective intervention programs for HIV prevention in adolescents and youth: a systematic review

Programas de intervención efectivos para la prevención del HIV en adolescentes y jóvenes: una revisión sistemática

Programas de intervenção efetivos para a prevenção do HIV em adolescentes e jovens: uma revisão sistemática

Autores: María Isabel Cardona-Cardona1; Sofía Posada-Mora2; Natalia Cadavid-Ruiz3; Linda Teresa Orcasita4

1. MA Student. Psychology - Department of Social Sciences - Pontificia Universidad Javeriana, Cali branch. Cali, Colombia
2. Psychologist - Department of Social Sciences - Pontificia Universidad Javeriana, Cali branch. Cali, Colombia
3. PhD - Associate Professor of the Department of Social Sciences - Research Group on Welfare, Work, Culture and Society at Pontificia Universidad Javeriana, Cali branch. Cali, Colombia
4. MA - Professor and Researcher of the Department of Social Sciences - Research Group on Welfare, Work, Culture and Society - Faculty of Humanities at Pontificia Universidad Javeriana, Cali branch. Cali, Colombia

Linda Teresa Orcasita Pineda
Pontificia Universidad Javeriana de Cali, Calle 18 No. 118-250
Cali, Colombia. Código Postal: 760031

Suporte Financeiro: Financiado pelo Programa Nacional de Formação de Capital Humano do Departamento de Ciência, Tecnologia e Inovação (Colciencias) da Colômbia e pela Pontificia Universidad Javeriana, seccional Cali.

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How to cite this article

Keywords: HIV, sexual and reproductive health, adolescent, young adult.
Palabra Clave: HIV, salud sexual y reproductiva, adolescente, adulto joven.
Descritores: HIV, saúde sexual e reprodutiva, adolescente, adulto jovem.

OBJECTIVE: This study aims to make a review of intervention programs to prevent HIV infection among adolescents and young people, with the purpose of revealing the characteristics that must be taken into account in future interventions in sexual and reproductive health.
METHODS: Asearch for articles about HIV intervention programs was performed in scientific databases published between 2004 and 2014.
RESULTS: 24 studies were analyzed as they met the inclusion criteria. Accordly to those, an HIV intervention program is successful when its contents and activities encourages the adolescents and young adults to have active participation, discussions and the opportunity to implement their acquired knowledge and new skills.
CONCLUSION: The current programs offer clear guidelines to replicate the effectiveness of programs; however, it is necessary to ensure that they respond to the interests and realities of adolescents and youth.

Objetivo: El presente estudio tiene por objetivo realizar una revisión sobre los programas de intervención para prevenir la infección por HIV en adolescentes y jóvenes, con el objetivo de revelar las características que deben ser analizadas en futuras intervenciones en salud sexual y reproductiva.
Métodos: Fue realizada una búsqueda por artículos sobre programas de intervención publicados entre 2004 y 2014 en bases de datos científicas.
Resultados: Fueron analizados 24 estudios que cumplían con los criterios de inclusión. De acuerdo con éstos, un programa es exitoso cuando los temas y las actividades que propone, promueven la participación activa, la discusión y la práctica de conocimientos y habilidades adquiridas por parte de los adolescentes y jóvenes.
Conclusión: Los actuales programas ofrecen líneas claras para replicar la eficacia de los programas, sin embargo, es necesario asegurar que respondan a los intereses y realidades de los adolescentes y jóvenes.

OBJETIVO: O presente estudo tem por objetivo realizar uma revisão sobre os programas de intervenção para prevenir a infecção por HIV em adolescentes e jovens, com o escopo de revelar as características que devem ser analisadas em futuras intervenções em saúde sexual e reprodutiva.
MÉTODOS: Foi realizado uma busca por artigos sobre programas de intervenção publicados entre 2004 e 2014 em bases de dados científicas.
RESULTADOS: Foram analisados 24 estudos que cumpriram com os critérios de inclusão. De acordo com estes, um programa é exitoso quando os temas e as atividades que propõe, promovem a participação ativa, a discussão e a prática dos conhecimentos e habilidades adquiridas por parte dos adolescentes e jovens.
CONCLUSÃO: Os atuais programas oferecem lineamentos claros para replicar a eficácia dos programas, no entanto, é preciso assegurar que respondam aos interesses e realidades dos adolescentes e jovens.


According to the Ministry of Social Assistance and the National Institute of Health1, the Human Immunodeficiency Virus (HIV) has become one of the infections that most affects and impacts public health in the world, being one of the main causes of mortality. In addition, according to the latest report of the World Health Organization (WHO)2, 36.7 million people currently live with this infection.

Similarly, the figures presented by the Joint United Nations Program (UNAIDS)3 continue to corroborate the high impact that this infection has on the world population, so much so that in 2015, 2.1 million new infections were reported and 1.1 million people died as a result of HIV/AIDS. In Latin America, there were 100.000 new infections and 50,000 deaths related to this virus.

In Colombia, the growth of this epidemic has also been gradually and steadily over the years. For example, in 2010, 6,707 cases of HIV infections were reported, in 2011, 7.381 cases were reported in 2012, 8.196 were reported, and for 2013, a total of 8.208 cases were reported. From 1985 to 2013, 92.379 cases of HIV / AIDS infection were reported, according to the Ministry of Health and Social Protection (MSP)4.

Particularly, there is a worldwide concern regarding adolescents and young people between the ages of 15 and 24, since they represent a highly vulnerable population with a high risk of HIV infection. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) 5 , 40% of the new cases reported are related to this population. Likewise, UNAIDS (2012) states that every day more than 2.400 young people acquire HIV infection, with five million adolescents living with this diagnosis. According to MSP4, the age group with the highest cases of HIV transmission is 25 to 29 years (around 19.3% of the population). This would allow us to think that people can contract the infection in the first decades of their life and that their detection has occurred between the 20 and 40 years of age6. This assumption is based on the fact that adolescence and youth are stages of the life cycle in which one is accustomed, on the one hand, to experience a greater increase in sexual practices without preventive measures and the use of psychoactive substances and, on the other hand, have limited access to health services that provide information and services for the appropriation of skills to live a responsible and healthy sexuality7,8,9,10,11.

Taking into account this global and national panorama, different public initiatives have emerged to generate actions to combat HIV/AIDS infection in adolescents and young people. For example, the Ministry of National Education (MEN) and the United Nations Population Fund (UNFPA)12 have presented the Education for Sexuality and Citizenship Construction Program (PESCC) as well as the Health Services for Adolescents and Youth (SSAAJ), which are strategies to transcend traditional pedagogical projects in sex education, based on an understanding of the sexuality of a biological perspective and include a vision of sexuality that is integral, encompassing the sociocultural context and the skills necessary to that boys and girls could be active agents of law. For this, the modules included topics such as sexuality, citizenship and human rights, with the objective of developing in children and young people specific knowledge about sexuality, cognitive skills, communicative skills and emotional competences.

Along the same lines, the Pan American Health Organization (PAHO)13 outlined the importance of designing national HIV prevention and promotion plans that included different recommendations, such as promoting knowledge about HIV transmission routes and their forms of transmission, prevention, ensure the promotion of human rights, and include in the design, implementation and evaluation of prevention programs for people diagnosed with HIV.

Likewise, UNFPA14 sought to promote the implementation of the Friendly Health Services, which aim to adapt health services to the needs of adolescents and young people, providing them with physical spaces in which they can find information and advisors, on the part of professionals in health, in issues related to sexual and reproductive health, methods of contraception, HIV testing, among others. Together, these public initiatives demonstrate how to continue to recognize the importance of addressing HIV prevention through the implementation of programs and projects that target adolescents and young people to live a responsible and healthy sexuality by learning new and access to the right and reliable information.

UNAIDS3 states that some of the challenges of taking up prevention for adolescents and young people are related to enabling them to access appropriate, high-quality and adapted sexual and reproductive health and education services for this population. Likewise, it is exposed that in different countries, comprehensive prevention strategies and programs are not implemented, and it is necessary to develop proposals adapted to the needs of the population in order to take into account their particularities of gender, social position, age, and cultural context to which it belongs.

Despite these different proposals to combat HIV transmission, there is still evidence of adolescent and young at-risk sexual practices, such as lack of consistent condom use, poor knowledge of HIV transmission and other sexually transmitted diseases (STD), low risk perception regarding the possibility of acquiring HIV or other STDs, beginning of sexual relations in the early ages, multiple sexual partners, among others. It is obvious that these risk practices are related to the continuous increase in the numbers of new people diagnosed with various STDs in this population range7,8,10,15.

With the objective of providing successful strategies and strategies for HIV prevention in the adolescent and young population, this article develops a systematic review of the scientific literature on the interventions implemented worldwide in this population to answer the question: which are the characteristics of intervention programs that seek to improve the sexual practices of adolescents and young people for HIV prevention? This review seeks to provide future researchers with evidence-informed knowledge, guidance and recommendations for future interventions in sexual and reproductive health.



For this review, a theoretical research design was used in retrospect to synthesize the results of a set of primary investigations on the particularities taken into account within the intervention programs, in order to make recommendations and improve sexual practices of adolescents and young people16.


For the development of this systematic review, 98 scientific articles were retrieved from which 24 were analyzed, since they fulfilled the following inclusion criteria: (a) it was a study published in a scientific journal between January 2004 and April 2014, considering magazines published in English and Spanish; (b) be empirical research to implement and evaluate an intervention program for the prevention of HIV or other STDs; (c) Include the description of the intervention program, in which the modules or themes worked, the duration, methodology and instruments used are taken into account; (d) reporting quantitative or qualitative data to evaluate the effectiveness of the intervention program; (e) that the intervention program should target adolescents and young people between the ages of 15 and 24.


This work began with the selection of the most recognized databases in the field of social sciences, particularly for the discipline of psychology, in search of bibliographic material that presented a description of intervention programs in HIV prevention, designed and implemented in adolescents and young people, who have had a high impact and successful results worldwide. These databases were: ProQuest Psychology Journals, PsycARTICLES (APA-American Psychological Association), EBSCO and SciELO (Scientific Electronic Library Online). The keywords used were selected from the English-language thesaurus proposed by the American Psychological Association (APA) 2015, using the <and>/<or> connectorsand defining the search selection fields as full title, title, and abstract. The key words considered were intervention program, project OR workshop; AIDS, HIV OR STI; promotion, prevention OR sex education; e young adults, teenagers OR juvenils . Key words have been used in English because they are the most widely used language in scientific writing, in addition to considering that all the databases used allow to retrieve articles written in any language from a key word in a specific language.

All articles retrieved from each database that matched the previous key words were reviewed to identify those bibliographic materials that fully complied with the inclusion criteria of the present study.

Data analysis

A content analysis of the selected articles was carried out, considering the following categories: (a) characterization of bibliographic materials; (b) conceptual model that supports the intervention; (c) intervention and evaluation variables; (d) sociodemographic description of the participants (age, sex, level of education, race); (e) description of the intervention (duration, number of sessions, methodology, activities employed); (f) results achieved, whether or not the program is successful, whether from a quantitative or qualitative analysis of the data. Each of these categories was coded into analysis matrices to compare the content of the selected bibliographic materials and thus to identify similarities and differences between the different articles reporting on HIV prevention programs and other successful STDs implemented in the adolescent population it's young.


In order to present a summary of the findings from the systematic review of the 24 scientific papers that met the inclusion criteria of the present study, this section was divided into the following categories of analysis: characterization of bibliographic materials, conceptual model that supports the intervention, variables intervention and evaluation, sociodemographic description of the participants, description of the intervention and results achieved. This category organization is presented to allow readers to find information about the most important aspects to consider when designing and implementing a sexual and reproductive health intervention program, according to the literature. The results are summarized in Table 1.

Characterization of bibliographic materials

For this characterization were taken into account variables such as the year and the country where the intervention proposals were made. It was found that 14 of the 24 studies that met the inclusion categories were implemented in the United States of America, six in Spanish-speaking countries, three in Africa and one in Vietnam, all implemented between 2004 and 2014. In this line, most of the studies were published recently, after 2013. These investigations carried out in the USA presented a greater systematization of the data since they specified in a punctual and detailed manner the objective categories for the intervention, as well as their impact on the delay of the sexual activity, the increase of the use of condoms and, therefore, STD prevention and unwanted pregnancy.

Conceptual model that supports the intervention

In 19 of the 24 interventions reviewed were structured proposals of intervention from defined theoretical models, which were the Model of Behavior-Information-Motivation Skills17, the Theory of Gender and Power18, The Theory of Action Reason19 and the Model of Beliefs in Health20; suggesting that their authors sought to sustain the outlines and contents of their programs to safeguard HIV infection and other STDs on theoretical grounds accepted by scientific communities. The most used model was the one proposed by Bandura21, as a frame of social cognitive theory, with the purpose of explaining human behaviors from the interrelationship between cognitive, affective and biological factors of the individual with their surrounding environment. It seems that this theory is taken into account within the different proposals analyzed here, since they explicitly offer the components considered necessary when proposing a program of intervention, regardless of the theme to be sought.

These studies highlight the value of how many components the Bandura21 model suggests to characterize an intervention. Specifically, these papers highlight the informational components (to provide knowledge about health risks), social skills and self-regulation (in a way that ensures that participants in the intervention put the acquired knowledge into practice), increased resilience and self-efficacy in the use of condoms, taking into account the construction of support networks, which become reliable sources of information and follow-up.

The studies report the importance of integrating theoretical models for their structuring, in order to complement and generate programs that are integral, successful and respond to all the specific needs of the populations that are going to work22, 23, 24. Among the most cited are the Model of Behavior-Information-Motivation Skills, Gender Theory and Power, and Cognitive Social Theory.

Intervention and evaluation variables

This category of analysis allows revealing which variables are included in the approach to sexual and reproductive health issues. In this systematic review, it was found that the knowledge variable was one of the main aspects to be developed, since of the 24 studies, 21 reported having included it within their interventions. This variable stands out due to the fact that adolescents who have knowledge about HIV and other STDs tend to have a greater perception of risk, that is, a greater probability of recognizing the possibility of contagion against these infections. Thus, the investigations showed that the higher the knowledge, the lower the risk practices25,26,27,28,29.

In addition, 17 of the investigations included the variable self-efficacy, since this is an ability that promotes action through effective strategies that safeguard the risk against HIV, specifically, the studies worked the capacity to say no to sexual relations, the ability to ask to the couple about previous sexual relations and the ability to correctly acquire and use condoms23,30,31,27,32.

Likewise, 11 of the 24 studies took into account the acquisition of social skills, such as communication and negotiation. This component allows to take to action the knowledge already acquired, through strategies that allow the solution of problems to establish agreements, the negotiation of the use of the condom and the making of assertive decisions in function of the HIV prevention33,34,27,35.

Finally, some of the studies reviewed suggest that it is important to include content that works on emotional regulation, since those adolescents and young people who can manage their feelings are able to control their behaviors in an assertive way36,25,37,26,28. It´s important to analyze how they are evaluating the different intervention proposals, so that it is possible to measure the effectiveness of the intervention proposals, and to establish the quality of the proposals, if they are appropriate for the population, and propose changes when necessary

Within this systematic review it was evidenced that, regarding the methodologies implemented for the evaluation of the intervention program, most of the studies exposed a quantitative drawing of the longitudinal type. Some studies used a two-phase conglomerate sampling to select their samples. Others did not report the strategy employed.

Likewise, most of the studies analyzed evaluated the effectiveness of their interventions through questionnaires that inquired about knowledge, attitudes, self-efficacy, risk perception and sexual risk practices. The moments of evaluation oscillated between two and four times in the time, before and after the intervention33,38,29. At this point, it should be pointed out that many of the articles that were discarded in this review did not report information about their methodology and form of evaluation, which did not allow evidence of their impact.

Sociodemographic description of participants

Of the 24 articles, 14 reported interventions in the USA. All of these were designed for younger youth (ages 12-20), including those groups considered to be at high risk, such as young Latinos and African-Americans. In addition, they all sought to include young people with limited socio-economic and cultural resources. On the other hand, four of these 14 papers focused on working only with women, while others sought to include the same number of participants of each gender.Similarly, the programs were implemented in adolescents and young people who were between the eighth and eleventh grade baccalaureate or were starting university life and belonged to educational institutions of low and medium socioeconomic levels39,22,23,40,38.31,29.35.

The importance of the approach of the adolescent and young population, since it is prone to sexual conduct of risk for HIV infection, since this group is initiating the sexual life, is not accustomed to use the condom and there is a low perception of risk. In addition, social determinants such as sex and ethnicity are considered, due to the increase in HIV prevalence in these population groups41,42.

Description of the interventions

The implementation of the programs was characterized by their application in small groups of approximately 15 participants. It seems that this strategy seeks to ensure greater control over the management of the group and ensure the understanding of the topics in each participant.

The work performed with each group ranged from 4 to 15 sessions, lasting between two and four hours each session. Each of the designed activities was dictated by experts in the use of participatory methodologies in order to allow the joint construction of knowledge between the facilitator and participants. For this reason, they promoted up activities that allowed the debate, self-knowledge, reflection, analysis of its limitations and qualities at risk. Among them stood out using paper game as a strategy to develop topics such as assertive communication, decision-making and negotiating condom. In general, the use of these methods allows participants to put into action the skills they were learning, offering the possibility to the participants and the facilitator, to provide feedback exercises. Finally, some studies have also made use of technologies such as computers, internet, social networking platforms and mobile messages, seeking to achieve the same objectives of the aforementioned methods, motivate participants and feed back their interventions39.27.

Those innovative proposals that had a significant impact on the population, succeeded in establishing horizontal relations, in which they promoted the interaction and exchange of ideas among teens and who drove the intervention, in order to promote the active participation and the generation of own strategies.

Results achieved

by the evaluated interventions

Understanding that the majority of studies were quantitative cutting, this systematic review were established the following criteria to determine whether the proposals were successful or not: a) assess the temporal effects of the intervention by comparing at least two stages: a pre-intervention and other post-intervention; b) specify the statistical analysis to measure the impact of the proposal (eg. employee statistical value, significance level, confidence intervals, effect size, etc.; see Table 2). From this analysis, it can be said that from those 24 articles, 20 were successful due to statistical impact obtained on different variables that had worked within the intervention proposed.

In general, different studies have reported that the variables that had a positive effect were knowledge, risk perception, self-efficacy, attitudes and the correct use of condoms, which allows the prevention of HIV and other STDs, as well as pregnancies unwanted. However, studies have reported greater impact on variables associated with knowledge about sexuality and HIV, than in preventive sexual practices of adolescents and youth. For this reason, these same studies suggest that for interventions to be successful whether to include the formation of new knowledge and skills, as well as the development of content related to emotional regulation, the life project, sexual rights and reproductive and self-perceptions of the participants22,43,28.


According to the different findings reported in this work, it is essential to recognize that to develop the contents of a successful intervention program, it must be justified emvários theoretical models that guide its development and sustain its intervention outlines44. These models should offer clear basis for defining policy guidelines, should include expertise in health and prevention, as well as social skills and strategies on self-efficacy. The review conducted in this study showed that use of this theoretical framework allows integrative design proposals with explanatory and interpretative support of the social realities that emerge in such a complex phenomenon as is the approach of sexuality.

Regarding the intervention variables, showed that the number of proposals focused to a greater extent in addressing self-efficacy in condom use tools, knowledge about STDs and, in some cases, communication strategies and negotiation45,34,29. This showed that there is still a sexuality gaze focused on biological and reproductive perspective, including sometimes the affective-relational dimension, but forgetting its function erotic variable that can play a key role in interventions due to the timing of development, as are adolescents and young people, characterized by the exploitation of new experiences and search for feelings of pleasure. Having regard to the above by the Ministry of Health and Social Amparo l1 It is essential to expose a new vision of sexuality that resignifique their experience and to consider the person as a full subject, political and social. Therefore, it is considered important that future interventions define the concept of sexuality that permeates the intervention, so that helps to choose their thematic content, as well as their approach. The results of this review suggest considering sexuality and its various dimensions (affective-communicative, erotic and biological-reproductive) to ensure the interest of young people and adolescents in the intervention program. In this connection, it is considered essential that programs develop theoretical components and social skills that allow teenagers to learn about the ways of transmission and methods of prevention of STD, without leaving aside the recognition of pleasurable and safe practices, as well as the expression of feelings, motives and emotions to experience a full sexuality.

It also identified the importance of the proposals consider mixed designs that integrate quantitative methodological perspectives and / or qualitative stringent for demonstrating objectively the effectiveness of the intervention, as well as their impact on adolescents and young, as several studies They were dismissed this analysis did not have sufficient information on its effectiveness. It´s obvious that the use of appropriate methodological designs will rely more empirical evidence, that addresses knowledge and recommendations for future studies on sexual and reproductive health.

As for the methodology implemented for the development of interventions, it was found that the programs should be implemented by professional experts in sexuality theme, which have a qualified and updated training to enable them to have knowledge about the transmission and prevention of STDs. However, none of them explains that this experience should include knowledge and proper management of the new emerging sexual practices in the social and cultural contexts of the population, with which it will work, considering that these skills are required to ensure the relevance of interventions. Obviously this conjecture should be evaluated to assess their inclusion in the new programs to improve sexual and reproductive health of adolescents and youth.

It was found that the programs should last at least 14 hours and must be carried out in small groups of about 15 participants in order to identify the characteristics of young people, make a closer follow-up and personalized, as well as having greater control full compliance with the intervention program. In addition, small groups demonstrated greater participation, reflection and depth in developed themes. The above is complemented by the above headdress et al.46, as these authors mention the importance of promoting spaces and activities that allow a real exchange of knowledge and learning.

Thus, the activities that are used to develop the themes should promote active participation, discussion and practice the knowledge and skills acquired in the process. Highway 44 mentions that the successful intervention programs implement participatory methodologies that include recreational activities, as these allow the joint construction of knowledge. In this way most of the proposals used activities such as role plays, discussions, the use of Information and Communication Technologies (ICT), Educational games, reflective activities, among others. None of the 24 studies analyzed justifies its use. Nevertheless, it is considered that these methods seem to function at work with young people because it allows them to observe and be observed in different situations close to their everyday context, identify and learn about what are the risk factors that may face and how to solve some circumstances applying assertive techniques of negotiation and communication. Thus, it is considered that the interactive and participatory methodologies such as those mentioned above, allow learning by doing, promoting a dialogue of knowledge between facilitator and participants.

To design proposals that point that young people can enjoy a pleasurable and responsible sexuality, it is essential to recognize the doubts, myths and fears associated with the subject of sexuality, taking into account the biopsychosocial changes for those who are going through this moment of the life cycle. Similarly, intervention programs should consider participatory methodologies and propose contents that develop cognitive, communicative and emotional skills, to enable the consolidation of knowledge, attitudes, beliefs, and social skills that are the basis for young people to gain confidence, identity, independence and autonomy when making decisions and adopt healthy sexual practices and personal self-care. For this reason, future studies should implement intervention programs that focus not only on biological and reproductive dimension, but consider a holistic approach to sexuality, addressing the communicative dimension, affective and erotic. So, should include the appropriation of sexual and reproductive rights, the recognition of protective factors and risk of the participants, as well as the context, the personal characteristics of the subject and their sexual practices in order to generate proposals according to the specific needs the adolescent and young population with which you are working. Finally, it recognizes the importance of establishing baselines before generating the thematic development of interventions, because each group of adolescents and young people have particular characteristics in their experiences and expressions of sexuality.


Financial Support: Funded by the National Program for Human Capital Formation of the Science, Technology and Innovation Department (Colciencias) of Colombia and the Pontificia Universidad Javeriana, Cali sectional.


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