Homeless and runaway youth are at risk for a variety of health issues including drug use, risky sex, and HIV infection. Through her Street Smart intervention, Dr. Rotheram created a groundbreaking small-group skills-based program for runaway youth that included evidence-based health information and skills for assessing and managing personal risk. Using tools like the “Feeling Thermometer,” and other group activities, Dr. Rotheram’s intervention helps vulnerable youth recognize, discuss, and cope with their feelings as well as locate and use local health resources. Street Smart was identified as a successful and scalable model by the CDC, which now promotes the program throughout the United States.
Dr. Rotheram has also worked to adapt Street Smart for homeless adolescents in Uganda, the positive results of which led PEPFAR to adopt and disseminate it to other countries.
Teens Linked to Care (TLC)Dr. Rotheram sought to address the unmet needs of at-risk youth, and in 1991 created and implemented a program in New York, San Francisco, and Los Angeles known as TLC. The intervention improves skills and changes risk behaviors by teaching adolescents to “Stay Healthy” by using health services and maintaining health; “Act Safe” by reducing risky behaviors and identifying personal triggers to risky behaviors; and “Being Together” to increase quality of life. TLC is another of Dr. Rotheram’s programs lauded by the CDC as a model for the United States, which led her and one of her mentees to expand the program into another intervention: CLEAR.
Choosing Life: Empowerment! Action! Results! (CLEAR)
Based on TLC’s success building emotional awareness and making healthy choices, CLEAR focuses on giving clients the tools to make healthy choices including setting goals, solving problems, and identifying the links between feelings, thoughts, and actions. Beyond just telling teens about HIV and AIDS transmission, this intervention asks them to see themselves as active architects in their own future. The CDC has recognized and replicated this intervention as a best-practices program in the Compendium of Evidence-Based HIV Prevention Interventions prevention strategy.
Safety Counts: Drug Use and Sexual Risk-Taking
The likelihood of HIV infection increases with injection drug use and the risky sexual activity that frequently arises as a result of the dynamics that surround drug use. To address this, Dr. Rotheram designed a behavioral intervention that successfully decreased drug use and sexual risk-taking. Centering the intervention around a personal risk reduction plan, her design changed the way HIV prevention looked to clients: the program asked them to design their own risk reduction plan and identify their sources of support to reach their goals. The CDC has recognized and replicated this intervention as a cornerstone of its HIV prevention program through the DEBI strategy.
Homelessness among youth leads to substantial risk for HIV; however, the reasons for this have not been well understood. This NIMH funded study examined the pathways into and out of homelessness for youth in the United States and in Australia, and their risk factors for HIV such as family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems. The results of this study led to interventions designed to help newly homeless youth to reduce their risk for HIV and find a way out of homelessness.
Adolescent Project LIGHT
Living in Good Health Together (LIGHT) is a small-group risk-reduction program that uses goal setting and regular self-assessment to motivate behavior change. Funded by a NIMH multi-site HIV prevention trial group, Dr. Rotheram’s team found significant reduction in risky behaviors and an increase in health-promoting choices as a result of this intervention. Results show that the more often teens attend a LIGHT session, the better their chances of preventing HIV and STD transmission. The CDC has included both LIGHT and Adolescent LIGHT into its Replicating Effective Programs project as best-evidence interventions in the Compendium of Evidence-Based HIV Prevention Interventions.
In 2007, nearly 1 million young people became infected with HIV in Sub-Saharan Africa. Uganda is one of the countries hardest hit by the HIV/AIDS pandemic with an estimated 10% of 15- to 49-year-olds being HIV infected (World Health Organization, 1999). Dr. Rotheram built on the lessons from her CDC-diffused model Street Smart, which reduced the transmission risk behaviors of U.S. youth living with HIV, to help the street and slum youth of Uganda.
Dr. Rotheram built a healthier Ugandan community by answering a desperate need for homeless youth with a cost-effective, useful, realistic, and sustainable prevention program. She combined her proven and successful program design with vocational training to remarkable results. Over two years, decreases were recorded in the number of sexual partners, mental health symptoms, delinquent acts, and drug use; condom use increased. By meeting a community need, Dr. Rotheram proved that providing employment in low income countries, in conjunction with HIV prevention, may offer the support young people need to prevent HIV acquisition. The success of the program so impressed the HIV-prevention community that PEPFAR adopted her work on prevention through information and vocational training as part of its mission to prevent HIV/AIDS worldwide.
Champions League Soccer
Young men aged 18-25 years in South Africa face the intersecting epidemics of HIV, alcohol and drug abuse, and unemployment. To address these challenges, Dr. Rotheram and her partners designed an intervention that would appeal to young men: soccer and job training. This program helped the young men shape positive daily routines through an organized soccer league. The men were required to be on time, complete practice, arrive sober and drug free, and show good sportsmanship.
The soccer program also created an opportunity for coaches to act as mentors to the young men, teach them about the health risks they faced, and demonstrate how to protect themselves. Good habits were encouraged and reinforced by offering training to become artisans to those who regularly followed the rules of the league. At the end of this program, coaches and family members of the young men reported seeing positive changes in their behavior at home and in their communities. Some of the young men even continued the soccer league on their own
- HIV Prevention
- Family Well-Being
- Mental Health
- Scientific Leadership