HIV and STI interventions coordinated with work, vocational training, or sports for youth

There is insufficient evidence to determine whether HIV and STI interventions coordinated with work, vocational training, or sports for youth reduce sexual risk behaviors among adolescents (CG-Youth sexual risk reduction and sports, CG-Youth sexual risk reduction and work training). Available international evidence, largely from Africa, suggests that sports-based HIV prevention interventions may positively affect HIV-related knowledge, self-efficacy, and condom use in the short-term (Kaufman 2013), and an intervention within vocational training in the Netherlands yielded increases in STI testing among older adolescents (Wolfers 2011). However, additional evidence is needed to confirm effects.

HIV and STI interventions coordinated with work, vocational training, or sports for youth to reduce risky sexual behavior among adolescents have the potential to decrease disparities in HIV and STI incidence, if they are designed for those most at risk. A pilot study of an employment and HIV prevention intervention for working age Black adolescent men who have sex with men (MSM) and transgender women suggests a targeted intervention has the potential to reduce transactional sex work and increase employment of participants (Hill 2022).

Inequalities by sexuality, gender, race, geographical location, and economic status persist in HIV diagnosis and care (Taggart 2021). In 2022, 19% of new HIV diagnoses were in those aged 13 to 24 years old (CDC-HIV diagnosis); young gay and bisexual males account for approximately 80% of new infections in the age group, with a majority among Black and Hispanic youth (CDC-HIV declines in youth). Chlamydia, gonorrhea, and syphilis also disproportionally affect racial and sexual minority groups. In 2021, chlamydia and gonorrhea rates were highest in young women 15 to 24 years old (CDC-STI Surveillance).

Before the 1960s, social norms largely prevented teaching sex education and sexual health outside the home (Elia 2009). Sex education in schools began receiving widespread support in the 1960s, with most people supporting sex education in public school curriculums by the 1980s, though persistent disagreements around the use of comprehensive sex education approaches or abstinence only programs persist (Kantor 2008). There have been few U.S. based efforts to incorporate HIV and STI interventions into work or sports activities for adolescents.

HIV infections among 13- to 24-year-olds declined by 34% between 2017 and 2021, largely among gay and bisexual males, though declines were lower among Black and Hispanic MSM than among white MSM, and infection rates remain higher in the Southern U.S. (CDC-HIV declines in youth).

• Do adolescents in your community have access to the necessary knowledge and resources to prevent HIV and STI infections? Are programs culturally and linguistically appropriate, and inclusive of all gender identities and sexual orientations?
• Are there existing employment or sports programs for adolescents in your community which could be expanded to integrate HIV and STI prevention efforts and/or resources?
• How does stigma, and other systematic barriers, prevent people from accessing sexual health care and STI testing in your community? What additional strategies can be implemented to overcome those barriers?

As of 2023, there are no interventions aimed at reducing risky sexual behavior among adolescents that are coordinated with work, vocational training, or sports programs available in the U.S.

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CDC-HIV declines in youth - Centers for Disease Control and Prevention (CDC). HIV declines among young people and drives overall decrease in new HIV infections.

CDC-HIV diagnosis - Centers for Disease Control and Prevention (CDC). HIV diagnoses, deaths, and prevalence.

CDC-STI Surveillance - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Surveillance.

CG-Youth sexual risk reduction and sports - The Guide to Community Preventive Services (The Community Guide). HIV, other STIs, and teen pregnancy: Youth development behavioral interventions to reduce sexual risk behaviors in adolescents coordinated with - sports or club participation.

CG-Youth sexual risk reduction and work training - The Guide to Community Preventive Services (The Community Guide). HIV, other STIs, and teen pregnancy: Youth development behavioral interventions to reduce sexual risk behaviors in adolescents coordinated with - work or vocational training.

Elia 2009* - Elia J. Chapter 3: School-based sexuality education: A century of sexual and social control. In: Schroeder E, Kuriansky J, eds. Sexuality education: Past, present, and future, Vol 4: Emerging techniques and technologies. Westport: Praeger; 2009:33-57.

Hill 2022 - Hill BJ, Motley DN, Rosentel K, et al. Employment as HIV prevention: An employment support intervention for adolescent men who have sex with men and adolescent transgender women of color. Journal of Acquired Immune Deficiency Syndromes. 2022;91(1):31-38.

Kantor 2008 - Kantor LM, Santelli JS, Teitler J, Balmer R. Abstinence-only policies and programs: An overview. Sexuality Research & Social Policy. 2008;5(3):6-17.

Kaufman 2013* - Kaufman A. Effectiveness of sport-based HIV prevention interventions: A systematic review of the evidence. AIDS and Behavior. 2013;17(3):987–1001.

Taggart 2021 - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.

Wolfers 2011 - Wolfers M, Kok G, Looman C, de Zwart O, Mackenbach J. Promoting STI testing among senior vocational students in Rotterdam, the Netherlands: Effects of a cluster randomized study. BMC Public Health. 2011;11(1):937.