Oral abstract presentations

Purpose: American Indian (AI) adolescents experience greater disparities in sexual risk-taking behaviors and have higher rates of Sexually Transmitted Infections (STIs) than other U.S. adolescents. Evidencebased interventions (EBI) tailored for AI youth combined with innovative STI screening opportunities are needed to reduce risk and subsequent infection. Focus on Youth, an EBI grounded in Protection Motivation Theory (PMT) was culturally adapted, renamed “Respecting the Circle of Life (RCL)” and evaluated through a randomized controlled trial (RCT) in one reservation tribal community. Participants ages 18 to 19 participated in a sub-study of self-administered STI screening. Methods: The RCT was conducted over two summer basketball camps. AI youth ages 13-19 were randomized by peer group to RCL or control. Assessments were collected at: baseline, immediately postcamp, and 6and 12-months post-camp. STI screening was conducted with a sub-set of participants postcamp. We evaluated whether RCL versus control significantly increased condom use self-efficacy, HIV riskreduction knowledge, efficacy, and condom use intention. Feasibility and acceptability outcomes of the selfadministered STI screen were collected immediately post-screening and at 3 months follow-up. Results: 267 adolescents were randomized to RCL (n=138) or control (n=129). RCL participants had significantly improved condom use self-efficacy through 12 months follow-up. They were more likely to intend to use a condom at next sex immediately post-camp, and had increased HIV knowledge post-camp and at 6-months follow-up. RCL participants showed significant improvements in several PMT theoretical constructs immediately post-camp. 32 youth took the self-administered STI test; 44% (n=14) tested positive for at least one STI. 69% preferred this method over visiting a clinic and 100% would use it again. Conclusions: This is among the first rigorous evaluations of an adapted EBI for HIV prevention with AI adolescents. The study supports the feasibility of conducting a RCT for HIV prevention in a rural, reservation-based Native community and indicates the RCL program may hold promise for decreasing HIV risk among AI adolescents. Sub-study results suggest self-administered STI testing may be an effective tool in increasing screening and treatment of STIs among AI youth. Future directions include a larger-scale RCT evaluating RCL impacts on behavior change triangulated with behavioral and biological outcomes including STI incidence.