Topics Discussed During Interventions
A number of different topics may be discussed during the intervention activities. Table 4-7 provides definitions for the terms used to classify topics discussed during the interventions.

Table 4-7
Topics Discussed During Interventions

As shown in Table 4-8, all, or nearly all, of the 10 sites discussed the full range of 20 topics assessed, including HIV risk factors, safer sex, HIV testing, HIV services, medical services, substance abuse, emotional problems, hassles, self-identity, health status, dating/sex, and risk reduction barriers. Across all sites, the most frequently discussed topics were youth empowerment and safer sex.

Table 4-8
Across Sites, What Topics Did Clients Discuss During Interventions?

Note. For a given site, a topic was considered to be discussed if it occurred more than five percent of the time.

Figure 4-8a shows the percentage of males and females who discussed various topics during service interventions. The topics are continued in Figure 4-8b.

Figure 4-8a. Percentage of males and females who discussed topics in at least one intervention, Part 1 (N=1,023 males, N=1,074 females).

• Among this group of topics, HIV risk factors, safer sex, HIV testing, HIV services, and medical services were the most frequently discussed by clients receiving at least one intervention. Self-identity, which appears in Figure 4-8b, also was discussed by a large proportion of clients.

• Males were more likely than females to discuss topics during the interventions such as HIV services (45.7 percent versus 40.9 percent), medical services (42.6 percent versus 40.5 percent), public assistance (19.6 percent versus 11.1 percent), alternative therapies (15.2 percent versus 6.2 percent), substance abuse (39.8 percent versus 28.2 percent), and emotional problems (35.9 percent versus 29.4 percent).

• Females were more likely than males to discuss topics such as HIV risk factors (60.9 percent versus 53.5 percent), HIV testing (53.9 percent versus 48.3 percent), and family planning (33.2 percent versus 12.8 percent).

• Females receiving at least one intervention attended a higher average number of interventions focusing on HIV testing and family planning compared to males (mean for HIV testing=2.42 versus 1.65; mean for family planning=1.96 versus 1.34). Males received more interventions focused on HIV services compared to females (mean=2.74 versus 1.96).

• Males discussed HIV services more frequently during interventions (mean=2.74) than did females (mean=1.96). Females discussed family planning during interventions (mean=1.90) more frequently than did males (mean=1.34); they also discussed HIV risk factors more often (mean=2.42) than did males (mean=1.65).

Additional Findings Based on HIV Status
HIV-positive individuals were less likely than individuals with unknown HIV status to discuss topics such as HIV risk factors (31.4 percent versus 60.5 percent), safer sex (40.4 percent versus 64.2 percent), and HIV testing (39.9 percent versus 52.5 percent). However, HIV-positives were more likely than individuals of unknown HIV status to discuss HIV services (75.0 percent versus 39.4 percent), medical services (70.2 percent versus 38.0 percent), public assistance (47.8 percent versus 11.3 percent), alternate therapies (50.9 percent versus 5.7 percent), substance abuse (59.2 percent versus 30.8 percent), and emotional problems (68.4 percent versus 28.2 percent). Differences as a function of HIV status were not observed for discussions of family planning.

Several differences emerged in the topics discussed by HIV-positive clients versus clients of unknown HIV status. HIV-positive clients discussed the following topics more often: HIV risk factors (mean=3.67 versus 2.07), safer sex (mean=5.03 versus 2.05), HIV services (mean=5.17 versus 1.70), medical services (mean=8.38 versus 1.89), public assistance (mean=4.25 versus 2.08), alternate therapies (mean=3.46 versus 1.52), substance abuse (mean=4.74 versus 2.32), and emotional problems (mean=6.42 versus 3.66).

HIV-positive males were least likely, compared to HIV-positive females and individuals of unknown HIV status, to discuss HIV risk factors, safer sex, or HIV testing. HIV-positive individuals, especially females, were more likely to discuss public assistance and alternate therapies compared to individuals with unknown HIV status.

Figure 4-8b. Percentage of males and females who discussed topics in at least one intervention, Part 2 (N=1,023 males, N=1,074 females).

• Frequently discussed topics included hassles, health status, dating and sex, and risk reduction barriers.

• Higher percentages of males than females discussed hassles (43.9 percent versus 33.0 percent), assertiveness (24.2 percent versus 21.9 percent), housing/jobs (32.4 percent versus 21.8 percent), self-identity (35.3 percent versus 31.1 percent), youth empowerment (43.6 percent versus 35.8 percent), living with HIV (30.2 percent versus 16.8 percent), and health status (52.0 percent versus 41.1 percent).

• Higher percentages of females compared to males discussed dating/sex (56.6 percent versus 51.8 percent), and risk reduction barriers (49.3 percent versus 41.9 percent).

• Males receiving at least one intervention (compared to females) participated in a higher mean number of interventions focusing on hassles (mean=5.45 versus 3.64) and living with HIV (mean=5.39 versus 3.48). Females, on the other hand, participated in more interventions focusing on enrollment (mean=1.37 versus 1.15).

• Males discussed hassles more frequently during interventions (mean=5.45) compared to females (mean=3.64). Males also discussed living with HIV (mean=5.39) and practical support (mean=7.47) more times on the average than did females (mean=3.48 and 3.58, respectively).

Additional Findings Based on HIV Status
For all topics except risk reduction barriers, individuals who were identified as being HIV-positive were more likely than those of unknown HIV status to discuss topics related to hassles (78.9 percent versus 33.3 percent), assertiveness (52.2 percent versus 19.5 percent), housing and jobs (62.7 percent versus 22.6 percent), enrollment (46.9 percent versus 21.6 percent), self-identity (59.6 percent versus 29.9 percent), youth empowerment (75.4 percent versus 35.3 percent), living with HIV (93.0 percent versus 14.8 percent), health status (89.0 percent versus 41.2 percent), and dating and sex (70.2 percent versus 52.3 percent). HIV-positive individuals were less likely (29.8 percent) to discuss risk reduction barriers than individuals of unknown HIV status (47.7 percent).

HIV-positive clients versus clients of unknown HIV status discussed the following more often: hassles (mean=10.34 versus 3.00), assertiveness (mean=4.67 versus 2.53), housing and jobs (mean=7.68 versus 4.07), enrollment (mean=1.42 versus 1.23), youth empowerment (mean=5.80 versus 4.62), living with HIV (mean=7.67 versus 2.37), health status (mean=8.26 versus 2.76), dating and sex (mean=7.78 versus 2.47), and risk reduction barriers (mean=5.88 versus 2.27).

Types of Items Received During Interventions
Table 4-9 defines the items and services that were provided to clients at various interventions. These ranged from brochures and similar educational materials to items such as bleach and condoms that are used to decrease the risk of HIV transmission from the injection of drugs and sexual intercourse.

Table 4-9
Items Provided at Interventions

Table 4-10 indicates the number of different sites that provided various items to clients during interventions and the median percentage of time they were distributed across sites. Brochures, other educational materials, and condoms were the most frequently distributed items, while immunizations, dental dams, and bleach were the least often distributed.

Table 4-10
Across Sites, What Types of Items
Did Clients Receive During Interventions?

Note. For a given site, an item was considered to be distributed if it occurred more than five percent of the time.

Figure 4-9 summarizes the percentage of young males and females who received various information and risk reduction items during service interventions.

Figure 4-9. Percentage of males and females who received items in at least one intervention session (N=1,023 males, N=1,074 females).

• When considering the clients who received items in at least one intervention session, the most commonly received items were brochures, other educational materials, and condoms.

• Higher percentages of females than males received brochures (46.6 percent versus 37.5 percent), other educational materials (41.7 percent versus 27.3 percent), medications (19.6 percent versus 11.9 percent), and dental dams (3.4 percent versus 1.8 percent).

• Males and females had similar percentages for referral lists/directories, wallet cards, immunizations, condoms, bus tokens, food vouchers, and bleach.

• Females received the following items more frequently during interventions than did males: brochures (mean=2.18 for females compared to 1.38 for males), other educational materials (mean=2.55 for females compared to 2.82 for males), referral lists (mean=2.99 for females compared to 1.94 for males), condoms (mean=2.34 for females compared to 1.74 for males), and dental dams (mean=10.00 for females compared to 1.00 for males).

Additional Findings Based on HIV Status
HIV-positive individuals were less likely than individuals with unknown HIV status to receive condoms (17.1 percent versus 43.6 percent). Condoms frequently are included in presentations about HIV testing and risk reduction. HIV-positive individuals were more likely than individuals of unknown HIV status to receive referral lists and directories (49.3 percent versus 26.9 percent), bus tokens and transportation (18.9 percent versus 9.9 percent), and food vouchers (13.6 percent versus 8.4 percent).

Of the clients who were given such items, HIV-positive clients compared to clients of unknown HIV status more frequently received referral lists and directories (mean 3.66 versus 2.21), wallet cards (mean=1.91 versus 1.21), immunizations (mean=2.00 versus 1.10), and medications (mean=4.48 versus 1.62).

HIV-positive females were more likely than HIV-positive males and individuals of unknown HIV status to receive wallet cards and immunizations. HIV-positive males were the least likely of this group to receive condoms.

Services Which Clients Were Referred
Table 4-11 and Figure 4-10 describe the services to which clients were referred during interventions. As shown in Table 4-11, most sites referred clients to all service categories, with the most frequent referrals across sites being HIV testing, medical services, social services, self-help groups, case management, and mental health.

Table 4-11
Across Sites, To What Services Were Clients Referred?

Note. For a given site, a referral to service was considered to be made if it occurred more than five percent of the time.

Figure 4-10 shows the percentage of young males and females who received various referrals during a service intervention.

Figure 4-10. Percentage of referrals made for males and females who received at least one intervention session (N=1023 males, N=1074 females).

• Males were more likely than females to be referred to social services (31.1 percent versus 27.0 percent), food and drop-in centers (11.9 percent versus 9.0 percent), shelter and housing (16.2 percent versus 12.5 percent), and self-help groups (25.6 percent versus 17.9 percent). Females were more likely than males to be referred to HIV testing (38.7 percent versus 27.6 percent), STD clinics (21.2 percent versus 12.0 percent), educational and vocational training (15.7 percent versus 12.7 percent), and family planning (22.6 percent versus 7.2 percent).

• Males and females were equally likely to be referred for medical services, case management, mental health, and substance abuse.

• Females received referrals during more interventions for HIV testing (mean = 2.51) than did males (mean = 1.81); females also received referrals during more interventions to go to an STD clinic (mean = 2.89) than did males (mean = 1.41).

Additional Findings Based on HIV Status
Relatively fewer referrals were made for HIV positive clients compared to clients with unknown HIV status for HIV testing (13.2 percent versus 35.7 percent), STD clinics (7.0 percent versus 17.9 percent), and family planning (10.1 percent versus 15.7 percent). A higher percentage of referrals were made for HIV positive individuals (compared to individuals with unknown HIV status) for medical services (64.9 percent versus 28.5 percent), social services (64.5 percent versus 24.7 percent), food and drop-in centers (18.9 percent versus 9.4 percent), shelter and housing (35.5 percent versus 11.7 percent), educational and vocational training (25.0 percent versus 12.9 percent), self-help groups (46.9 percent versus 18.6 percent), case management (43.0 percent versus 31.6 percent), mental health services (38.2 percent versus 16.5 percent), and substance abuse services (20.6 percent versus 10.6 percent).

Of the clients receiving referrals, a greater number of referrals were made for HIV positive clients compared to clients of unknown HIV status for STD clinics (mean = 2.42 versus 1.19), medical services (mean = 5.85 versus 1.69), social services (mean = 4.77 versus 1.66), food/drop-in centers (mean = 2.23 versus 1.54), shelter/housing (mean 3.53 versus 1.64), case managers (mean = 4.62 versus 2.06), mental health services (mean = 4.14 versus 2.03), and substance abuse (mean = 2.36 versus 1.60).

The percentage of individuals receiving referrals to social services, self-help groups, case management, and family planning was greatest for HIV positive females, compared to HIV positive males and clients of unknown HIV status.

Locations of Interventions
Table 4-12 and the Figure 4-11 provide descriptive information about the locations where interventions were conducted across sites. Most sites conducted interventions at community-based organizations and by telephone, whereas few sites held interventions in the hospital, at home, on the job, or at a restaurant.

Table 4-12
Across Sites, Where Did Clients Receive Interventions?

Note. Sites indicating that interventions took place at the location more than five percent of the time were considered to be conducting interventions at that location.

Figure 4-11 below summarizes the locations where clients received service interventions across the 10 adolescent SPNS projects.

Figure 4-11. Percentage of males and females receiving interventions at least once in various locations (N=1023 males, N=1074 females).

• About one client in two received interventions at a clinic.

• Males were more likely than females to receive interventions on streets (4.1 percent versus 1.7 percent), at community-based organizations (23.5 percent versus 11.9 percent), at shelters and drop-in centers (15.0 percent versus 11.3 percent), on the telephone (19.7 percent versus 9.8 percent), at jobs (6.4 percent versus 2.0 percent), and at restaurants (3.3 percent versus 0.7 percent).

• Females were more likely to receive interventions at the clinic (54.1 percent versus 49.4 percent) and at the hospital (16.7 percent versus 8.4 percent). No percentage differences emerged by gender in the inclinations provided at home.

• Males received more interventions in community-based organizations (mean = 7.09) than did females (mean = 3.52); males also received more interventions at home (mean = 4.52) than did females (mean = 2.46).

Additional Findings Based on HIV Status
HIV positive individuals were more likely than individuals of unknown HIV status to have received at least one intervention on the street (13.6 percent versus 1.6 percent), in community-based organizations (65.4 percent versus 11.7 percent), on the telephone (77.2 percent versus 7.0 percent), at home (18.0 percent versus 1.8 percent), and at a restaurant (13.2 percent versus 0.6 percent). They were less likely to have received an intervention at a shelter or drop-in center (6.1 percent versus 13.9 percent) or at a clinic (19.3 percent versus 55.8 percent). The percentages of interventions held at hospitals and at jobs did not differ as a function of HIV status.

HIV positive clients compared to clients of unknown HIV status participated in more interventions in community-based organizations (mean = 8.30 versus 4.19), clinics (mean = 5.57 versus 2.28), hospitals (mean 7.64 versus 1.64), on the telephone (mean = 7.50 versus 3.77), and on the job (mean = 30.57 versus 4.93). Note that the finding for interventions held on the job is based on a small sample of HIV positive individuals (n = 7).

HIV positive males, compared to HIV positive females and individuals of unidentified HIV status, were most likely to receive interventions at community-based organizations, HIV positive females compared to HIV positive males were more likely to receive services at clinics and at home.

Summary
The results presented in this chapter illustrate the types of intervention young people from the 10 adolescent SPNS projects. Results have been presented in the context of client gender and HIV status.

Across many different types of services, the interventions provided by the adolescent SPNS projects appear to be matched appropriately to the needs of the clients served. For example, youth identified as HIV positive tended to receive a greater proportion of interventions focused on treatment and case management compared to youth not identified as HIV positive. In contrast, youth not known to be HIV positive tended to receive a greater proportion of interventions focused on prevention and risk reduction than the youth known to be HIV positive.

The intensity of program involvement also varied depending on the identification of the clients’ HIV status. Youth identified as HIV positive received many more interventions than youth not identified as HIV positive. Overall, the total number of raw service sessions recorded in the evaluation data system was higher on the average for youth known to be HIV positive compared to those whose HIV status is unknown. As examples of specific service types that reflected this difference, HIV positive youth received a higher average number of interventions by physicians, nurses, case managers, counselors, peer counselors, and teachers than youth not identified as HIV positive. Youth with HIV received more HIV risk assessments, were tested more frequently and received post-test counseling more frequently than non-positive youth. Positive youth received more medically-oriented interventions, as well as more individual counseling and crisis intervention sessions than youth not identified as such. Although in many cases the percentage of HIV positive youth who received at least one of these service sessions was lower than the percentage of youth of unknown HIV status, it has been demonstrated that the youth who were engaged in these services returned for multiple visits and appear to be successfully engaged in care.

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