AIDS Care

Vol. 24, No. 1, January 2012, 119
128

Participant satisfaction with group and individual components of Adolescent Impact: a secondary
prevention intervention for HIV-positive youth
R.D. LaGrangea*, S. Abramowitzb, L.J. Koenigc, W. Barnesa, L. Connera and D. Moschelb
a
Adolescent Medicine, Childrens National Medical Center, Washington, DC, USA; bDepartment of Pediatrics, New York
University Medical Center, New York, NY, USA; cDivision of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, GA, USA
(Received 26 October 2010; final version received 26 May 2011)

Adolescent Impact, a developmentally targeted behavioral intervention aimed at decreasing risk behaviors and
promoting health care adherence, was delivered to 83 HIV-infected youth, aged 13
21 years, receiving care in five
urban HIV centers. Participants completed a patient satisfaction survey following the 12 part intervention
consisting of seven groups and five individual sessions. A feedback questionnaire was also completed during each
group session to gain more insight on participant experiences. Several indicators suggested high levels of
satisfaction. First, overall attendance was relatively high. Second, participants rated their subjective experience
and group content favorably. No differences in satisfaction ratings emerged between perinatally infected
adolescents and those who acquired HIV through risk behaviors. However, differences emerged regarding
perceived intervention utility and content-specific preferences. Findings suggest that Adolescent Impact
participants were satisfied with the intervention and that a heterogeneous group of HIV-infected youth could
be advantageously integrated into the same secondary prevention program.
Keywords: HIV; youth; adolescents; satisfaction; intervention

Introduction Shaffer, 1995; Rotheram-Borus et al., 1997). Further-

Despite a reduction in cases of HIV/AIDS among
several age groups since 2001, the number of newly
infected 15
29-year-olds has consistently increased
(Centers for Disease Control and Prevention [CDC],
2008; CDC, 2009). In 2006, adolescents and young
adults accounted for the largest number of new HIV
infections (19,200) and 34% of diagnosed cases in the
US that year (CDC, 2009). Moreover, many experts
agree that this number is an underestimate, given the
likelihood that a significant proportion of seroposi-
tive young people are unaware of their serostatus
(National Institute of Allergy and Infectious Disease,
2006; Rotheram-Borus & Futterman, 2000). The
increasing number of youth living with HIV (YLH)
in the US underscores the need to develop, evaluate,
and disseminate developmentally appropriate and
effective secondary prevention programs for this
population (Kalichman, Kelly, & Rompa, 1997;
Posner & Marks, 1996).
Considering the behavioral habits of this popula-
tion, the high percentage of YLH will likely continue to
account for a significant percentage of HIV transmis-
sions. Unfortunately, data suggest that at least a third
of infected adolescents will continue engaging in
transmission risk behaviors after learning about their
status (Hein, Dell, Futterman, Rotheram-Borus, &
more, the number of sexual partners and the frequency
of sexual activity are highest among late adolescents
and early adults (Rotheram-Borus et al., 2004; Santel-
li, Lindberg, Abma, McNeely, & Resnick, 2000). The
implementation and dissemination of evidence-based
secondary prevention programs is one of the most
effective strategies for limiting HIV transmission
(Rotheram-Borus & Miler, 1998) and health care
costs, and can substantially decrease morbidity rates
among young people (National Institute of Health,
1997). The paucity of empirically validated prevention
programs for adolescents likely reflects the unique
challenges of designing interventions for the wide
scope of needs that arise during this developmental
period.
Teens Linked to Care (TLC; Rotheram-Borus et
al., 2001), one of the first interventions for HIV-
positive adolescents, consisted of three modules
delivered in a group format over 36 sessions. The
intervention led to positive changes in psychosocial
characteristics and reduced risk behavior among
participants. However, attendance rates were rela-
tively low, likely due to the large time demand and
the necessity of attending group during specified
hours. A shorter follow-up intervention, Choosing
Life: Empowerment, Action, and Results (CLEAR;
Rotheram-Borus et al., 2004) was developed using 18

*Corresponding author. Email: rlagrang@cnmc.org

ISSN 0954-0121 print/ISSN 1360-0451 online

# 2012 Taylor & Francis
http://dx.doi.org/10.1080/09540121.2011.592817
http://www.tandfonline.com
120 R.D. LaGrange et al.
one-to-one counseling sessions (e.g., in person or by
telephone). The in-person intervention resulted in a
significantly higher percentage of YLH engaging in
safer sexual behaviors when compared with the
control group. Taken together, these results indicate
that both small-group and in-person individual inter-
vention modalities can be effective intervention
strategies for young people with HIV. Though these
distinct intervention methods are important compo-
nents in the arsenal of interventions, the changing
characteristics of the HIV epidemic among youth
highlight the need to expand the types of interven-
tions that may be effective with the current popula-
tion of YLH.
Adolescent HIV clinics are now treating a sub-
stantial number of adolescents born with HIV (i.e.,
perinatally infected youth [PIY]) along with those
youth who became infected through drug and risk
behavior (behaviorally infected youth [BIY]). Also, a
larger proportion of YLH are African-American
compared to those included in TLC (27%) or
CLEAR (26%), and patients seen in adolescent
clinics are considerably younger on average than the
range of patients included in CLEAR (range 16
29
years, mean 23). Moreover, highly active antiretro-
viral therapy (HAART) was unavailable at the time
of the TLC trial and has since resulted in a new focus
on issues of adherence to care and treatment.
Conceptual background
Adolescent Impact was developed to address the
health and risk behaviors of YLH, and designed to
address some of the challenges experienced in earlier
prevention work (Song, Lee, Rotheram-Borus, &
Swendeman, 2006), emerging demographic changes
and the developmental needs of the growing popula-
tion of YLH. We also sought to create an efficient
curriculum that YLH would attend and enjoy. At 36
intervention sessions, the TLC investigation was
labor- and time-intensive for both participants and
clinic staff. Although CLEAR reduced the number of
TLC sessions by 50%, it still required significant staff
resources that may be beyond the means of many
moderately sized clinics or agencies, especially in a
one-to-one format.
We designed a novel intervention integrating both
individual and group modalities that were adminis-
tered in a structured and coordinated fashion. This
approach allowed for peer-based interactive and
experiential learning in groups while still providing
the flexibility and privacy required to address indivi-
dual adherence promotion and risk-reduction needs.
The investigators also wanted to determine whether a
single intervention could meet the needs of an
increasingly diverse population of YLH. This paper
will describe the Adolescent Impact intervention as a
prevention model for a broad range of HIV-positive
youth and address its acceptance by describing
attendance and participant experiences.
Methods
Participants
Enrollment for this study included 166 YLH, ages
13
21 years (Mean16.8 years), who were aware of
their HIV status and receiving care at one of the five
HIV clinics in Washington, DC; Baltimore, MD; or
New York, NY. Participants were predominantly of
minority race/ethnicity (94% African-American or
Hispanic); 53% were female and 59.6% were PIY.
Informed consent was obtained from all participants
ages ]18 years, emancipated minors, and clinic
patients where a waiver of consent was obtained.
Parental consent and participant assent were ob-
tained for participants B18 years of age. Participants
with less than borderline intellectual functioning were
excluded from this study. Eligible participants were
scheduled for a baseline assessment and then rando-
mized to one of two treatment arms (i.e., intervention
or wait-list control).
Data presented here are derived from 83 trial
participants who were randomized to, and took part
in, the intervention arm of the study. Participant
feedback surveys were collected from 81 (98%) of the
83 youth at the completion of the study. Participants
age ranged from 14 to 21 years (mean 18.3, SD
2.6). When grouped according to transmission cate-
gory, there were 32 (40%) BIY and 48 (60%) PIY.
Procedure
The Adolescent Impact intervention was implemen-
ted in 12 sessions over a 13-week period consisting of
an integrated combination of seven group and five
individual sessions, all designed to meet specific
educational goals and behavioral objectives. Topics
of the five individual sessions were designed not only
to coordinate with the content of group sessions, but
also to allow for an individualized and tailored
approach to adherence promotion and risk behavior
reduction based on each individuals behavior profile.
Whenever possible, individual sessions were sched-
uled for the same day as group sessions or medical
appointments in order to minimize the number of
times participants were needed to come to the clinic.
The curriculum for the seven group sessions consisted
of 20 activities that addressed the educational and
behavioral objectives of each session (see Table 1).
 AIDS Care 121

Table 1. Topics and goals for individual and group sessions, Adolescent Impact, 2003
2006.

Intervention
type Session Topic Session goals

Individual 1 Introduction to intervention 1.
sessions
2 Medications and HIV care
3 Disclosure of HIV status
and social support
4 Sexual risk behavior
5 Sexual risk behavior and
wrap-up
Group sessions 1 Introduction to group
2 HIV and medications
3 Adherence to care barriers/ 1.
strategies
2.
4 Transmission risk
5 Risk reduction
Introduce participants to goals and objectives of individual and
group sessions
2. Establish rapport between Individual Counselor (IC) and study
participant
3. Review baseline issues related to adherence and organizational
tools for improving it
4. Discuss health care team recommendations for substance use
and/or mental health referrals
5. Determine if medication assessment will be done in clinic or at
home
1. Assess barriers to medication and appointment adherence and
related home environment
2. Create a plan of action based on findings from home survey
1. Review baseline issues relevant to disclosure of HIV status and
social support.
2. Assess impact of disclosure/non-disclosure on medication
adherence and engaging in risky sex
3. Provide teens with skills to determine if disclosure is desirable/
appropriate, and to disclose
4. Assess social support deficits and social isolation and refer to
clinic case manager to discuss available clinic or community
social support services for HIV-infected teens
1. Review baseline sexual risk behavior data
2. Assess teens intentions/goals related to: (1) relationships; (2)
sexual activity; and (3) reproduction
3. Develop individualized risk reduction plan
4. Rehearse behavioral skills required to safely refuse sex or refrain
from unprotected sex
1. Review sexual risk behavior topics from Session 4
2. Discuss the barriers to safer sex (including substance use).
3. Help participants further develop and confirm a risk reduction
plan
4. Provide closure for the intervention
5. Remind participants of follow-up assessments and encourage
1. Introduce participants to group intervention and address
questions or concerns
2. Establish group ground rules
1. Provide participants with comprehensive information on
antiretroviral medications
2. Introduce the concept of patient readiness for participants not
currently on medication
Explain impact of behavior choices on the immune system and
HIV disease progression
Address medication/HIV treatment adherence, maintaining a
healthy lifestyle, and barriers to accomplishing them
1. Introduce the topic of sexuality as it is presented in modern life
2. Discuss sex and the media and absence of safe sex messages
3. Review the ways HIV is transmitted
4. Develop and commit to a personal goal regarding healthy
behaviour
1. Discuss the difficulties associated with HIV disclosure
2. Discuss impact of disclosure on medication/treatment adherence,
STIs, and sex activities
3. Understanding levels of transmission risks and ways to reduce
them
122 R.D. LaGrange et al.
Table 1 (Continued )
Intervention
type Session Topic
6 Coping with stress 1.
2.
7 Closure 1.
Incentives were used to reduce the risk of attri-
tion. To compensate participants for their time, all
participants received dinner prior to group sessions,
as well as $50 for completing the baseline interview
and $15 for each of four post-intervention research
interviews. Intervention arm participants received $15
for attending each intervention session. An incentive
structure rewarded maximal intervention attendance;
participants received a $10 bonus for attending three
consecutive group sessions (up to $20), and a $15
bonus for attending all seven group sessions, totaling
a maximum of $215 for intervention participation.
Measures
Demographic measures included age, race/ethnicity,
gender, and mode of transmission. Participants self-
identified as BIY or PIY for anonymous post-group
session reports. To take into account developmental
factors, for purposes of analyses we divided adoles-
cents into two groups, with the younger age group
comprising youth aged 13
17 years (58%) and the
older age group comprising youth aged 18
21 years
(42%). In addition, an anonymous feedback ques-
tionnaire was administered to all participants to
receive participant feedback and assess participant
satisfaction. Participant feedback was assessed using
a three-point Likert scale in response to the ques-
tion, What did you like?, content analyzed and
categorized into various categories (see Table 2).
Participant satisfaction was also assessed using a
Likert scale to evaluate various aspects of group
sessions (see Table 2).
Results
Analyses were completed on both participant feed-
back data and attendance records. Descriptive statis-
tics were calculated, including frequencies, means,
and standard deviations for the variables under
examination. Chi-square analysis was used to exam-
ine the relationship between categorical demographic/
health variables (e.g., age, sex, and transmission
Session goals
Introduce content and activities to teach coping skills for stress
and living with HIV
Emphasize impact of stress on immune function, disease
progression, healthy coping
Review and consolidate knowledge gained and skills learned
category), with a Bonferroni correction made to
correct for multiple comparisons.
As no significant differences emerged when com-
paring data across the different sites or the different
intervention groups, results were aggregated and
examined across the seven group sessions. ANOVA
was used to examine cross-session differences for the
participants as a whole and separately by exposure
mode and group session. Content analysis examining
what participants liked about each session was
conducted using a theme-based approach.
Participant satisfaction
Subjective aspects of the group format were rated
quite highly (Table 3). Participants uniformly rated
Table 2. Participant feedback and participant satisfaction
assessment.
Participant feedback
Content 0: Nothing
categories
1: The group, meeting other people
2: Talking about HIV; talking about
other related topics
3: The main activity
4: An activity other than the main
activity
5: Learning something; learning
something new
Participant satisfaction
Participant 1: Meeting importance
perceptions of 2: Intervention benefit
3: Overall rating
4: Privacy protection
5: Caring and helpfulness of the group
leader
6: Feelings about other participants
7: Comfort level with group
8: Content interest and importance
9: Benefit of pre-group dinner
10: Impact on medication adherence
11: Impact on risk reduction
12: Differential benefit of group and
individual sessions
 AIDS Care 123

Table 3. Participant feedback about curriculum process and content, Adolescent Impact Intervention Group Sessions,
Adolescent Impact, 2003
2006.

Age Sex Exposure

Total 13
17 18
21 Male Female PIY BIY

N (%) N (%) N (%) N (%) N (%) N (%) N (%)

Group leader caring and 66 (94) 44 (96) 22 (92) 25 (89) 41 (98) 43 (96) 23 (92)
helpful
Group participants
Liked and care about me 56 (80) 38 (83) 18 (75) 23 (82) 33 (79) 37 (82) 19 (76)
Liked but didnt care 11 (16) 5 (11) 6 (25) 3 (11) 8 (19) 5 (11) 6 (24)
about me
Eating before group was
An important part of 31 (44) 21 (46) 10 (40) 15 (52) 16 (38) 20 (46) 11 (41)
each meeting
Lots of fun 49 (69) 33 (72) 16 (64) 30 (71) 19 (66) 33 (75) 16 (59)
Helped me relax/get to 60 (84) 39 (84) 21 (84) 37 (88) 23 (79) 37 (84) 23 (85)
know people
My privacy
Always protected 55 (79) 36 (78) 19 (79) 22 (79) 33 (79) 34 (76) 21 (84)
Generally protected 9 (13) 5 (11) 4 (17) 3 (11) 6 (14) 7 (16) 8 (32)
Group was
Very important 49 (70) 34 (74) 15 (63) 17 (61) 32 (76) 33 (73) 16 (64)
Fun, but OK to miss one 15 (21) 7 (15) 8 (33) 9 (32) 6 (14) 7 (16) 8 (32)
session
Compared to individual
sessions, groups were
The best 32 (46) 21 (46) 11 (46) 14 (50) 18 (43) 20 (44) 12 (48)
Good 35 (50) 23 (50) 12 (50) 11 (39) 24 (57) 23 (51) 12 (48)
Talking in group was
Always comfortable 36 (50) 23 (49) 13 (52) 22 (52) 14 (47) 23 (51) 13 (48)
Usually comfortable 29 (40) 18 (38) 11 (44) 16 (38) 13 (43) 16 (36) 13 (48)
Group content was
Always interesting and 54 (75) 33 (70) 21 (84) 32 (76) 32 (73) 34 (76) 20 (74)
important
Usually interesting and 14 (19) 12 (26) 2 (8) 6 (14) 8 (27) 8 (18) 6 (21)
important
What I learned in group
will help me
Take all my medications
Strongly agree 52 (72) 33 (70) 17 (76) 32 (76) 20 (67) 33 (73) 19 (70)
Somewhat strongly 13 (18) 8 (17) 5 (20) 6 (14) 7 (23) 8 (18) 5 (18)
agree
Make safe choices when
I have sex
Strongly agree 62 (86) 38 (81) 24 (96) 38 (90) 24 (80) 37 (82) 25 (93)
Somewhat strongly 6 (8) 5 (11) 1 (4) 1 (2) 5 (17) 4 (9) 2 (7)
agree
Which will help you take
care of HIV?
Group 41 (63) 30 (73) 11 (46) 22 (60) 19 (68) 27 (63) 10 (46)
Individual 21 (32) 10 (24) 11 (46) 12 (32) 9 (32) 11 (26) 6 (27)
Notes: PIY, perinatally infected youth; BIY, behaviorally infected youth.
124 R.D. LaGrange et al.

group leaders as caring and helpful (n66; 94%),
with most rating fellow group members as, liking
and caring about me (n56; 80%). Most partici-
pants (n 60; 84%) reported that the meal served
prior to the group, helped me relax and get to know
other people in the group with 49 (69%) noting that,
dinner was fun. Most participants reported feeling
that their privacy was, always well protected
(n 55; 79%). Coming to group was very important
for 49 (70%) of the participants, with 15 (21%)
reporting that it was fun but, if I missed one or more
it didnt matter to me. Participants indicated that,
relative to the individual sessions, the groups were,
the best (n 32; 46%) or, good (n 35; 50%).
Half reported always (n36; 50%) or usually
(n  29; 40%) feeling comfortable talking with people
in group.
Participants also rated the content of groups
highly. Ninety percent of participants rated the
content as always (n54; 75%) or usually (n 14;
19%) interesting and important. Most participants
also strongly agreed (n  62; 86%) that what they
learned would help them to make safe choices when
having sex. A somewhat smaller number of partici-
pants strongly agreed (n52; 72%) that what they
learned would help them take all their medications.
When asked which component of the intervention
participants felt would be more likely to affect the
way they take care of their HIV, a majority reported
that the group sessions (n41; 63%) would be more
likely to change their behaviors than the individual
sessions (n21; 32%). This was a consistent finding
across all ages, genders, and exposure modes except
for older adolescents who indicated that group and
individual sessions were equally as likely to affect
their HIV care behaviors (n11; 46%). There were
no significant differences by mode of transmission or
sex. However, younger participants preferred the
group component more than the older participants
(73% vs. 46%: x2 4.858 [1, 65] p B0.028).
Session-specific preferences
Participants offered 602 substantive comments about
what they liked in each group session (Figure 1).
Commensurate with their proportions in the inter-
vention, PIY provided 287 (64%), BIY provided 161
(36%). Content analysis of 700 comments identified
three major reasons participants enjoyed group ses-
sions: (1) participating in session activities (397;
57%), (2) talking with the group/others (129; 18%),
and (3) learning something (42; 6%). The proportion
of respondents who liked the activities increased
throughout the groups and only dropped slightly
with Session 7 (53%, 57%, 60%, 66%, 85%, 94%,
and 89%). Session 2 focused on HIV medications and
had the largest proportion of respondents reporting
that they learned something new (38%). Reported
benefits of group participation (e.g., meeting new
people, talking to each other, and talking about HIV)
was highest earlier on, such as in Sessions 1 (27%)
and 3 (25%) and lowest for latter Sessions 6 (3%) and
7 (5%).
Activity helpfulness
Whereas participants generally felt session activities
were helpful, some differences among our sample did
emerge (Table 4). Overall ratings of activity utility
ranged from 75% to 92%. Eighty percent of the
participants rated 17 of 20 activities as being very
helpful. However, transmission mode moderated the
perceived utility ratings of four activities considered
to be among the most helpful. PIY rated the utility of
the following session activities significantly higher
than their BIY peers: Overcoming Medication
Barriers (100% vs. 75%: x2 9.609 [2, 48]
p B0.01); Healthy Living (100% vs. 80%:
x2 7.728 [3, 49] pB0.05); Re-infection (93% vs.
76: x2 10.643 [3, 46] pB0.01); and, Ways to
Reduce Risk (93% vs. 82%: x2 8.988 [3, 46]
p B0.03). Interestingly, BIY only had a significantly
higher helpfulness rating than PIY on one activity,
Resistance (84% vs. 76%, x2 12.646 [4, 44]
pB0.01). This session activity was considered to be
among the least helpful of the intervention. These
results likely highlight the different priorities and
areas of concern for YLH that vary according to
exposure mode.
The content of comments differed significantly for
BIY versus PIY (x2 11.390 [3, 371] pB0.01). BIY
were more likely to say they liked the session activities
(81% vs. 68%), whereas PIY were more likely to
report that they liked learning something (18% vs.
4%) and enjoyed the social aspects of the group (20%
vs. 15%).
Participant attendance
Attendance data were analyzed by examining the
number of sessions where participants were present
as scheduled. Group attendance was relatively con-
sistent throughout the intervention with the percen-
tage of persons attending each group ranging
between 64% and 76%. Attendance was slightly
higher for individual sessions, with rates ranging
from 78% to 95%. Although, these proportions,
unlike those obtained for group sessions, declined
over time.

Participant Feedback by Session
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1 2 3 4
Session
Figure 1. Session-specic preferences of what participants liked about the group intervention, Adolescent Impact, 2003
2005.
Limitations
Several limitations must be noted. First, these results
address only participant experiences of the interven-
tion and not intervention efficacy. Although interest
or satisfaction may be necessary for program
attendance, it may not lead to behavioral change.
Second, because eligible patients were referred to the
study by their providers, and those uninterested
likely screened themselves out before enrollment,
we were unable to determine true recruitment rates.
Thus, we cannot say whether these participants are
representative of all HIV-positive youths being
treated in these clinics. Moreover, because partici-
pants were recruited from urban clinics, the results
may not be generalizable beyond this subset of
YLH.
Discussion
The Adolescent Impact intervention was developed to
provide a health promotion and risk reduction
program for the diverse group of HIV-positive
adolescents currently in care. We wanted to develop
a program that would meet the interests of the current
population of youth in care since the emergence of
HAART regardless of whether they acquired HIV
perinatally or through drug and sex risk behavior.
Data are not yet available to determine the impact of
the program; however, results from this study suggest
that Adolescent Impact was able to maintain partici-
pant interest. Both BIY and PIY gave Adolescent
Impact positive marks for its process and content.
Although we found slight differences with regards to
content preferences, overall satisfaction was high
suggesting that these two subpopulations could be
AIDS Care 125
Learned Something
Activities
The Group/Talking
with Others
Nothing
5 6 7
advantageously integrated into similar behavioral
interventions. These results do not imply that YLH
are receptive to all HIV prevention material in exactly
the same manner. For example, BIY in this study
preferred the medically-related information presented
in the session about HIV medications more than PIY.
Furthermore, our younger participants preferred
group over individual sessions more often than their
older peers, presumably because it represented one of
the first times they were able to interact with other
YLH. These findings suggest that providers still may
need to find a way to tailor certain AIDS-related
information or intervention modalities, as well as,
determine whether developmental differences account
for these preferences.
Differences were also obtained between PIY and
BIY regarding their perceptions of activity helpful-
ness. As a strategy to maximize participant satisfac-
tion, Adolescent Impact was designed to be
interactive and youth-friendly. Some of the activities
developed were more successful at this than others.
Over 80% found all but three activities helpful or very
helpful. PIY found six activities more helpful than
BIY (overcoming medication barriers, healthy living,
re-infection information, and ways to reduce risk),
while there was only one activity that the BIY
thought was more helpful than the PIY (discussion
on resistance). That PIY found all the activities in the
session about HIV and Medications more useful to
them than did the BIY could suggest that PIY
appreciated the interactive nature in which their
healthcare information was presented. It may be
that these youth grew up without being given much
education about HIV or knowledge about living with
the disease because of their young age. Providers
should consider incorporating developmentally
126 R.D. LaGrange et al.

Table 4. Participant utility ratings of curriculum activity (overall and by transmission mode), Adolescent Impact, 2005
2006.

Perceived utility Session Activity N (%) % PIY % BIY x2 (df) p x2

Very helpful 3 Overcoming 52 (85%) 100 75 9.609 (2, 48)

med barriers p B0.01
3 Healthy living 53 (90) 100 80 7.728 (3, 49)
p B 0.05
5 Communicating 53 (92) 100 83
effectively
5 On-line safety 54 (91) 100 83
help
5 Saying no 53 (90) 96 83
4 Re-infection 48 (87) 93 76 10.643 (3, 46)
help p B0.01
4 Ways to reduce 48 (90) 93 82 8.988 (3, 46)
risk help p B0.03
1 Game helped 35 (91) 91 90
3 Overcoming 52 (85) 90 75
barriers to
healthy living
Helpful 6 Coping with 55 (85) 89 85
stress helps
4 Intimacy 48 (81) 86 71
without sex
helps
4 Sex risk help 45 (84) 85 81 6.151 (2, 43)
p B0.04
2 How different 48 (87) 85 89
meds work
3 Barriers to 52 (81) 83 75
healthy living
6 Stress effects 55 (84) 82 83
health
Not very helpful 3 Medication 52 (79) 79 75
barriers
2 How HIV 49 (79) 77 79
works
2 How 49 (81) 77 84
medications
work
2 Resistance 48 (81) 76 84 12.646 (4, 44)
p B0.01
4 Sex and the 48 (75) 72 76
media
Notes: PIY, perinatally infected youth; BIY, behaviorally infected youth.

appropriate interactive teaching methods when pre-
senting health education material to YLH, especially
when they are younger.
Since attendance is required to implement pre-
vention efforts efficaciously, participant satisfaction
an important component of program success (Glass
& Arnkoff, 2000; McMurty & Hudson, 2000;
Nabors, Weist, Reynolds, Tashman, & Jackson,
1999) and provides valuable of data for improving
research outcomes and program evaluation (Schiff,
Witte, & El-Bassel, 2003). Attendance at the Ado-
lescent Impact group sessions was higher than
results previously reported with YLH (Rotheram-
Borus et al., 2001, 2004) suggesting that 12 inter-
vention sessions, incorporating both group and
individual sessions, over the period of three months
is feasible and acceptable for most youth. This
understanding may be especially helpful for future

prevention designers. Paying more attention to
participant satisfaction and feedback should contri-
bute markedly toward improving the quality, integ-
rity, and relevance of prevention programs among
high-risk populations (Schiff et al., 2003). A greater
understanding of motivation and the other variables
that influence participation can help overcome
barriers to recruitment and retention efforts (Stan-
ford et al., 2003), and can help expand needed
prevention- and health promotion-based program-
ming to YLH.
Acknowledgements
The findings and conclusions in this report are those of the
authors and do not necessarily represent the views of
the Centers for Disease Control and Prevention. The
Adolescent Impact study was funded by the Centers for
Disease Control and Prevention through cooperative agree-
ments U64CCU219448 (New York University School of
Medicine), U64CCU319459 (Childrens National Medical
Center) and U64CCU319455 (University of Maryland
School of Medicine).
Childrens National Medical Center; Washington,
D.C.: Lawrence DAngelo, Jean Fletcher, Maureen Lyon,
Kathryn Platky; Yolanda Peele, Anne Sill, Connie Trexler,
Shawnese Gilpin; University of Maryland School of
Medicine; Baltimore, MD: Ligia Peralta, Vicki Tepper,
John Farley, Hibest Assefa, Maria Metcalf, Rhonda Phill;
New York University School of Medicine, New York, NY:
Sulachni Chandwani, Jennifer Lewis, Stephanie Marhefka,
Lisa Orban, Cornell Medical Center, New York, NY:
Joseph Stavola, Christine Nguyen, Harriet Plaskow, Erika
Rexhouse, Centers for Disease Control & Prevention,
Atlanta, GA: Renee Stein, Holly Clark, Krystal Hodge,
Goli Vamshidar, Sivakumar Rangarajan, Zaneta Gaul,
Ngozi Kamalu, Bob Yang, Mary Glenn Fowler, Sherri
Pals, Jeff Wiener.
References
Centers for Disease Control and Prevention (CDC). (2008).
HIV/AIDS surveillance report, 2006. Vol. 18. Atlanta,
GA: U.S. Department of Health and Human Services,
Center for Disease Control and Prevention.
Centers for Disease Control and Prevention (CDC). (2009).
HIV/AIDS surveillance report, 2007. Vol. 19. Atlanta,
GA: U.S. Department of Health and Human Services,
Center for Disease Control and Prevention.
Glass, C.R., & Arnkoff, D.B. (2000). Consumer perspec-
tives on helpful and hindering factors in mental health
treatment. Journal of Clinical Psychology, 56, 1467

1480.
Hein, K., Dell, R., Futterman, D., Rotheram-Borus, M.J.,
& Shaffer, N. (1995). Comparison of HIV and HIV

AIDS Care 127
adolescents: Risk factors and psychosocial determi-
nants. Pediatrics, 95, 96
104.
Kalichman, S.C., Kelly, J.A., & Rompa, D. (1997).
Continued high-risk among HIV seropositive gay and
bisexual men seeking HIV prevention services. Health
Psychology, 16, 369
373.
McMurty, S.L., & Hudson, W.W. (2000). The client
satisfaction inventory: Results of an initial validation
study. Research on Social Work Practice, 10, 644
663.
Nabors, L.A., Weist, M.D., Reynolds, M.W., Tashman,
N.A., & Jackson, C.Y. (1999). Adolescent satisfaction
with school-based mental health services. Journal of
Child and Family Studies, 8(2), 229
236.
National Institute of Allergy and Infectious Disease. (2006).
HIV infection in adolescents and young adults in the
U.S. Retrieved December 8, 2008, from http://www.
niaid.nih.gov.proxy-hs.researchport.umd.edu/factshee
ts/hivadolescent.htm
National Institute of Health. (1997). Interventions to
prevent HIV risk behaviors. NIH Consensus Statement
1997, 15(2), 1
41.
Posner, S.F., & Marks, G. (1996). Prevalence of high risk
sex among HIV-positive gay an bisexual men: A
longitudinal analysis. American Journal of Preventive
Medicine, 12, 472
477.
Rotheram-Borus, M.J., & Futterman, D.A. (2000). Pro-
moting early detection of human immunodeciency
virus infection among adolescents. Archives of Pedia-
tric and Adolescent Medicine, 154, 435
439.
Rotheram-Borus, M.J., Lee, M.B., Murphy, D.A.,
Futterman, D., Duan, N., Birnbaum, J.M., . . . the
Teens Linked to Care Consortium. (2001). Efcacy of
a preventive intervention for youths living with HIV.
American Journal of Public Health, 91(3), 400
405.
Rotheram-Borus, M.J., & Miler, S. (1998). Secondary
prevention for youths living with HIV. AIDS Care,
98(10), 17
34.
Rotheram-Borus, M.J., Murphy, D.A., Coleman, C.L.,
Kennedy, M., Reid, H.M., Cline, T.R., . . . Kipke, M.
(1997). Risk acts, health care, and medical adherence
among HIV youths in care over time. AIDS and
Behavior, 1, 43
52.
Rotheram-Borus, M.J., Swendeman, D., Comulada, S.,
Weiss, R.E., Lee, M., & Lightfoot, M. (2004). Preven-
tion for substance-using HIV-positive young people:
Telephone and in-person delivery. Journal of Acquired
Immune Deciency Syndrome, 37(2), S68
S77.
Santelli, J.S., Lindberg, L.D., Abma, J., McNeely, C.S., &
Resnick, M. (2000). Adolescent sexual behavior: Esti-
mates and trends from four nationally representative
surveys. Family Planning Perspectives, 32, 156
165.
Schiff, M., Witte, S.S., & El-Bassel, N. (2003). Client
satisfaction and perceived helping components of an
HIV/AIDS preventive intervention for urban couples.
Research on Social Work Practice, 13(4), 468
492.
Song, J., Lee, M.B., Rotheram-Borus, M.J., &
Swendeman, D. (2006). Predictors of intervention
128 R.D. LaGrange et al.
adherence among young people living with HIV.
American Journal of Health Behavior, 30(2), 136
146.
Stanford, P.D., Monte, D.A., Briggs, F.M., Flynn, P.M.,
Tanney, M., Ellenberg, J.H., . . . Reaching for Excel-
lence in Adolescent Care and Health Project. (2003).
Recruitment and retention of adolescent participants
in HIV research: Findings from the REACH (Reach-
ing for Excellence in Adolescent Care and Health)
Project. Journal of Adolescent Health, 32(3), 192
203.
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