Preventing HIV among juveniles with criminal justice involvement: Evidence from randomized and quasi-randomized controlled trials

Background:  Juvenile offenders are at elevated risk for HIV and other STIs compared to other adolescents.  We conducted an up-to-date systematic review of HIV prevention trials among juveniles with criminal justice involvement.

Methods:  Using Cochrane review methodology, we searched 16 electronic databases for randomized and quasi-randomized controlled trials, testing any interventions aiming to prevent HIV infection among minors (aged approximately 12-19) reporting at least one formal contact with the juvenile justice system.  We conducted a descriptive review and methodological appraisal of trials; heterogeneity and incomplete trial reports prevented a meta-analysis.

Results: Of 32, 271 abstracts screened, 11 trials (N=3716) met inclusion criteria.  All took place in North America.  Five trials identified protective effects against sexual and drug use outcomes among males or mixed male-female samples.  Characteristics of successful programs included wrap-around formatting, spanning both incarceration and community settings; emphasis on both drug use and HIV prevention; and involvement of parents or other family members in case management or program activities.

Discussion: This review found evidence for efficacy of HIV prevention interventions in juvenile offenders. Despite the lack of clear patterns among the 5 trials that demonstrated efficacy, this review shows that reducing HIV risk among juvenile offenders is feasible and necessary.   Research is needed to develop effective HIV prevention programs for female juvenile offenders as well as intervention trials that incorporate mental health services.