Objective: Structural interventions are identified to reduce adolescents' HIV risk.
Method: The goals, strategies, approaches, and delivery sites of adolescent HIV prevention programs are reviewed.
Results: In addition to reducing sexual activity and substance use, HIV prevention programs may also reduce adolescents' HIV risk by: decreasing poverty; ensuring access to HIV testing, healthcare, general social skills training, and employment opportunities; and requiring community service for students. Adolescent HIV prevention programs do not currently utilize diverse modalities (computers, videotapes, television, telephone groups, computerized telephones) or sites (parents' workplaces, religious organizations, self-help networks, primary healthcare clinics) for delivering interventions. Diversifying current approaches to HIV prevention include: economic development programs; mandating delivery of programs at key developmental milestones (e.g. childbirth, marriage) and settings (school-based clinics, condom availability programs); securing changes in legislative and funding policies through ballot initiatives or lawsuits; and privatizing prevention activities.
Conclusions: To implement structural HIV interventions for adolescents requires researchers to shift their community norms regarding the value of innovation, adopt designs other than randomized controlled trials, expand their theoretical models, and adopt strategies used by lawyers, private enterprise, and lobbyists.