A collaboration between the Rollins School of Public Health and the Boys & Girls Clubs of Metro Atlanta, Keepin' It R.E.A.L.! will compare three HIV interventions to determine which is the most effective in encouraging youth to postpone s exual intercourse. At a recent group session, one girl made a collage to summarize the lessons she had learned.

hat night, the back room of a Boys & Girls Club in metropolitan Atlanta felt more like a party than a classroom. Purple balloons hung from the cinder-block walls. Laid out along a counter were boxes of pizza and chicken, a vegetable tray with dip, ham and cheese croissants, pound cakes, and fudge brownies. A boom box blasted out a rap song. The dozen or so children and young teens in the room leaned over bright yellow poster boards and stacks of magazines, cutting and pasting images. One boy complained that he wanted a different partner. Another stopped to strut and show off some fancy fo otwork. As the collages began to take shape, the young artists sang along with the music, called across the tables to friends on the other side, or consulted with their partners. Kendell Childers, a research project coordinator at the Rollins School of Public Health, moved calmly and steadily through the throng, keeping the kids on track. "Remember you should include pictures of all the things we've talked about and the things we've learned," she said. For the past three months, Childers has met once every other week with these adolescents to discuss problem behaviors such as smoking, alcohol abuse, illicit drug use, violence, and early sexual activity. Tonight, the final sessi on, is a celebration. Childers's group is part of an HIV prevention project known as "Keepin' It R.E.A.L.!" - Responsible Empowered Aware Living. A collaboration between the School of Public Health and the Boys & Girls Clubs of Metro Atlanta, Keepin' It R.E.A.L.! will compa re three HIV interventions to determine which is the most effective in encouraging youth to postpone sexual intercourse. Funded by the National Institute of Mental Health, the project will enroll some 1,152 children and their mothers. These participants w ill be assigned evenly to one of the three approaches under study, meeting in staggered small groups during the 24-month project. "The program is designed for 11- to 14-year-old adolescents, and a major risk factor for contracting HIV in this group is sexual intercourse," says Colleen DiIorio, a professor of behavioral sciences and health education, who oversees these family inte rvention comparisons. "If we can delay intercourse until they are more mature decision makers, then we delay the major risk factor for AIDS."

Kendell Childers (left) and Brigitte Manteuffel staff the HIV prevention project for young teens. Health educator Coleen DiIorio (left) discusses group sessions on sexuality with facilitator Pamela Denzmore-Nwagbara. They want participants to feel comfortable when discussing sexual matters.

ost HIV prevention programs for teens try to get across information with just one session," says DiIorio. "However, with just a one-time session, there is a high failure rate. Many adolescents may not yet be ready to learn. Or the presentation may come too late." Keepin' It R.E.A.L.! wants to compare this approach with two other models. While the former is a one-hour presentation on HIV prevention, the other models under study offer information over several months. Each approach includes follow-up interviews at four, 12, and 24 months after enrollment. Parents are an integral component to the study. "Parents, unlike their children, are usually ready for this information," DiIorio says. "When you teach the parents, then they can provide the information on an ongoing, as-needed basis to their children. " The AIDS Knowledge and Skills groups receive social cognitive training. Facilitators lead discussions on HIV and AIDS, physical and emotional changes that occur during puberty, strategies for delaying sexual intercourse, communications skills, and asse rtiveness training. The program seeks to make parents and their children more comfortable in discussing issues of sexuality. "We're trying to improve communication about sex," says Felicia Morton, a facilitator for this group, "and to get parents to remem ber what it was like to be a teenager faced with these issues." "We had thought that although adolescents were not discussing sexual issues with their parents, they were talking about these things with friends," DiIorio says. "But what research has shown is that younger adolescents don't talk to their friends about sex either. They have only perceptions of what their friends are doing. This program allows the children to actually talk about the issues." Participants learn not only through discussions but also through role playing, games, and take-home activities. At one meeting, adolescents and their parents present skits with puppets using scripts they have written. One group, for example, acted out scene where a male marionette is pressuring a female puppet to have intercourse. The girl uses assertive communications skills taught in the program to refuse. One of the homework assignments is an interview given by adolescents to their mothers. The survey asks questions such as, What did you like to do when you were my age? How old were you when you had your first kiss? What did you believe about pre-marita l sex? "The questions are designed to stimulate conversation between the parents and the teens," says Morton.

The life skills component of Keepin' It R.E.A.L.! attempts to give adolescents a wholesome environment and the interpersonal communications skills they need to live in that environment, according to DiIorio. Researchers hope this nurturin g will delay the first sexual intercourse. Above, teens enrolled in a life skills session collaborate on making posters that cover topics such as smoking, drug abuse, and violence.

he third program studied in "Keepin' It R.E.A.L.!" is based on a problem-behavior theory. The model suggests that problem behaviors such as early sexual intercourse, smoking, drug use, and violence occur tog ether and are associated with factors such as low academic achievement and low self-esteem. "Providing supportive environments in which teens have opportunities to be involved and contribute meaningfully to family, school, and community can offset these r isk factors," says DiIorio. "The overall goal is empowering teens with a better sense of self," says Brigitte Manteuffel, the project director for Keepin' It R.E.A.L.!. "Experiences related to community, education, and career choices provide opportunities to build self-esteem, pr ovide contact with alternate role models, and assist in dispelling hopelessness." In addition to attending meetings at the Boys and Girls Clubs, adolescents enrolled in this program visit a senior citizens facility, take part in a community service activity, and visit work sites. Childers, for example, took one group to the technica l operating facility of Delta Air Lines. Other groups have visited the Fulton County Prosecutor's office and Lithonia Lighting. Parents of these children meet separately to discuss issues related to raising adolescents. "These groups enable the mothers to develop and share parenting skills," says Manteuffel, "allowing them to discover shared experiences, to share solutions, and to receive guidance from a facilitator." The final activity of the life skills program is an overnight trip to a university. Childers's group, for example, will visit Tuskegee University this spring, where they'll have breakfast with a circuit court judge, tour the Booker T. Washington home o n the historic university campus, meet the director of Moton Field (the training ground of the first Tuskegee airmen), and attend a basketball game. "The life skills program is a rewarding experience for the adolescents," says Childers, "because it takes them out of their usual patterns and brings a new experience to them." Public health educators are turning more and more to group teaching models like those explored in Keepin' It R.E.A.L.!. "Issues of sexuality are less effective when focused on individuals because we need to change the norms of an entire group," DiIorio says. "The next generation of studies in HIV prevention approaches groups of children, parents and children, or couples."