Choosing Life: Empowerment, Action, Results Intervention for Youth Living with HIV

Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: preventing transmission of HIV to others, maintaining health care regimens, and improving quality of life. From 1995 to 1999, Teens Linking Care (TLC), an intensive 31-session, three-module intervention was designed, implemented, and evaluated to help youth living with HIV meet these challenges. Youth living with HIV significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: (1) only 30% of youth living with HIV continue their substance use and sex risk after learning they are seropositive; (2) 30% of youth living with HIV never attended any of the group intervention sessions; and (3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medication regimens.

Choosing Life: Empowerment, Action, Results (CLEAR) is a National Institute on Drug Abuse (NIDA) funded project that continues from the previous project, TLC which examined the effectiveness of an experimental intervention and prevention project with HIV positive youth. The intervention provided education and skills training designed to reduce HIV transmission, increase adherence to medical treatment and regimens, and improve quality of life. CLEAR has modified the intervention to better address the needs of HIV-positive youth and offers two modes of delivery, one-on-one telephone sessions or one-on-one in-person sessions. In addition to measuring the effectiveness of the intervention, CLEAR also seeks to learn more about youth living with HIV over time, their relationships and health, how they cope with problems, and how drug and alcohol use impacts sexual and other risk behaviors that may lead to the transmission of HIV. CLEAR will also assess the cost effectiveness of delivering these interventions so that they may be widely disseminated to HIV/AIDS service providers across the country and around the world.

Approximately 400 youth ages 13 to 29 living with HIV were interviewed through November 2000. All youth were eligible for a baseline interview that will contribute to the understanding of the lives of young people living with HIV. Youth who reported using alcohol or drugs at least five times in the past three months were eligible to participate in the intervention and long term follow up portions of the study.

Following the baseline interview, eligible participants were interviewed every three months for the first nine months and then every six months for a year, for a total of six interviews over 21 months. Interviews take approximately 90 minutes to complete and are conducted at the agency where the participant was recruited or at UCLA. Participants are asked to provide optional urine samples during the project to help track their health status (i.e., STDs) and to confirm self-reports of drug use.

Eligible participants were randomly assigned to receive the telephone intervention, in person intervention, or a control group that will be allowed to select their preferred mode of delivery (in person or phone) 15 months after the baseline interview. Both interventions consist of eighteen 90-minute sessions, delivered one session per week.