CDC COMMUNITY GUIDE: Prevention of HIV/AIDS, other STIs and Pregnancy: Group-Based Comprehensive Risk Reduction Interventions for Adolescents

Comprehensive risk reduction (CRR) interventions promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). These interventions may:
• Suggest a hierarchy of recommended behaviors that identifies abstinence as the best, or preferred method but also provides information about sexual risk reduction strategies
• Promote abstinence and sexual risk reduction without placing one approach above another
• Promote sexual risk reduction strategies, primarily or solely

This review evaluated CRR interventions delivered in school or community settings to groups of adolescents (10-19 years old). These interventions may also include other components such as condom distribution and STI testing.

The Community Preventive Services Task Force recommends group-based comprehensive risk reduction (CRR) interventions delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). The recommendation is based on sufficient evidence of effectiveness in:
• Reducing a number of self-reported risk behaviors, including:
- Engagement in any sexual activity
-Frequency of sexual activity
- Number of partners, and
- Frequency of unprotected sexual activity
• Increasing the self-reported use of protection against pregnancy and STIs
• Reducing the incidence of self-reported or clinically-documented sexually transmitted infections.

There is limited direct evidence of effectiveness, however, for reducing pregnancy and HIV.

Results from the Systematic Reviews:
Sixty-two studies with 83 study arms qualified for this review.

Results from meta-analyses show that effects were favorable and statistically significant for the following outcomes:
• Sexual activity: decrease of approximately 12% (54 study arms)
• Frequency of sexual activity: OR = 0.81, 95% CI 0.72, 0.90 (14 study arms)
• Number of partners: decrease of approximately 14% (OR = 0.83, 95% CI 0.74, 0.93; 27 study arms)
• Unprotected sexual activity: decrease of approximately 25% (OR = 0.70, 95% CI 0.60, 0.82; 28 study arms)
• STIs: decrease of approximately 31% (OR = 0.65, 95% CI 0.47, 0.90; 8 study arms)
• Use of protection (including use of condoms, oral contraceptives or both): increase of approximately 13% (OR = 1.39, 95% CI 1.19, 1.62; 50 study arms)
- Condom use: increase of approximately 12% (OR = 1.45, 95% CI 1.20, 1.74; 44 study arms)